Quote from working4change
Recently, our 33 bed cardiac step-down floor changed from centralized telemetry with telemetry techs to decentralized. Which means that the RNs now carry pagers filled with our patients room numbers (usually 5 patients each-spread throughout our large unit) but the pagers go off for arrhythmias on all 33 patients. There is a central bank of monitors at the desk but no one is watching them. Already, there have been several instances where patients went into afib or had runs of v tach without anyone noticing. One patient monitor was on standby for several hours. The problem is that the pager goes off every 2-3 minutes in our pockets, causing us to run and check on the patient. Some are true arrhythmias, most are artifact. Sometimes it alarms asystole with a heart rate of 70. I can't make a phone call to a doctor or pull medications without constant interruptions. I am concerned that we will become complacent and miss an arrhythmia or make a medication error with all this chaos. I have never heard of this being done before. I am sure that it is a cost cutting measure. Does anyone else work in environment like this? How have you managed this successfully?
I am going to be popular here right now. Not ALL telemetry units have monitor techs. I think the reality of "running for every alarm" is a bit extreme. If the telemetry alarm are properly set....less acute alarms can wait for a short period of time for intervention. Your management needs to develop policies with the medical staff what is an acceptable "wait" for the alarm and rhythms. I have been a nurse for 33 years and I have never had a monitor tech to watch monitors in any step down/PCCU/ED/ICU/CCU/Tele I have worked or managed.......and I have never had a patient have an untoward outcome because and alarm was not answered, or not answered in a timely manner.
The AJCC (American Journal of Critical Care) has made recommendations for both ICU and PCU nurses to accommodate these changes and improve your practice with some very good suggestions.
Unfortunately there are "false" alarms and yes those foolish monitors will ring all day long. I do not know what system of monitors and monitor analysis you have......and I'll admit some are better than others. I always felt that if the monitors were always right....the hospital would NOT need me anymore. I have seen one system that has the alarms notification on computerized lighted "bars" on the ceiling placed at certain points in the hallway and all you do is stick you head out the door. Of course that doesn't tell you the what the monitor actually shows.
Monitoring systems have levels of notification the only ones that need to be immediately are "red" or "emergent" alarms....v.tach, v.fib, asystole, hr>200 (or whatever limit is decided),extreme bradycardia HR<40, and asystole. You can set certain alarms to have greater priority or lesser priority according to the patients needs and respond accordingly. Stat alarms of course need to be answered immediately as those are life threatining. There will be false alarms....but that is telemetry. A fib is not life threatening and can "wait" a short peroid of time which need to be determined by policy. I have always have the monitors set to HR >150 and V.tach to be 4 beats and up for response attention as emergent alarms.
In reality, a controlled a Fib even if "new" is survival rhythm. I required my staff to look at the monitor on their patients hourly and address the alarms and "clear them" every four. I also paid the secretary the top of her scale and "monitor trained" her for that rare occurrence. I always reminded the staff that leads off/battery inoperative can be asystole misread by the computer and to NEVR SHUT OFF THE ALARMS. I also had an additional banks of monitors (just the screens) so the staff could check the monitors frequently and portable bedside monitors that certain patients used when interventions for arrhythmias needed to be monitored.
Learning to adjust is difficult, change is HARD, as us here in AN discovered with the upgrade. I think the success will depend on the motivation of your facility and your bosses active presence to ensure a safe transition. Their decision to change may have been premature as The Joint Commission and HHS are coming out with recommendations very soon...the will change the playing field completely. Telemetry "mishaps are right now "Sentinel Events" http://www.jointcommission.org/sea_issue_48/
with The JC and it will be a new focus soon.
Joint Commission: Nine ways to combat health worker fatigue - The Advisory Board Daily Briefing
Lawmaker Urges HHS To Address 'Alarm Fatigue' Among Health Providers
Rep. Edward Markey (D-Mass.) has sent a letter to HHS Secretary Kathleen Sebelius calling on her to task the Institute of Medicine to address the issue of "alarm fatigue" in health care settings, the Boston Globe
's "White Coat Notes
Alarm fatigue refers to medical workers ignoring or becoming desensitized to audio and visual alerts from medical devices
Lawmaker Urges HHS To Address 'Alarm Fatigue' Among Health Providers - iHealthBeat
These changes will make the hospital address these issues for they will be apart of survey and reimbursement. This is a focus for patient and safety goals and will become a greater focus soon .......if you are feeling unsafe....you can let The JC know
This subject is high on their radar.
I know that this seems overwhelming but it is done at multiple facilities across th4e nations every day. There is evidence that alarm fatigue affects even telemetry techs and ignoring an alarm has lead to an untoward event even with a monitored tech present AND has even occurred in patients being monitored by an EICU. So having a moniotred tech doesn't ensure the patients safety......hard work and diligence however does.
Whether or not this is feasable for your facility I can't tell as it depends on the monitors, the MD's the staff and the manager. I just wanted you to know that it has been done and is done all across the US sucessfully and changing is hard but it can be done. I wish you the best .....Peace!