Triage and Assessment

Able to do Virtually

RNs are can virtually assess new and urgent primary care issues and effectively triage over either phone or video. This would include reviewing the patient’s primary concern, available electronic record health records, and the development of management plans.

In a virtual visit, a short-term management plan can be developed with the patient that could include self-management, follow up, or triaging for face-to-face care or to acute care.

Virtual follow up can also be provided, as needed for the specific issue.

VIDEO MAY HELP in the assessment of new concerns, especially where some level of visual inspection is needed.

Not Able to Do Virtually

Physical exam and point of care testing (blood glucose and urine) cannot be carried out virtually and thus limits assessment, increasing the need in some cases for redirection for in person assessment.

Able to do Virtually

RNs can use virtual tools to engage new patients in a practice, taking a full history during an initial registration visit. This would include taking a comprehensive health history, including psychosocial, cultural, mental health, substance use, determinants of health, emotional, cognitive, cultural, allergies, etc.

This visit could also include assessing patient's understanding of their health status and determinants of health. RNs can also synthesize health assessment information to identify health concerns, potential screening needs and suggest if any community resources could be accessed.

Able to Do Virtually with Modifications

While much of the history can be virtually, any physical assessment will require in-person visit. Some patients may have at-home equipment (e.g. glucometer, BP cuff) that can provide some physical measurements that can be included in the visit history.

Not Able to Do Virtually

Physical exam is generally limited and most would need to be deferred to a face to face assessment.

Able to do Virtually

RNs can assess patients prior to any face-to face visit to assess symptoms that may be potentially COVID symptoms. We do not expect that RNs would do the standard pre-screening as this would be a standard check list that could be performed by office assistants.

We expect an increasing need for COVID specific care in the fall / winter or 2020. RNs can provide a range of COVID specific care, including: education for infection prevention, screening of symptoms, referrals to community testing and when to be assessed in person all of which can be completed virtually for many people.

RNs can setup and manage a clinic-wide program proactively reach out to higher risk patients to develop person-centred plans for reducing exposure risk (e.g. physical distancing, having a mask, able to access medications and groceries, etc.)

RNs can also connect virtually with patients who may be more at risk of indirect effects of the global pandemic due to economic loss, isolation, etc.

Able to Do Virtually with Modifications

RNs can assess for signs and symptoms of COVID virtually, but some physical assessment would require in-person assessment (which may be provided at a specific site in your community).

Able to do Virtually

An RN can be involved in pre-op assessments, taking a focused health history virtually as well as completing chart review, and a medication review and completing much of the pre-operative forms. This is generally a large part of the pre-op assessment. The patient can then be educated on, if a face to face physical is required, on how that appointment will be structured, how it will be very focused (to limit possible exposure, etc.) and what to expect.

Able to Do Virtually with Modifications

If patients have home health monitoring equipment (e.g. BP machine), you may be able to collect some physical exam data, but much of the physical assessment will require in-person visit.

Not Able to Do Virtually

Required physical assessment would have to be done in person, but a virtual pre-visit would reduce the duration of the physical assessment portion.

Able to do Virtually

RNs are able to virtually take a Best Possible Medication History. This would include reviewing medications (including over-the-counter medications, alternative medications) as well as assessing for adverse reactions or intolerances and taking an allergy history. The EMR medication list can be kept up to date when reviewed at each visit.

Assessing access to medications and treatments by determining health coverage can also be done remotely. Assessing access to medications and appropriate treatments/interventions particularly important during COVID isolation.

VIDEO MAY HELP with reviewing specific medications as you can see the pills and the bottles on screen. This can be helpful both to assess which medications the patient has and also how much of each medication is left at home (suggesting adherence).

Able to Do Virtually with Modifications

While most education on medications can be provided virtually, some teaching on medication self-administration, such as insulin, would benefit from face-to-face, hands on teaching, although it is possible to demonstrate with video.

Not Able to Do Virtually

Actual face-to-face care would be required for patients that require administration of medication (e.g. injections). This could be done by either seeking alternate locations or planning a very specific process for injections on site (e.g. a ½ day clinic) where patients are met virtually beforehand (phone or video) to address any other concerns and then come in ONLY for the injection with proper PPE to minimize contact / exposure. Patient education to allow for self-administration during the pandemic is also suggested, where appropriate.

