MONITORING PATIENTS. Responding to Readings

CHAPTER 6 MONITORING PATIENTS Responding to Readings This section covers the steps required to respond to patient readings within LifeStream. You can view patient readings on the Current Status or Tabular Trends screens. When viewing a reading from the Current Status screen, double-clicking on the reading will display the Tabular Trends screen. To respond to a selected reading from the Current Status screen or Tabular Trends screen: LifeStream Manager User Manual 61

1. Select a reading to respond to. The reading is highlighted. 2. Select the Respond to Reading button. The Respond to Readings window appears: 3. You may perform the following actions, explained below: Acknowledge the Reading Place a Reading on Hold Invalidate the Reading or Select Measurements Add Clinician-Entered Vital Signs Acknowledge a Reading 1. Select the appropriate response by clicking the box next to each response to check it. You may make multiple selections. 2. Click in the Comments area and type comments. 3. Consider the validity of readings. Select Acknowledge when ready. Note: Be aware that once acknowledged, you cannot go back and mark a reading as invalid. If you need time to consider a reading, place a hold on the reading. 62 Monitoring Patients

Put a Reading on Hold 1. Select the appropriate responses. 2. Enter comments. 3. Select Hold. The window closes and the reading will now appear on the bottom of the Current Status menu until it can be acknowledged. Invalidate a Reading or Select Responses 1. Select the check box for the vital sign you are responding to. The check mark disappears. 2. Enter comments. 3. Select Save Validity. 4. Select Close to exit the menu, or perform another task. Clinician-Entered Vital Signs Clinician-entered vitals can be entered on the Tabular Trends and Respond to Readings windows. To add clinician-entered vitals: 1. Select the patient for whom you will enter vitals and double click from the Current Status menu. 2. From the Tabular Trends screen, select the Clinician-Entered Vitals button, or from the Responding to Readings window, select Clinician Vitals. 3. Make entries in the menu, as noted below. You may enter information on different tabs without needing to save. All entered vital sign measurements are entered as one reading data packet. Field Temperature Weight Heart Rate Systolic Diastolic SpO2 Date/Time Comments Glucose Tab Add Row Delete Row Description Type the patient s temperature. Type the patient s weight. Type the patient s heart rate. Type the patient s systolic reading. Type the patient s diastolic reading. Type the patient s SpO2 reading Type the date and time in which the readings were taken in the date/time format shown. You can click on the drop-down menu and select the date from the calendar. Remember to reference the patients time zone when entering a time to ensure data consistency. Type any comments about the vitals you entered. Click to add a glucose measurement. Select the glucose reading you want to delete. LifeStream Manager User Manual 63

Field Reading Date/Time Comments Peak Flow Tab Add Row Delete Row PEF FEV1 Date/Time Comments PT/INR Tab Add Row Delete Row PT INR Date/Time Comments Description Type the patient s glucose reading. Type the date and time in which the readings were taken in the date/time format shown. You can also click on the pull-down menu and select the date from the calendar. Type any comments about the vitals you entered. Add a peak flow measurement. Delete an entered peak flow measurement. Type the patient s peak expiratory flow (PEF) reading. Type the patient s forced expiratory volume (FEV1) reading Type the date and time in which the readings were taken in the date/time format shown. You can also click on the pull-down menu and select the date from the calendar. Type any comments about the vitals you entered. Add a measurement as part of the same reading. Delete an entered measurement. Type the patient s prothrombin time (PT) reading. Type the patient s international normalized ratio (INR) reading Type the date and time in which the readings were taken in the date/time format shown. You can also click on the pull-down menu and select the date from the calendar. Type any comments about the vitals you entered. 4. When you are finished, select Save. The information you entered appears in the Vitals Pane with a C beside the reading. Adjusting Alert Limits For each reading that a patient takes, you can set alert limits that will notify you if the patient's expected vital sign measurements fall outside the patient s expected range. The alert limits must be established to generate red condition status alerts on the Current Status window. Until Alert Limits are set, patient readings will continue to appear in a No Limits Set condition status. To set alert limits: 1. Select the patient for whom you want to set Alert Limits. 2. From the Patient section of the Navigation Pane, select Alert Limits. 3. Select Edit to begin editing the Alert Limits menu. 64 Monitoring Patients

4. Make edits in the menu, as noted: Note: For each of the tabs displayed in the Alert Limits menu, the last 14 days of readings (if available) appear in the lower pane. Letter Field Description A Vitals Tabs By default, the menu displays the most common vital sign measurement alert limits in the Vitals tab. Select one of the other tabs to enable alert conditions, and then set alert condition status levels for all other assigned peripherals. B Alert Enabled Check this box to enable alert conditions for each assigned vital sign. C High / Low Limits Set the threshold for a condition status alert, by setting the minimum high and low deviation from an expected normal range, for each assigned vital sign measurement. When the patient reading is lower than the low parameter, or higher than the high parameter, a condition status alert will be generated. Patient readings equal to, or within the set parameters will not trigger a condition status alert. D Alert if Missing Check to enable a Missing Data condition status if the reading is missing. E Weight Gain Check to enable daily and weekly weight gain alert condition parameters to be set. When enabled a patient reading exceeding your set parameters for 1 day, and after 7 days, will generate an alert condition. Patient readings equal to, or below the set parameters will not trigger a condition status alert. 5. Select Save. The limits are set. LifeStream Manager User Manual 65

