TELEHEALTH AND RESPIRATORY CARE

BY KRISTA HOWARD, RRT OBJECTIVES

• Definition of Telehealth • Overview of telehealth and respiratory care in today’s world • Type of devices used: C-pap, Bipap, Nebulizers, oxygen and ventilators • Conclusion DEFINITION OF TELEHEALTH

• Telehealth is the provision of healthcare services by the exchange of medical information from the provider to the patients through the use of electronic and telecommunications technologies.

During this COVID-19 pandemic the US government expanded Telehealth services to limit exposures, face to face contact in order to limit the spread of COVID-19. COVERAGE OF TELEHEALTH

• Federal and state governments are taking actions to remove barriers to telehealth services during COVID-19. • CMS has issued temporary measures to make it easier for people enrolled in Medicare, Medicaid, and the Children's Health Insurance Program (CHIP) to receive medical care through telehealth services during the COVID-19 Public Health Emergency. • As part of the Coronavirus Aid, Relief, and Economic Security Act, Congress appropriated $200 million to the Commission for telehealth coverage. • Bill for telehealth services (both video and audio-only) as if they were provided in person OVERVIEW OF TELEHEALTH AND RESPIRATORY CARE IN TODAY’S WORLD

• Telehealth is not a new healthcare technology • The healthcare industry is quickly tipping to more digital formats, with telehealth care access becoming all the more common for patients with low-acuity health needs. But as more patients and providers hop onto the technology, it will be important to understand the communication strategies best equipped to deliver a positive patient experience. .

OVERVIEW OF TELEHEALTH AND RESPIRATORY CARE IN TODAY’S WORLD CONT’

• Respiratory therapist Clinicians delivering care via telehealth should be prepared by following these steps: Deliver patient’s equipment to their door or front porch (label all equipment) prior to the telehealth session. In case of mailing the equipment, teach patient about transit time to avoid unnecessary interruption of therapy. Respiratory therapist’ space– clear of distractions; good lighting; private and secure (HIPAA) Communication plan- appropriate level of communication via patient’s mean of communication and allow time for teaching back method. OVERVIEW OF TELEHEALTH AND RESPIRATORY CARE IN TODAY’S WORLD CONT’

• Recently the widespread of COVID-19 and the long term complications of COVID-19 patients are mostly respiratory related. This leads to an increased need of effective and efficient uses of devices such as C-pap, Bi-pap, oxygen delivery devices, nebulizers and ventilators. OVERVIEW OF TELEHEALTH AND RESPIRATORY CARE IN TODAY’S WORLD CON’T

• Appropriate education related to the usage of the above devices via telehealth is critical to maximize therapy. • Telehealth provides numerous benefits for patients and providers in addition to the reduction of the costs of healthcare services. ADVANTAGES OF TELEHEALTH

• Conduct telehealth with patients located in their homes and outside of designated rural areas • Practice remote care, even across state lines, through telehealth is cost effective • Deliver care to both established and new patients through telehealth • Improve costs savings by eliminating the need of PPE and less chance of disease spread. • Saves on in-home travelling time and improves education of the patient in their own settings. ADVANTAGES OF TELEHEALTH CON’T

• Allows Respiratory therapist to see more patients in less time which increases revenue • Better patient’s understanding of education and device. • Improves outcome of the RT and patient’s interaction because patient has less questions later. • Improves patient’s health outcome because using device correctly. RESPIRATORY THERAPIST AND TELEHEALTH USE

• Respiratory therapist must label all equipment prior to dropping them for the patient and prior to telehealth session. • All equipment must include some “sample instruction guide” identical to the teaching material that respiratory therapist will use for telehealth encounter. • Teaching material must have simple and good illustrations and can be send either via mail or electronically prior to encounter. OXYGEN THERAPY : ASSEMBLY YOUR OXYGEN TANK OR YOUR CONCENTRATOR (SAMPLE INSTRUCTIONS)

• Attach the regulator to the cylinder • Secure the regulator by tightening the T-screw in the counterclockwise direction. • Check the pressure by spinning the nozzle counterclockwise. • Attach the delivery (tubing) device to the nipple adapt on the tank or the concentrator OXYGEN THERAPY CON’T (SAMPLE INSTRUCTIONS)

• Be sure the tubing is not bent or kicked or blocked. • Set your flow rate according to your prescription • Your oxygen tank or concentrator will look like in these pictures OXYGEN THERAPY CON’T (SAMPLE INSTRUCTIONS)

