Telehealth has exploded as a result of the COVID-19 pandemic, and this trend will likely continue even after the pandemic subsides. Remote patient monitoring (RPM) is a form of telehealth that nurses can excel in — and help facilitate optimal patient outcomes. But first, they need to understand the nature of this approach and its potential liabilities.
What is RPM?
RPM refers to the use of technology to transmit data between patients and clinicians. The data can be entered manually or automatically gathered through a device and transmitted to another location, such as a hospital or clinician office. Once the data is received by the healthcare provider, the information can then be used to manage patients’ conditions more effectively. For example, a patient at home may use a digital device to monitor their blood pressure and transmit readings that are automatically updated to the patient’s electronic health record, where their clinician can review them and adjust dosages of antihypertensive agents as needed. Or, a patient with diabetes can transmit glucose levels to ensure insulin dosage is appropriate. The data also can be used to ensure smooth care transitions, from, for instance, hospital to home.
RPM benefits
RPM can benefit patients, clinicians, and health systems.
Regular self-monitoring can help patients (and clinicians reviewing the data remotely) detect subtle changes indicating a complication that might be missed until signs and symptoms are more serious. Early detection promotes early treatment, potentially avoiding an unnecessary trip to a hospital or another setting, where patients are exposed to the risk of healthcare-acquired infection. In addition, self-management can give patients greater insight into how their lifestyle may be affecting their health, resulting in behavior changes; this, along with a reduction in healthcare visits, can enhance patient satisfaction.
RPM gives clinicians access to a wealth of data so they can make better treatment decisions. For example, those working in an office or clinic are no longer restricted to basing the treatment plan on a few data points from a single visit. RPM data also may be more accurate, as in the case of blood pressure readings, when the “white coat” effect can result in falsely high readings. Another possible benefit is that earlier detection of patient problems, resulting in the need for less intensive intervention, may help reduce clinician workload.
RPM can reduce costs associated with unnecessary hospital, office, and clinic visits, which benefits healthcare systems.
Protect yourself: reducing liability
Nurses are an ideal choice to orient patients to RPM, monitor incoming data, and provide ongoing support. However, before embarking on RPM participation, nurses should know how to help protect themselves from potential liability.
- Education. Nurses need to provide patients with education related to the use of the device and document that education in the health record. Ask patients for a return demonstration to ensure they are using the device properly.
- Quality monitoring. As appropriate, nurses should check to ensure devices are functioning properly. For example, home blood pressure monitoring devices should be validated for accuracy. Nurses can do this by asking the patient to bring the device to the next visit for comparison with the provider’s device. Guidelines for conducting a blood pressure device accuracy test can be downloaded at targetbp.org/tools_downloads/device-accuracy-test. In addition, nurses may want to subscribe to FDA MedWatch Safety Alerts (https://www.fda.gov/safety/medwatch-fda-safety-information-and-adverse-event-reporting-program/subscribe-medwatch-safety-alerts), which provides information about potential device-related problems.
- Role responsibilities. Clear protocols are needed to address who is responsible for monitoring incoming data and taking action as needed. Any interventions, for example, calling a patient as a result of a low pulse oximetry reading or notifying the physician of a high glucose reading, should be documented in the same way it would be done for onsite care. The primary clinician should be responsible for obtaining informed consent when the patient will be using a device to collect data.
- Critical thinking. Nurses must evaluate data with a critical eye, in the same way they would if they saw the patient face-to-face. For example, do abnormal glucose results seem congruent with the patient’s reported signs and symptoms? If not, explore whether the patient is using the device correctly and check for possible device malfunction.
The bottom line is that with RPM, a nurse is still expected to meet the same standards of care associated with face-to-face interactions.
A valuable tool
RPM can be a valuable tool for managing care, particularly the care of patients with chronic diseases. Nurses can take several steps to ensure patients achieve maximum benefits from RPM while helping to protect themselves from liability that could result in legal action.
References
Dolan S. The technology, devices, and benefits of remote patient monitoring in the healthcare industry. 2021. https://www.insiderintelligence.com/insights/remote-patient-monitoring-industry-explained/
HHS. HIPAA for professionals. 2021. https://www.hhs.gov/hipaa/for-professionals/index.html
HHS. HITECH Act enforcement interim final rule. 2017. https://www.hhs.gov/hipaa/for-professionals/special-topics/hitech-act-enforcement-interim-final-rule/index.html
Mayo Clinic. Remote patient monitoring: Comprehensive care at home. 2021. https://www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/remote-patient-monitoring-comprehensive-care-at-home
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This risk management information was provided by Nurses Service Organization (NSO), the nation’s largest provider of nurses’ professional liability insurance coverage for over 550,000 nurses since 1976. This individual professional liability insurance policy is administered through NSO and underwritten by American Casualty Company of Reading, Pennsylvania, a CNA company. Reproduction without permission of the publisher is prohibited. For questions, send an e-mail to [email protected] or call 1-800-247-1500. www.nso.com.
This article is provided for general informational purposes only and is not intended to provide individualized business, insurance or legal advice.