Smart Limits The Smart Limits feature enables you to set a calculated limit profile based on previous readings. Once set, you can modify the smart limits to specifically tailor them to individual patient conditions. You cannot use Smart Limits for peripheral medical device test results - low and high limits must be manually set. Example: The previous blood pressure reading was 120 systolic/80 diastolic. The Smart Limits calculation may assign a +/- 15 mmhg variance to each of these indicators. New limits would be set at 144 systolic/96 diastolic at the upper end of the range and 106 systolic/54 diastolic at the lower end of the range. When selected, the Smart Limits button automatically calculates vitals limits based on the following formulas: Vitals Calculation Temperature +/- 2 Weight +/- 3 lbs Diastolic +/- 15 mmhg Systolic +/- 15 mmhg SpO 2-5% - upper limit set to 100% Heart Rate +/- 15 bpm Alert Only on Scheduled Peripherals Add or Edit Notes If a patient needs to retake a reading outside of the scheduled reading time, the Alert Only on Scheduled Peripherals setting may be enabled by an administrator in System Configuration so that alerts are not produced when the patient only reports one vital instead of all of their regularly scheduled vitals. Notes may be added to a patient record at any time. Two types of notes exist: Care Notes: Each patient has one Care Note, which remains visible and editable by all care providers. To edit or read the Care Note, select the Care Note button from the Toolbar whenever it is visible. General Notes: General notes may be added to the patient record, and are visible from the Patient List, or from the Notes tab in the Patient Information menu. To edit or add notes: 1. Select a patient, and confirm their name appears in LifeStream s Title Bar. 2. Click the Patient Information menu, from the Patient section of the Navigation Pane. 3. Select the Notes tab. 66 Monitoring Patients

4. Select Add Note. 5. In the menu that appears, select a General Note or Care Note. Each patient may have multiple general notes added to their record. 6. Add the note text and select OK. 7. All notes appear in the Notes tab for review. You may Edit or Delete any selected note in the Notes tab. Note: If you select a Care Note, you will override the existing Care Note with your new note. Add or Edit Episodes An episode automatically begins the day when a patient is admitted to LifeStream, when an Episode ID is assigned. Even after telemonitoring equipment has been unassigned, the episode end date remains open until a care provider ends it, or creates a new episode. To add or edit an episode: 1. Select a patient, and confirm their name appears in LifeStream s Title Bar. 2. Click the Patient Information menu, from the Patient section of the Navigation Pane. 3. Select the Episodes tab. Add or Edit Visits 4. From the Toolbar, select the Add Episode button, to end the current episode and create a new episode. 5. Select OK. The new episode, and a new Episode ID appears. 6. You may also select Edit Episode to edit the most recent active episode, or End Episode, to end the current episode without creating a new episode. To note any patient visits during the telemonitoring session: 1. Select a patient, and confirm their name appears in LifeStream s Title Bar. 2. Click the Patient Information menu, from the Patient section of the Navigation Pane. 3. Select the Visits tab. 4. From the Toolbar, select the Add Visit button. 5. In the Add Visit dialog box, type the name of the visit, or choose from the Visit Type menu which lists all entered visit types for quick selection. 6. Enter the Care Provider name. LifeStream Manager User Manual 67

7. Enter the Visit Date or pick a date from the calendar menu. 8. Enter a description. 9. Select OK. The visit type will be listed under the Visits Tab. You may edit or delete the visit by highlighting it and clicking Edit or Delete from the Toolbar. LifeStream MobileHelp (PERS) LifeStream integrates with mobile Personal Emergency Response Systems (PERS), including MobileHelp Solo and Duo mobile PERS systems. Separate from vitals sign packets, these PERS alert notification packets allow your staff to triage, acknowledge and trend PERS notifications just like vital sign packets. Note: This functionality is available in LifeStream v4.10 and higher. To determine which version of LifeStream you have, from the Toolbar, select Help, then About. A window appears containing the version of LifeStream on you computer. MobileHelp PERS packets are notifications only. They are not emergency alerts and are intended to be responded to in the same fashion as a vital sign packet. LifeStream MobileHelp enables patients to be as mobile as they want to be, while enabling you to locate them 24/7 via cellular tracking capabilities. Emergency calls are handled by MobileHelp emergency call centers, and notification of events are provided through LifeStream MobileHelp PERS packets. LifeStream MobileHelp provides a seamless communication infrastructure giving you the ability to view notifications of emergency services calls, low batteries, and device testing through LifeStream s Current Status screen. Because you can view all notifications from the MobileHelp devices alongside vital signs, you receive a more complete picture of a patient s health and status and your daily workflows are simplified. MobileHelp notifications are sent to LifeStream via a secure server network and appear in Current Status window as a brown PERS condition and can be filtered using the current status filtering feature. You can view all the MobileHelp PERS notifications in the patient s Tabular Trends screen, which provides up to 90 days of trending for the notifications. If you select one PERS packet, you can view the PERS event detail, including the time/date of event, the type of event (emergency service calls, low battery notices, device testing messages etc.), who responded, who was contacted, and the resolution to the event. Depending on your user settings, when you select a PERS packet, PERS event detail appears in the Vital Sign panel on the right of your screen or at the bottom of the Current Status screen. If you double-click on the packet within Current Status screen, the patient s Tabular Trend screen opens allowing you to view up to 90 days of PERS notifications. 68 Monitoring Patients

