The primary nursing model of remote monitoring in patients with implantable cardiac devices (CIED)

Abstract

Introduction The treatment of cardiac pathologies with devices has led to an exponential increase in patients with CIED, who need more frequent, more careful check-ups, with a consequent increase in the number and clinical complexity of patients who refer to cardiac stimulation centers. Aim The use of remote monitoring makes it possible to have a continuous flow of information relating not only to the performance of the device but also to clinical events such as arrhythmias and heart failure without the need for direct contact, drastically reducing hospital accesses and at the same time promptly detecting any critical issues that require intervention in a more or less short time. The benefits of remote monitoring, as we have seen over the years, intervene at multiple levels, economic, social and clinical. Materials and methods Numerous studies have shown how remote monitoring can replace outpatient check-ups without compromising patient safety, reducing resource consumption, while scheduling at least one outpatient follow-up per year as recommended by international guidelines. With the introduction of telecardiology and remote monitoring in clinical practice, new organizational models have been implemented, which harmonize and codify the activity of the various professionals involved in the diagnostic and therapeutic process. This model must guarantee a precise definition of roles and responsibilities, traceability of actions, continuity of care, low consumption of resources, patient satisfaction and acceptance, integration with traditional hospital and out-of-hospital diagnosis and treatment pathways. A model that encompasses all these peculiar features is the PRIMARY NURSE MODEL. Primary nursing is a relationship based and resource driven system of care delivery, the building blocks are: attribution and acceptance by each individual of personal responsibility in making decisions; assignment of day to day care according to the case method; direct person to person communication; a person operationally responsible for the quality of care provided to patients. The decentralised decision making approach is based on three basic concepts: the nurse's decision making authority, responsibility and accountability. Results and conclusions The real CORE of this model is represented by the responsibility for the decisions made by a single nurse. Then each patient is assigned to a nurse responsible for continuity of care, whose duties include patient and caregiver education and training, website data entry, review of critical case transmissions and assessments, and submission of critical cases to the physician.