Telemetry and baseline EKG

[chrislo09]

I am wondering if most hospitals do a baseline EKG before initiating telemetry on a patient? This has recently become an issue at my hospital. We previously always did an EKG on initiation or prior to telemetry. We have been converting all of our paper orders to computer and if the doctor doesn't specify to do the EKG than it isn't being done. Our policy for telemetry also doesn't say anything about doing an EKG. Isn't it important to have a baseline incase something changes?

[nurseprnRN, BSN, RN]

Telemetry is what tells you if it changes, from the minute you put it on until the minute you take it off. If you are looking for more subtle changes of ischemia, as opposed to merely dysrhythmias, you should be getting 12-leads anyway.

That said, most people who buy themselves a slot on telemetry have had a 12-lead anyway sometime recently. If someone has been in the hospital admitted thru the ER or OR and is now on tele, I would find it very unusual for a 12-lead not to have been done at some point. For most adults a 12-lead within 30 days is standard for preop clearance. Doing another one merely because you are about to slap on tele leads sounds like padding the bill to me.