You are a registered nurse who works with wound care patients. J. S. is a 34 year-old woman who had a mastectomy six weeks ago. She
QUESTION
You are a registered nurse who works with wound care patients. J. S. is a 34 year-old woman who had a mastectomy six weeks ago. She developed a staph infection and the surgical site was debrided as part of the treatment.
You now care for J. S. at her home and photograph her wound. The photos are sent to the multidisciplinary care team at the wound center. The team makes changes in the treatment plan based on your assessment and photographs of the wound. A physician in a nearby state also has a weekly video conference with J. S. about the plan of care.
- What concerns about using telehealth do you have for J. S.?
- What potential liability or licensure concerns exist?
- What privacy concerns potentially exist?
- What limitations might telehealth have in this case?
Textbook: Handbook of Informatics for nurses and healthcare professionals. sixth edition. Toni Hebda. Chapter 19.
ANSWER
Telehealth Concerns and Considerations in Wound Care: A Comprehensive Analysis
Introduction
Telehealth has emerged as a valuable tool in healthcare delivery, allowing remote patient monitoring, assessment, and consultation. In the case of J. S., a 34-year-old woman who underwent a mastectomy and developed a staph infection, telehealth is being utilized to facilitate wound care management. However, the implementation of telehealth raises several concerns and considerations that must be addressed to ensure the optimal delivery of care, minimize potential liability issues, maintain patient privacy, and acknowledge its limitations.
Concerns about using telehealth for J. S.:
Inadequate physical examination: One of the primary concerns with telehealth in wound care is the limitation of a comprehensive physical examination. While photographs can provide visual information about the wound, they may not capture other vital aspects such as texture, odor, or pain intensity, which could impact treatment decisions. Therefore, relying solely on photographs may pose challenges in accurately assessing the wound’s status and progression.
Limited tactile assessment: The absence of physical contact in telehealth consultations restricts the healthcare provider’s ability to conduct a tactile assessment By not being able to palpate the wound or surrounding areas, important information about tissue texture, tenderness, or the presence of induration might be missed, potentially affecting the accuracy of the diagnosis and treatment plan.
Potential liability or licensure concerns
Cross-state practice: The involvement of a physician from a nearby state in the video conference introduces potential licensure issues. Healthcare providers must ensure they comply with state regulations regarding the practice of telehealth across state lines. Failure to do so may result in legal and professional consequences.
Standard of care: Telehealth services must adhere to the same standard of care as in-person consultations. The healthcare providers involved must be competent in delivering care through telehealth and remain aware of any legal or professional obligations specific to telehealth practice. Failure to meet the expected standard of care may lead to liability claims if patient outcomes are compromised.
Privacy concerns
Data security: The transmission and storage of patient data, including photographs, through telehealth platforms raise concerns about data security and privacy breaches. Healthcare providers must ensure compliance with relevant privacy regulations, implement robust security measures, and employ secure communication channels to protect patient information from unauthorized access or breaches.
Consent and confidentiality: Telehealth consultations necessitate explicit patient consent for the use and sharing of health information, including photographs. Healthcare providers must ensure that patients understand the risks and benefits of telehealth and obtain informed consent (Keenan et al., 2022). Additionally, maintaining patient confidentiality and securely storing electronic health records are crucial to protect patient privacy.
Limitations of telehealth in this case
Lack of physical proximity: The inability to physically examine the wound may limit the healthcare provider’s ability to make accurate assessments and may delay the detection of potential complications or adverse events (Nagle, 2022). Some aspects of wound care, such as the application of dressings or performing specific procedures, may require hands-on intervention, which is not possible through telehealth.
Technological limitations: Telehealth relies on stable internet connections, appropriate software, and user proficiency. Technical issues, such as connectivity problems or software malfunctions, can disrupt the continuity of care and compromise the effectiveness of telehealth interventions.
Conclusion
Telehealth has the potential to revolutionize wound care management, providing remote assessment and consultation. However, it is essential to address concerns related to physical examination limitations, potential liability and licensure issues, privacy and data security, and the inherent limitations of telehealth technology. By proactively addressing these concerns, healthcare providers can optimize the delivery of telehealth services, ensuring patient safety, privacy, and quality care in the management of wound care patients like J. S.
References
Gajarawala, S. N., & Pelkowski, J. N. (2021). Telehealth Benefits and Barriers. The Journal for Nurse Practitioners, 17(2), 218–221. https://doi.org/10.1016/j.nurpra.2020.09.013
Keenan, A., Tsourtos, G., & Tieman, J. (2022). Promise and peril-defining ethical telehealth practice from the clinician and patient perspective: A qualitative study. Digital Health, 8, 205520762110703. https://doi.org/10.1177/20552076211070394
Nagle, S. M. (2022, October 19). Wound Assessment. StatPearls – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK482198/
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