What do you do when telemetry calls?

[RaziRN]

So I work on an extremely busy medical floor that receives the majority of admissions in our small county hospital. We're a catch-all for everything! We have a lot of patients on telemetry and patients just transferred out of ICU. Often times I'll get several calls from the telemetry technician during the night. Mostly the calls are telling me that patient A had a six beat run of PVCs but are now back to their regular rhythm or Patient B has "bradied" down from the 70's to the 50's. I'm not usually all that concerned about these calls but I tell the telemetry tech that I'll check on the patient and the patient is usually fine. I even take the extra step to call the tech back most times to let them know my findings. Most of the time the patient is either sleeping, having a bowel movement or up and moving around (causing them to be tachycardic or at least have a higher HR than what they usually have.) Don't get me wrong, I appreciate the telemetry techs and realize that they have to let the nurse know. I'm especially appreciative when they call about something that should be taken very seriously (ie. pt converting to A-fib or a pt. with a HR in the 200's). However, I'm a new grad and 99% of the time I have 6-7 patients to care for. And it never fails that telemetry calls with these things while at your most stressed point ( such as trying to fulfill at least five different pt. demands/needs.) Now I certainly do not know everything, so I'm asking what do you more experienced nurses do in this case? I've talked to my fellow nurses who have more than 30 years experience and they tell me that they chart what telemetry reported and their assessment of the pt. and any interventions they may have needed to make. I can completely jive with this if it's something really serious such as symptomatic bradycardia, tachycardia or new onset A-fib or a run a v-tach. However, it's those calls where they tell you about the six beat run of PVCs but rhythm is back to normal where I have trouble with that concept. If I charted every time telemetry called with something like that I would never get any pt. care done nor would I leave the hospital ( at least on most nights). So, what do you do in those situations? Am I looking at this in the wrong perspective? I'm a new grad and am still trying to improve my time management/organization skills and knowledge base. Any advice would be greatly appreciated. :)

[Dalzac, LPN, LVN, RN]

I was a monitor tech before I was a nurse and as a tech our job was to notify the nurse about the aberrant EKG. A run of 6 beats can be a forewarning of something coming. PVC's mean there is something irritating the ventricles. As a nurse it is your job to check all of the warnings you have been given. The tech might say they are off the monitor but then what if they are in V Fib and you didn't check? If they are consistanly having Bradycardia You say they always do that but what if they have quit breathing or are having difficulty breathing. Your pts have just come out of ICU. They still need a little closer eye on them. The reason they are still on the monitor means the pt still needs watching. The doctor checks those strips and when he sees the aberrant rhythms and nothing was charted except the tech saying nurse notified He may have wanted something done and you will look like you were negligent. It is very important to recognize these finding and chart them no matter what. You are the First defense for patients. There is nothing worse to know a patients v tach, asystole,or v fib could have been prevented if you had spoken up the first time you saw it.

[UM Review RN, ASN, RN]

Never worked with this type of setup...I usually would go look at the monitor and the patient to confirm, because of a all the weird things I've found. Monitor techs can be wrong, leads can get hooked up to the wrong patient, pacers can function when the patient is obviously dead, never take anything for granted with a tele patient.

[BluegrassRN]

After I've checked on the patient, gotten vitals and an assessment, I always ask the tech "Is this the first time, or have they been doing anything else funky earlier?" and "Does your charge nurse think I should call the doc, or should we just keep an eye on things?" I also always ask them to call me if anything else funky comes across, and I try to eyeball the monitor more frequently myself.

[JulieCVICURN, BSN, RN]

As a cardiac ICU nurse, I definitely want to know about 6 beat runs of PVC's. This is considered V-tach, and if it's not typical for the patient then you need to be checking electrolytes. Most of the time this happens in my unit (when it's not post CABG) is that the potassium or magnesium levels are off. And even when it is post surgical, usually it's still an electrolyte issue. If it's not, you might end up getting a lidocaine order from a doctor for persistent small runs.

