Absolutely. Frequent, ongoing communication with every patient’s healthcare team is vital to the success of our home health monitoring program.
Every 2-3 months, a summary of the patient’s MTRs (Medication Tracking Records) is compiled and shared with the primary care physician, clinical specialist, case manager and, for patients with mental health concerns, the mental health and addictions care team.
The summary includes the following information (when applicable):
- Blood pressure and pulse rate (ranges and averages)
- Random and/or fasting blood sugars obtained through download of glucose meter
- Body weight
- Any medication adherence or health concerns
- Any specific information requested by the physician and/or case manager
- Any recommendations by the pharmacist for changes to medication therapy
As well, our pharmacists and registered nurse managers are in communication with visiting nurses at least once a day – more frequently if urgent concerns arise. The visiting nurses also submit daily reports on each patient, which are reviewed by our pharmacists.
Of course, any urgent concerns are immediately addressed as medically appropriate, and the healthcare team is informed and consulted in a timely manner.