The PERS packets appear similar to the following in the Current Status screen: The PERS packets appear similar to the following in the Tabular Trends screen: You respond to the PERS packets in the same manner as a vital sign packet. Depending on the screen you are in, either double-click on the packet, or select the Respond to Reading button. This opens the Respond to Readings window, where you can note the PERS event details and add any additional comments related to the event that you want to track in LifeStream. When you are finished, select Acknowledge. The PERS packet is removed from the Current Status screen. LifeStream Manager User Manual 69

The PERS packets appear similar to the following in the Respond to Readings window: LifeStream MobileHelp PERS devices can also be added to your equipment list within LifeStream and assigned to patients just as Telehealth monitors and peripherals are. This enables you to keep track of your PERS inventory, and also enables LifeStream to be able to receive the notifications from the device. There are two available LifeStream MobileHelp PERS devices available, PERS Solo, and PERS Duo. Contact your Honeywell Life Care Solutions Sales Representative or Clinical Consultant for detailed information on the PERS devices. Many of the organizational lists available within LifeStream, including the equipment list and patient list, include columns and/or tabs to display information about the MobileHelp PERS devices and PERS monitoring begin and end dates. Several standard reports, including Tabular Trends, Multi-Patient Trends, Equipment List, Patient List, Patient Activity, and Monitoring Summary, include options to include LifeStream MobileHelp PERS data or information in the report. 70 Monitoring Patients

Manual Entry Monitors If the Manual Entry Monitors feature is purchased, a virtual monitor may be assigned to a patient without installing equipment in the patient s home. This feature may allow patients to use their own devices, and may be used as a tool to aid in the progression from monitoring to independence. All patient data tracked during Manual-Entry Monitoring comes from Clinician- Entered Vital Signs, entered after a patient communicates their vital sign measurements with a care provider. To set up Manual Entry Monitors: 1. Assign a Manual Entry Monitor from available equipment to a qualifying patient. If Manual Entry Monitors are not available for assignment, check that a license has been granted to your organization; and that an administrator has entered these monitors into the Equipment List. 2. A monitor schedule must be set, corresponding to the time when Vital Sign measurements are expected to be reported. 3. Manual Entry Monitor assignment and scheduling will cause a Transmit Error (orange condition) to display in the Dashboard, as a reminder to contact the patient to retrieve vital sign measurements. 4. When a measurement has been received, select the Transmit Error and click Respond to Reading. See the Clinician-Entered Vital signs section of this manual for more information about entering vital sign measurements. LifeStream Manager User Manual 71

Suspending a Patient LifeStream enables you to suspend a patient who is still active, but will not require monitoring for a period of time. You can use a Suspension Summary report to keep track of and follow up on these patients, as necessary. Example: If a patient is admitted to the hospital, it may be efficient to suspend the patient from monitoring. Suspension prevents the logging of Transmit Error (orange) conditions if the monitor is turned off while the patient is gone; and suppresses Empty Packet (orange) conditions if the monitor has been left on. To suspend a patient: 1. Select the patient to be suspended. 2. From the Patient Information window, select the Add Suspension button. A window similar to the following appears: 3. Make entries in the following fields, as noted: Field Begin Date End Date Reason Description Select the beginning date of the suspension. Select the anticipated end date of the suspension. Type the reason for the suspension, or change to the suspension. 4. Select OK. The suspension is saved. 5. To edit the suspension dates, click the Edit Suspension button. 6. To end the suspension, click the End Suspension button. 72 Monitoring Patients

Discharging a Patient To discharge a patient from an active telemonitoring session, their monitor must be unassigned. A monitor cannot be unassigned if unacknowledged vital sign readings exist. To discharge a patient: 1. Select a patient, and confirm their name appears in LifeStream s Title Bar. 2. Select the Tabular Trends menu from the Navigation Pane. 3. In the Tabular Trends menu, sort the column with the check boxes so that any Unacknowledged Readings (unchecked boxes) are sorted to the top of the menu. Respond to any unacknowledged readings. 4. Select the Patient Information menu, from the Patient section of the Navigation Pane. 5. Select the Patient Equipment tab. 6. Select the monitor from the assigned list, and click the Unassign Selected Equipment button from the Toolbar. All peripheral equipment will also be unassigned, and the patient has been discharged. LifeStream Manager User Manual 73

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