Create a 5–10 minute video of yourself, as a presenter, in which you will propose an evidence-based plan to improve the outcomes for a patient and examine how remote collaboration provided benefits or challenges to designing and delivering the care. As technologies and the health care industry continue to evolve, remote care, diagnosis, and collaboration are becoming increasingly more regular methods by which nurses are expected to work. Learning the ways in which evidence-based models and care can help remote work produce better outcomes will become critical for success. Additionally, understanding how to leverage EBP principles in collaboration will be important in the success of institutions delivering quality, safe, and cost-effective care. It could also lead to better job satisfaction for those engaging in remote collaboration.

Remote Collaboration and Evidence-Based Care Introduction The Patient Presents Collaboration Begins Consulting With the Pediatrician The Care Plan Continues Respiratory Therapist Consult on Skype Conclusion Introduction Evidence-based care can be a challenge in any medical situation, but particular challenges present themselves when care is being provided remotely. In order to provide quality care to patients who live in rural settings or have difficulty with transportation to a care site, health care professionals must sometimes collaborate with other professionals in different ZIP codes or even time zones. In this activity, you will observe how health care professionals collaborate remotely and virtually to provide care for a patient in Valley City, North Dakota. The Patient Presents Dr. Erica Copeland and Virginia Anderson, a pediatric nurse, discuss Caitlynn, who came into the ER last night and has now been admitted to the pediatric unit. Dr. Copeland starts the conversation. Dr. Copeland: Nurse, can you give me an update on Caitlynn? I know she’s two years old and she’s been admitted for pneumonia. Does she have any history of breathing problems? Virginia Anderson: Yes, this is her second admission for pneumonia in the last six months. She had a meconium ileus at birth. Dr. Copeland: All right. Is she presenting with any other symptoms? Virginia Anderson: She has decreased breath sounds at the right bases and rhonchi scattered in the upper lobes. Respirations are 32 and shallow with a temp of 101. Dr. Copeland: What have we done for her so far? Virginia Anderson: The respiratory therapist administered nebulized aerosol and chest physiotherapy. After the aerosol she had thick secretions. Dr. Copeland: I see her weight is 20.7 pounds, and there’s been some decreased subcutaneous tissue observed in her extremities? Virginia Anderson: Correct. I noticed this too, so she might have some malabsorption of nutrients. Dr. Copeland: Have we done a sweat chloride test yet? Virginia Anderson: Yes, and the results were 65 milliequivalents per liter. Also, the mother reports that when she kisses her, she tastes salty. Dr. Copeland: All right. Well, I think it’s fair to say we might be dealing with cystic fibrosis here. Let’s get her started on an IV with piperacillin, and keep an eye on her temperature. Collaboration Begins Later, the diagnosis is confirmed: Caitlynn has cystic fibrosis. Dr. Copeland, Virginia Anderson, and Rebecca Helgo, the hospital’s respiratory therapist have a short consult, where they realize that Caitlynn’s care will not be easy. Dr. Copeland starts the conversation. Dr. Copeland: Let’s talk about Caitlynn Bergan. Her mother, uh, [checks notes] Janice, has been informed of her diagnosis. I didn’t realize this when she first came in, but she doesn’t live in Valley City; she’s in McHenry. Rebecca Helgo: That’s a tough drive during winter. They’re over an hour away, aren’t they? Dr. Copeland: That’s right. It was a toss-up between coming here or going to Jamestown, but I guess the father — Doug — thought Valley City was the better choice. Anyway, I’ve put her on Pancrease enzymes and we’ll be recommending a high-protein, extra-calorie diet along with the fat-soluble vitamins — A, D, E, and K. I’ll update her pediatrician on her condition, and order dornase alfa. Let’s see how she does with the breathing treatments. How are those going? Rebecca Helgo: Quite well, actually. She’s too young to get her to do the huff breaths, but we’re keeping the secretions thin and manageable with the aerosol treatments. I am concerned about her day-to-day treatment, though. She’ll be back here with pneumonia if the parents can’t stay on top of that. She’s at risk for impaired gas exchange and respiratory distress, which will cause her anxiety and more distress, and that’s not going to help her stay well. Dr. Copeland: How well do you think the parents will be able to handle the treatment? Virginia Anderson: That might get tricky. I gather that the mother and father are still married but separated. We’ll need to make sure that at least one of them gets the education they need. But they both work, and trips here aren’t the easiest choice. We should get a social services consult to coordinate services and identify some assistance for the family in McHenry. Rebecca Helgo: I can do some education here, and then do a Skype consult with one or both of them once she’s been discharged and is back home. Dr. Copeland: It sounded like both parents work long hours. Are you going to be able to schedule times that work? Rebecca Helgo: I may have to do some after-hours appointments. We’ll have to sort that out. Virginia Anderson: She’s had one bowel obstruction already, so I think we need to help them monitor for DIOS too. Does the pediatrician’s office have a telemedicine relationship with us? That might be helpful in preventing unnecessary trips here. Dr. Copeland: Let’s find out a bit more and see what our options are. Consulting With the Pediatrician Later that day, Dr. Copeland and Virginia Anderson talk to Dr. Benjamin, Caitlynn’s pediatrician, about how his office can coordinate with the hospital on Caitlynn’s care. Dr. Copeland greets Dr. Benjamin. Dr. Copeland: Hello, Dr. Benjamin. I’m sorry to be meeting under such circumstances, but I hope we can work with you to help the Bergans handle Caitlynn’s care. On the line with me is Virginia Anderson, the nurse assigned to Caitlynn while she’s here. Dr. Benjamin: Hello to both of you. Yes, it’s unfortunate. This is the first case I’ve seen among my own patients. Dr. Copeland: Are you familiar with the CF protocol? Dr. Benjamin: I am, but I’d love to get any more details that relate to Caitlynn. She’s done with most of her immunizations, but she’s still needs her HAV and influenza, of course. I’m also not sure where to order some of the pancreatic enzymes and medications you listed. Virginia Anderson: We can help with all that. Do you have telemedicine access to Valley City? Dr. Benjamin: No, but we do have it with Cooperstown Medical Center. We kind of have to in a town of less than 100 people. Dr. Copeland: We may be able to use Skype on a more informal basis for consults between us, but it might be good to get connected with Valley City on your telemedicine equipment. If the parents bring Caitlynn to you with symptoms, and you’re not sure whether the hour-long trip is necessary, we can do a telemedicine appointment and make sure. Dr. Benjamin: All right. It sounds l