Able to do Virtually

RNs are can virtually assess for presence or need for advanced care directives. By taking a whole person approach, RNs, can approach the subject of advanced directives with people, provide education on advanced care directives and record their insights.

This can be done proactively in primary care and may be particularly important for patients who are worried about what may happen in light of the pandemic as they hear that a population of patients require ICU and ventilator care.

Part of the work could include appropriate sharing of advanced directives with local acute facilities, with the patients express consent

Able to Do Virtually with Modifications

Discussions around advanced directives may benefit from having existing relationship with patients, which is where video visits may be helpful to build that relationship more quickly than phone. Further, a “warm hand off” or recommendation from the primary care provider can be very helpful in setting the stage for shared care, especially for this kind of topic.

Able to do Virtually

RNs are able to do some virtual assessment of cognitive function, including talking with the patient, talking with their family, and assessing needs for interdisciplinary team/community resources/referrals.

Able to Do Virtually with Modifications

Assessing social/environmental status (live alone, finances, insurance coverage, assess key social determinants of health and health inequities) is possible virtually but will rely more on history. This may be slightly limited compared to a home visit, if one would have been considered, especially if the patient or caregivers do not have access to video.

Some functional cognitive assessments have virtual versions. See resource for administering a partial MoCA remotely.

Able to do Virtually

RNs can meet with patients virtually to assess acute and/or chronic pain.  Both can be assessed virtually through histories and the use of validated verbal tools. Implementing evidence-informed practices of pain prevention and management using pharmacological and non-pharmacological measures can also be accomplished virtually for many patients. Follow up to assess treatment effectiveness is also well suited to virtual visits. These may be preferable for some patients as it reduces the burden of travel

Not Able to Do Virtually

Some causes of pain, particularly acute pain, may require in-person assessment to assess cause or may require in-person delivery of specific interventions

Able to do Virtually

RNs can virtually review nutritional status of patients, including discussing food safety and accessibility, assessing nutrition literacy and providing education and supportive counselling. This can be important during the pandemic when patients may have lost work or may have trouble accessing food safely or are avoiding getting food due to perceived or actual risk.

Able to Do Virtually with Modifications

In some cases, a home visit may provide additional insight into a person’s food safety and dietary habits that would not be possible with virtual visit, particularly without video. However, with video, a nutritional assessment done virtually may be better than an office visit, if the patient is able to show you what they are eating or what is in their kitchen. This will give you more information than the office visit and could be a benefit to virtual care.

Able to do Virtually

RNs can provide comprehensive assessment for those at risk for STI of all genders. This includes taking a sexual health history, a safety assessment, and mental health screening.

RNs can provide additional education on sexual health, review lab results and recommend treatment.

RNs can be involved in contact tracing, coordinating testing and treatment of STI contacts.

  • RNs with BCCNP STI management certified practice can order some STI labs, which can be faxed to the laboratory for clients to self-collect.
  • RNs without certified practice can do everything in the NNPBC guidelines for the exception independently ordering labs, and dispensing/administering treatments. In this case, if a prescriber (MD, NP) is reviewing labs and they see a positive gonorrhea result, for example, they can write the prescription and the can RN provide counselling and partner care without the client ever seeing the prescriber if that’s appropriate

Able to Do Virtually with Modifications

While certified nurses are able to administer and/or dispense STI treatments per the NNPBC STI management guidelines, this would have to be in person (they can’t send a prescription to a pharmacy). All anticipatory counselling can be done virtually in a pre-visit. RN administration and or dispensing would require an in-person visit. Depending on the condition, it may make more sense for a prescriber to send a prescription to a pharmacy.

Not Able to Do Virtually

Some STI treatments would need to be administered in person (e.g. Penicillin G injections for syphilis treatment).

Physical exams and on-site diagnostic testing and treatment would require in-person visit.

Go back to the guide

<Triage and Assessment

Health Education

Health Promotion & Disease/Injury Prevention

Chronic Disease Management

Care Coordination

COVID-Specific Care

 

Legend

Able to do Virtually
Able to do either on phone or video with reasonable confidence that for most clients you would achieve similar quality of care.

Able to Do Virtually with Modifications
There may be limitations to performing the task virtually. Video may be preferable to phone or significant modifications are required that limit the quality of care.

Not Able to Do Virtually
Not able to perform task virtually. May require in-person assessment or intervention.