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The Use of Novel Ventricular Assist Device Smart Phone Application for Outpatient Management in Children RPH


Beth Hawkins, MSN
Beth.Hawkins@cardio.chboston.org

Christina VanderPluym, MD
Christina.Vanderpluym@childrens.harvard.edu
Boston Children's Hospital
Boston, MA, USA



The era of smartphone technology is upon us. Everywhere you turn, from street corners to restaurants, adults and children are glued to their phones for information, entertainment and socialization. Based on data from the Pew Research Center, 77% of Americans own a smartphone as of 2016, up from only 35% smartphone ownership in 2011, with 100% of adults aged 18-29 owning a cell phone [1].

Given the success and popularity of smartphone technology - especially in the adolescent and young adult population - we felt that the crossover of this technology to home monitoring for the complex medical care of outpatient ventricular assist device (VAD) could prove more efficient and effective than traditional modes of communication and monitoring. Management of outpatient VAD- especially in the pediatric population- is a new and evolving field of care [2]. The daily tasks of a VAD patient include; sterile driveline dressing changes, recording pump performance, vital signs, INR measurement and remembering to take medications. All this information must be seamlessly communicated between the VAD patients/families and their care providers on a day-to-day basis [3]. Over the course of the Boston Children's Hospital Outpatient VAD Program, we have attempted multiple strategies to convey this information in a secure and efficient manner [4]. From these experiences, we identified the key aspects of home monitoring that would streamline outpatient care: (1) fast and easy patient data entry, (2) platform for electronically captured data to be trended and (3) an effective communication modality. Based on the prolific use of smartphones in our pediatric VAD population by both parents and patients, we developed a pediatric focused VAD app with support from the Fast Track Innovations Grant from Boston Children's Hospital.Boston VADkids app

Boston VADkids App

The Boston VADkids® app has 3 main features related to: education/reference material (device specific- HeartWare HVAD®, HeartWare Inc.®, Framingham, MA), data entry (patient and device specific) and secure communication through texting (text, emoji, and photos).

Education/Reference Material
When a patient is discharged on a VAD, the patient and their caregivers participate in intensive education. The enormity of information makes it hard to retain. Boston VADkids appAs such, we uploaded the information contained in our patient's home management guide directly to the app, including all the necessary instructions of how to care for the patient on VAD. This is now an easily accessible guide that can be tabbed through by topic, rather than turning pages in a manual.

Since the reference material is so important in case of an emergency, there is a section that is accessible without a log in and password. This will allow first responders or a layperson who might come across a VAD patient in distress, the ability to open the app with critical information about the VAD and how to deal with emergencies as well as our center's contact information so they can call for more information. All VAD patients wear a medical alert bracelet that directs people to their phone for this information.

Data Entry
The specific fields of entry include: patient weight, temperature, blood pressure, home INR values (measure on point of care home INR machine CoaguCheck XS®, Roche Diagnostics®) and device settings such as operatingBoston VADkids app speed, flow, power consumption and any alarms. Data entry takes less than 5 minutes and can be visualized on a provider dashboard that is reviewed daily by members of the VAD care team. Additional alarms for out-of-range values can be set that will send email alerts to providers to check values. Current initiatives are focused on marrying this data input into hospital electronic medical records.

Communication Modality
We wanted the app to be able to support secure texting between our team and the patient and families. Adolescents wanted a private option of communicating with us. All providers have the ability to view or join the text thread. Parents and adolescents have separate views, so that adolescents can privately ask questions that they might not feel comfortable asking in front of their parents.

Picture Capability
The ability to send photos through secure texting was pivotal for monitoring and assessing the driveline exit site. Taking photos of the driveline and texting it to the care team allows for closer surveillance for infection.

Conclusion:
The VADKids App is the first smartphone app specifically designed for the pediatric VAD recipient with the intended goal to improve our patients' quality of life by streamline communication with the care team. If you would like more information on using the app at your center, please contact christina.vanderpluym@childrens.harvard.edu. ■

Disclosure Statement: The author has no conflicts of interest to disclose.


References:

  1. Mobile Fact Sheet, 2016. Pew Research Center, Washinton, D.C. http://www.pewinternet.org/fact-sheet/mobile/
  2. Schweiger M, Vanderpluym C, Jeewa A, et al. Outpatient management of intra-corporeal left ventricular assist device system in children: A multi-center experience. Am J Transplant. 2015;15(2):453-460. doi:10.1111/ajt.13003.
  3. Conway J, Vanderpluym C, Jeewa A, Sinnadurai S, Schubert A, Lorts A. Now how do we get them home? Outpatient care of pediatric patients on mechanical circulatory support. Pediatr Transplant. 2016;20(2):194-202. doi:10.1111/petr.12674.
  4. Hawkins B, Fynn-Thompson F, Daly KP, Corf M, Blume E, Connor J, Porter C, Almond C, VanderPluym C. The Evolution of a Pediatric Ventricular Assist Device Program: The Boston Children's Hospital Experience. Pediatr Cardiol. 2017 Jun;38(5):1032-1041. doi: 10.1007/s00246-017-1615-8. Epub 2017 Apr 29



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