• Put the cannula in your nose • If you are not sure if the oxygen is flowing, you can put the cannula in the glass of water. Oxygen is flowing if the water bubbles. • Keep your nose and mouth moist with water based lubricant • Ask for foam cushion for your ears KEEP YOUR EQUIPMENT CLEAN(SAMPLE INSTRUCTION)

• Every week wash your nasal cannula, clean you air filter and wipe the outside of your concentrators • Wash your humidifier with soap and warm water, rinse it and refill with distilled water • Replace air filter every month and tubing every 2 months • Ask for maintenance every year CPAP (SAMPLE INSTRUCTIONS)

• Tips: • Use your CPAP for short periods of time at home while you watch TV or read. • This may help you to get used to wearing your mask. It will feel more natural when you are trying to fall asleep. • Follow the same tips and instructions for a Bipap Use. CPAP (SAMPLE INSTRUCTIONS)

• Make small adjustments to increase your level of comfort. • Make sure your mask is a good fit. The most common problems with CPAP occur when the mask does not fit properly. If the mask is too big, the straps holding it to your face will need to be pulled tightly. • A mask that is too small will not seal properly and air will leak out through the edges. The air may blow into your eyes. If you are having either problem, you may need a different mask or headgear. CPAP (SAMPLE INSTRUCTIONS)

• If the pressure feels too high as you are trying to fall asleep, use the “ramp” mode on your CPAP unit. The ramp mode will start your device on a low pressure setting and gradually increase the pressure over time. You should be able to fall asleep before the air pressure reaches its proper level. • Use a saline nasal spray to ease mild nasal congestion. A nasal decongestant can help with nasal or sinus congestion. CPAP (SAMPLE INSTRUCTIONS)

• Use a humidifier if you have a dry mouth, throat or nose • Schedule a regular time to clean your equipment. • If you are having problems remembering how to use your CPAP every night, find someone to help. • In case of doubt about how the adjustments work, talk to the staff or your respiratory therapist at any of the Kohll’s pharmacy locations. CPAP (SAMPLE INSTRUCTIONS)

• Putting on and adjusting straps is one of the most reported cause of non-adherence to therapy. • Provide patient with these illustrations. • Follow these easy steps to improve your comfort and your respiration. 3D

•3D software specific to certain masks NEBULIZER (SAMPLE INSTRUCTIONS)

• Place the compressor where it can safely reach its power source and where you can reach the ON/OFF switch. • Add medications and other solutions as prescribed by your physician to the medicine cup. • Connect the air tubing from the compressor to the nebulizer base. • Attach a mouthpiece or the face mask to the tubing connected to the nebulizer. • Turn the compressor on and check the nebulizer for misting. • If the Nebulizer Is Not Misting • Check all connections. • Refer to manufacturer's instructions NEBULIZER CON’T (SAMPLE INSTRUCTIONS)

• Take your treatment • Make sure to rinse your nebulizer equipment after each use • Every other day, soak all parts of the nebulizer (except mask, tubing and interrupter) for 1 hour in a solution of 1 part distilled white vinegar and 3 parts hot water. • Air dry the parts, reattach them and get them ready for the next use • Check the manufacturer's instructions for cleaning and care of the compressor that you are using. VENTILATORS (SAMPLE INSTRUCTIONS)

• The use of Respironics Trilogy 202 Ventilator has a better outcome with in hospital education and trial prior to patient’s discharge. • Before operating Trilogy202, you need to set up the circuit type and the screen according to your prescription. VENTILATORS CON’T (SAMPLE INSTRUCTIONS)

• Cleaning the Ventilator: Unplug the device and clean the front panel and exterior of the enclosure as needed using a clean cloth dampened with any of the following cleaning agents: – Water – Soapy water or a mild detergent – Hydrogen Peroxide (3%) – Isopropyl Alcohol (91%) – 10% bleach solution (10% bleach, 90% water) • Let it air dried before the next usage • Clean the gray foam filter at least once every two weeks and replace it with a new filter every six months or sooner if needed. • Clean the Patient Circuit daily. VIDEOS

• Manufacturer provided videos provide step by step directions

• Youtube CHALLENGES WITH TELEHEALTH

•Language barriers

•Mask not fitting well

•Hard of hearing patients

•Language barriers CONCLUSION

• COVID-19 has changed the need and delivery of all aspects of healthcare system. • The significant impact of COVID-19 complications calls for the use of multiple respiratory care equipment in the setting of required social distancing. • The government had made big changes leading to the coverage and access of telehealth respiratory therapy to all Medicare members. • Kohll’s Rx is one of the major respiratory supplier in Nebraska. Contact one of our multiple pharmacy locations for more information.