Telehealth

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  • #45315

    Hello again,

    I work at a sleep away camp where there is no prescribing MD on site.

    The nurses have been great with triaging, but we often face the situation that we must send our campers to rule out anything more serious.

    Has anyone used telehealth as a back up for when a camp RN needs tp escalate care, before sending a camper off site to urgent care etc.

    Somme situations may not warrant a visit to the MD, but the RN may need to discuss their triage findings with an MD.

    Granted our Wifi access is not the best (almost non existent) but I wanted to hear your thoughts, and anyone’s experience with this.

    Thank you again,

    Giselle

    #45319
    Amanda Cook
    Member

    My husband and I have volunteered these types of consultations for a camp for many years. We primarily help the on-site staff with decisions like what could be safely monitored first and what should be seen more urgently. There are always a lot of ‘what do you think this might be?’ questions, and of course, how to manage a particular issue in the camp environment (what activities to adjust, infection control, etc). Since the health center staff is typically new to camp health each year, this allows us to offer a consistent experience to the process.

    Traditionally as RNs, we couldn’t diagnose, only help brainstorm differentials and general things to consider when making decisions. Once I became an NP, I volunteered diagnostic and treatment services for simple conditions that could be easily assessed via telehealth. This method has allowed campers and staff to remain on campus and often lets campers start treatment earlier, which gets them back to enjoying camp faster. Before any formal treatment, I do require verbal permission from the parents, even though they’ve signed the general consent forms. I always want them to have the option to request an in-person visit elsewhere, if they prefer.

    An important thing to consider is how you will manage camper health privacy concerns with telehealth. We do not involve camper names or other identifying information in our communication, unless I need to provide formal care. That allows them to text simple questions without needing wifi or secure communication services. Anything sensitive must go through a secure outlet, like Doximity or an encrypted messenger service. The camp has provided me access to their electronic health forms, which lets me securely see any additional information on the camper. Of course, I maintain documentation of any specific services, and the on-site staff are reminded to document when they consult with us, as well. States have varying rules on telehealth, so it would be important for any provider you use to be aware of them. The camp and the provider will also need to consider liability coverage and concerns before committing to the process.

    This method has worked very well for us over the years. Most parents appreciate having the option for quick, on-site care for their camper, and the staff appreciate having lifelines to call when they have situations that don’t fall neatly into the treatment protocols. I will say that this camp includes several families that attended over generations and the campers often attend the same schools. Many of the parents know us from when they were campers, so they trust our involvement. The closer-knit relationship may be what allows our situation to work well and may not apply as easily for camps with a wider population net. Keep that in mind. I hope this is helpful!

    #45352

    Giselle:

    Great question. Amanda hit on many of the things to consider with telehealth -whether informally or formally arranged. The nurses at camp should have access to a prescriber (MD, NP, PA)who has signed standing orders and hopefully that person would be willing to have some discussion regarding RN questions and assessment findings. This could be another option.

    Your relationship with the families is key to making decisions about elevating care. This is the reason we encourage camp nurses to really “beef up” their assessment skills and be able to share findings with other healthcare providers who can give feedback.

    Take care
    Tracey

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