Home health nurse Portia Ollero is amazed that an 87-year-old patient she treats for congestive heart failure hasn't returned to the hospital in more than a year. Ollero said the woman patient's physician frequently comments about how he can't believe the patient has been able to stay out of the hospital for this long. Ollero, RN, also is impressed by how easily the nurses from VNA Healthtrends' office in Huntley in Chicago's far northwest suburbs have been able to treat the woman's congestive heart failure at her home, using a regularly adjusted dosage of diuretics, better diet and other lifestyle changes, and a small, portable electronic monitor known as ZOE. "There are a lot of things involved with monitoring CHF, and the ZOE is a big part of that for us now," said Ollero, branch director of nursing for VNA Healthtrends in Huntley. Last year, the home health nurses with VNA Healthtrends Illinois launched an experiment. For years, the nurses had cared for patients suffering from CHF at their homes. However, no matter how much attention was given, or how much education on diet, exercise and proper self-care was provided, the nurses struggled to reduce the number of patients who inevitably would return to the hospital for readmissions to treat CHF recurrence, reducing the patient's quality of life, risking infections and other complications and costing the healthcare system tens of thousands of dollars with each readmission. "It's an overall frustration, and a national health problem," said Teresa Fitzgerald, RN, VNA Healthtrend's executive director of product development.
How ZOE works
About two years ago, Fitzgerald said she stumbled upon something she and others at VNA Healthtrends believed could help address the problem -- the ZOE fluid status monitor. The device, made by Noninvasive Medical Technologies, Inc., of Las Vegas, uses a low-amplitude, high-frequency electrical current to detect fluid levels in the body. It has been in use in hospitals and clinical settings for years, Fitzgerald said, but its portability and precise metric capabilities led her to suspect the battery-powered device easily could be deployed in the monitoring and treatment of CHF patients in home health settings as well. In early 2014, VNA Healthtrends acquired its first ZOE monitors and trained its nurses how to use them. In March 2014, the organization began a trial program, adding the ZOE to the treatment regimen of a few CHF patients. The results were encouraging so VNA Healthtrends expanded use of the ZOE to other areas of the state it covers.
Possible outcomes
VNA Healthtrend's COO Annette Heneghan, RN, said the results have exceeded their expectations. Before adding the ZOE to their care regimen, about 28% of VNA Healthtrend's CHF patients would return to the hospital for further treatment of the condition. Between March 2014 and May 2015, after incorporating the ZOE as part of the care regimen, hospital readmissions among CHF patients went down to zero, according to Fitzgerald. The secret, Fitzgerald said, lies in the ability of the ZOE to detect even minute changes in fluid levels. This gives nurses a headstart of as much as two weeks to detect the development of CHF problems and allows doctors to adjust medications appropriately to reduce fluid levels and head off the problems, without the patient ever leaving home. Edna DePeugh, RN, who works out of VNA Healthtrends' Decatur, Ill., office, said the ZOE monitor has helped her not only keep patients out of the hospital, but makes her job easier, as patients, watching fluid levels change, can better understand how the lifestyle changes the nurses are asking them to make impact their health. "They see why they need to use their medications precisely, avoid salt, and do the other things we ask," DePeugh said. "They're aware of what we're doing and why we're doing it." DePeugh, a nursing professional for more than four decades who worked for more than 20 years in critical care at St. John's Hospital in Springfield, said the device has helped make her a better nurse. "It's helped me assess all my patients better, even my non-ZOE ones, picking up on little subtle changes," DePeugh said. She said using the ZOE has helped her better identify signs of pending fluid overload, such as slight respiratory changes. She said the ZOE also has helped in rehydrating, without hospitalization, a CHF patient who needed to come off diuretics because she had become dehydrated. "I've been on the ground floor for a lot of advances in cardiac medicine, and some of it has come and gone," DePeugh said. "But this is so exciting because it's actually bringing a great tool outside the hospital, right into the patient's home." Ollero said doctors and hospitals have noticed as well with many now ordering ZOE monitoring for discharged CHF patients. "We're keeping them out of the hospital, and that's better for everyone," she said.
