As a person involved in caring for patients and promoting the best possible health outcomes, I regard the proper use of evidence as a cornerstone for high-quality care that is compatible with patients’ interests and needs. In this paper, I will discuss the case of Caitlynn, a pediatric patient with cystic fibrosis, and propose a care plan that will be aimed at improving this patient’s safety and reducing the risks of unfavorable events and further complications. Caring for patients living far from their providers can be challenging and may require remote collaboration, which can be observed in the case of Caitlynn.
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To begin with, let me introduce relevant details about the patient. Caitlynn Bergan, a 2-year old girl, was admitted for pneumonia and a previous history of issues with breathing. Patient care during hospitalization involved different measures to normalize breathing.
Eventually, as per the results of sweat chloride tests, the young patient was diagnosed with cystic fibrosis – a potentially life-threatening condition. Currently, there is no known cure for cystic fibrosis, and what such patients actually require is proper measures to manage and minimize the symptoms of this condition. The key problem is that the risks of complications still exist despite the provided effective care. Significantly, Caitlynn lives far from Valley City Regional Hospital, and unnecessary trips to the hospital would be an extra financial burden on the family.
The proposed care plan for Caitlynn involves keeping to a diet, the use of equipment for vest therapy, and interprofessional collaboration via telehealth. After receiving patient education and getting acquainted with credible publications and manuals related to cystic fibrosis and the signs of complications, the patient’s parents are to take the girl home to closely monitor her condition. To promote the child’s safety, the parents are to implement recommendations related to nutrition (more high-calorie foods to support development and growth). Providing them with a vest device for safe and effective chest physical therapy is another critical measure to promote positive outcomes.
Next, it will be important to establish telemedicine communication between the patient’s local pediatrician and the respiratory therapist from Valley City Regional Hospital. The pediatrician is to be provided with assistance and education regarding equipment and software for telehealth spirometry. Spirometry assessments will be conducted at a mutually convenient time, and the pediatrician will be able to send the results to the respiratory therapist in case of warning symptoms and evaluate the necessity of admission to Valley City Regional Hospital.
Now, I am going to discuss the ways how an EBP model has helped to develop a care plan proposed earlier. The John Hopkins EBP Model is aimed at facilitating and accelerating decision-making due to three steps, such as developing a practice question, evaluating evidence, and translating evidence into practice. Given the lack of adequate cystic fibrosis resources in McHenry, the practice question relates to the best ways to enable the local pediatrician and the family to manage the condition’s symptoms and evaluate the need for specialized services.
As for step two, I analyzed evidence from the case in combination with evidence from professional sources researching patients with cystic fibrosis. As for the first component, putting the child on an age-appropriate diet is necessary to normalize Caitlynn’s BMI, and it is an evidence-based measure that helps with digestive symptoms in cystic fibrosis and is critical to support young patients’ healthy development. Next, chest physiotherapy must be performed regularly and correctly to facilitate breathing and avoid hurting Caitlynn.
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However, as the conversation with Janice has revealed, it is difficult for her to perform chest percussion without putting too much pressure on the child’s chest, which contributes to the risks of rib injuries or ineffective mucus management. Evidence from the review article by Hansen (2019) suggests that HFCWO therapy, also known as vest therapy, is superior or at least equal to other airway clearance techniques in terms of positive health effects in cystic fibrosis patients. The benefits of vest therapy include the promotion of self-care (most patients can use it without therapists’ help) and its effectiveness compared to chest physiotherapy conducted by inexperienced individuals (Hansen, 2019).
Next, during evidence analysis and translation, the need for telehealth communication was revealed. Despite her professional education and awareness of cystic fibrosis protocols, Caitlynn’s pediatrician does not specialize in respiratory care and, therefore, is not able to manage all symptoms or complications that may occur. To prevent unnecessary and costly trips to Valley City Regional Hospital, the pediatrician should be able to contact the respiratory therapist and other members of the care team and analyze the situation together. There is solid evidence to support the effectiveness of HIPAA-compliant telemedicine programs in remote health monitoring and consultative visits (Baker & Stanley, 2018).
Also, it is known that telehealth spirometry facilitates patient health monitoring and supports cystic fibrosis teams’ ability to provide effective remote care and reduce the risks of infections in children with this disease (Logie, Welsh, & Ranganathan, 2019). Both the pediatrician and the patient’s mother have demonstrated their readiness to collaborate with the team from Valley City, which increases the chances of success in implementing remote counseling. However, specialized telemedicine software will be required – the use of Skype can compromise patient safety, which is why it is not recommended for use.
Now, let me briefly summarize the most relevant and important evidence used to formulate the plan. Basically, telemedicine practices are needed due to the risks of unnecessary trips to Valley City Regional Hospital and the absence of local professionals specializing in cystic fibrosis and related complications. Next, the use of equipment for vest therapy is necessary due to its high effectiveness for airway clearance and independence that it offers to patients (Hansen, 2019). This measure is also critical since it will prevent Janice’s mistakes and knowledge gaps regarding physiotherapy from impacting the child’s health.
Finally, I would like to reflect on the benefits of remote interdisciplinary collaboration in the case of Caitlynn and touch upon the challenges. Most importantly, the collaboration significantly reduces the amount of time needed to coordinate different specialists’ efforts and share the results of patient evaluations. Next, in the given case, remote collaboration is what helps the patient’s family to prevent spending time and money on unnecessary trips, thus enabling them to use their resources in a wise manner.
An important challenge observed in the scenario is that the collaborating parties, including patients, may struggle with getting an answer from each other due to being busy and other factors. A helpful strategy to reduce this issue is planning teleconsultations between a few specialists beforehand (Baker & Stanley, 2018). Moreover, aside from telemedicine software, it is helpful to increase the number of communication channels and use phone calls and text messages to elicit a reply as soon as possible.
Baker, J., & Stanley, A. (2018). Telemedicine technology: A review of services, equipment, and other aspects. Current Allergy and Asthma Reports, 18(11), 1-8.
Hansen, G. (2019). HFCWO therapy: Weighing the evidence. Respiratory Therapy, 14(2), 45-50.
Logie, K., Welsh, L., & Ranganathan, S. C. (2019). Telehealth spirometry for children with cystic fibrosis. Archives of Disease in Childhood, 1-3.