Psychiatric Care

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A Psychiatric Nurse Practitioner (PNP), working in a collaborative practice with a Psychiatrist, has been counseling a patient recently discharged from a psychiatric inpatient stay. Upon discharge, Our Partner AMC set up the patient with technology to provide two-way teleconferencing via the patient’s television set, along with a medication management device and a blood pressure monitor.

During the course of a particular remote evaluation, (at the beginning of which the PNP obtains the patient’s permission to record the video session), the PNP has determined that a Medical Social Worker (MSW) should be introduced to assist with resources needed to address abuses from a family member as well as financial management issues that might jeopardize the patient’s living arrangements. The PNP asks the patient if she feels comfortable with a “warm” video transfer, whereby the PNP would make the televideo introduction with a 3-way televideo call, and then sign off. The patient declined, saying she would be more comfortable if the PNP remained on. At some point in this 3-way call, the patient asks to have a private word with the PNP, and the MSW’s ability to hear the 2-way televideo conversation is temporarily blocked (by either the PNP or the patient). The MSW is then unblocked from the conversation, and arranges for an in-home evaluation in the near future. Before the MSW signs off however, she proceeds to show the patient (and the PNP) a PDF or other image file of the necessary forms she has been referring to in their conversation that they will need to review at the home visit. The patient tells her that the image is too small for her see what she’s referring to, and so the MSW enlarges the image until the patient is satisfied. 

For the remainder of the (now 2-way) televideo session, the PNP notices symptomatology, such as rapid eye blinking and altered speech patterns that make her suspect that the patient is experiencing side effects from a recent change in her medication regimen. She presses RECORD, capturing these symptoms, which she informs the patient that these recordings will be shared with the psychiatrist to evaluate whether a medication modification is recommended. She completes the session by asking the patient some additional assessment questions, watches the patient takes a blood pressure reading, asks to see the patient’s pupils up close, etc. The patient signs off.

The PNP then contacts the psychiatrist via a 2-way televideo consultation to review her findings. Together they share and view the web portal page on the patient. The PNP plays the recorded video segment of the patient back for the doctor to illustrate the symptomatology she identified. She also directs the doctor’s attention to blood pressure trends and medication compliance information since the patient’s last medication change. The psychiatrist agrees there may be an issue and suggests that the patient make an appointment. The PNP informs the doctor that they have been having difficulty getting the patient to agree to a clinic visit. The doctor then suggests they get the patient on a 3-way televideo call to make their case together.

While they waited to contact the patient, the doctor informs the PNP that he has a new patient whose referred for telemonitoring but the patient is hearing impaired, which may preclude enrollment onto the telemonitoring program. The PNP assures the doctor that this tp be a problem, as the televideo technology supports speech-to-text or TDD/TDY streaming (on the bottom of the video image). For TDD/TDY, the clinician can use her own key pad to type out statements, and Meditel360 will set up the appropriate keypad interface with the patient.