I don't need to know about random PVC's or even regular bi or tri-geminy if it's typical for the patient, but a new run of PVC's that may or does recur? Definitely. If you do not pay attention to those short runs of V-tach, they could very easily turn into a code situation that you could easily have prevented by paying attention and getting the patient what they need to stop it from happening.

[casi, ASN, RN]

As a monitor tech I'm going to suggest giving the monitor some parameters on patients that you think may cause them to call a lot. A few parameters I got last night we're "frequent PVC's are okay he's got a bad heart and hospice is being consulted. Let me know if there are any long runs of v-tach", "The patient is on cardiazem, please let me know if their heart rate starts getting low. I also need to know if it is sustained above 120.", or my favorite from last night "Just let me know if there is sustained v-tach."

We are a cardiac floor that gets a lot of sick hearts so our parameters can be a bit wide.

Also please don't be so quick to write off PVCs. Frequent PVCs can turn into v-tach pretty quickly. Also please remember anything more than 3 PVCs in a row is v-tach.

[RaziRN]

Wow, thanks for all the helpful replies! I honestly did not know that more than 6 PVCs in a row was considered V-tach or that they could be a pre-cursor to v-tach. Looks like it's time for some self study on EKG strip findings! I just completed a class on how to read the EKG monitors but unfortunately they did not teach us why a pt. might be having a certain rhythm or the implications of that rhythm ( this bothered me because I'm the type of person that needs to know they "why" of everything in order to learn and understand. Needless to say, I was very disappointed with the class.) As for those of you who just look at the monitor. Well, I'm not that proficient in EKG interpretation and we only have one monitor on our 50 bed unit. It's at the nurses' station which is not where we nurses are. We have little satellite "report" rooms on each hall that we do our charting in and this allows us to keep a close eye/ear on our patients. I feel it would be an inefficient use of my time to run up to the nurses' station and spend perhaps five minutes trying to interpret the EKG. : / I don't know, this is all so overwhelming and we deal with such a wide variety of patients who often come in with several issues. The pt. that I kept receiving calls about the other night had, had PVCs before and he had come in with a CVA and HTN and to be honest with you I was more concerned with his deteriorating mental status and new onset of left sided paralysis. I figured stroke had progressed and got orders for another CT scan of the brain. BP was in acceptable parameters. I feel like I don't know anything or know at all what I'm doing. God have mercy on my patients. Let me shut up before this turns into another overwhelmed new grad post. Thanks again for all the replies, please keep them coming. I'm learning a lot!

[mightymitern]

wow, I am just amazed that many of you have had Tele Techs. I have never heard of this. We monitor our own tele's9 sometimes 5-6 at a time), but we have alarms that go off when something is askew. I am imagining the tech is only doing what their job entails. Good for you for calling them back to let them know your Pt is ok. A six beat run may/may not be something underlying. Are you supposed to chart each time they call? Anyway, just curious how the whole Tech thing works.

[jorjaRN]

It's funny that we're talking about the 6 PVCs in a row, because there has been some discussion on my floor recently about whether it's 3 in a row or 5 in a row that contitutes a run of V-tach. Not to highjack the thread, but what is everyone's opionion on that?

On my floor, we have monitors at the nurse's station, and on each hallway, which are the same as the ones the monitor techs are watching, so we can go and look at whatever rythym the tech is calling about. They also give report to each other at shift change, passing along what each patients' "normals" have been, and what the nurses have been concerned/wanted to know about. I usually check with my monitor tech to make sure that our parameters match up at the beginning of the shift.

Out procedure for any abnormalities is that the monitor tech calls the desk, and lets the charge nurse know if there has been a significant event or change. Usually the charge nurse goes to check the patient, or lets the patients' nurse know if it's not an overly concerning change (such as bradying down from the 70s to the 50s). If it is an event such as a run of PVCs/V-tach, a pause, conversion to a-fib, etc, They print a strip of the event and send it to the nurses station. We then look it over, measure it, and decide if the doctor needs to be notified. All of these strips, as well as the daily "sample" strips of the patients' normal rythym are kept in the patient's chart, so comparisons can be made.

[juliaann]

I was a monitor tech on a busy general cardiac floor (mostly 24 hour chest pain obs and CABGs 3-5 days post op, post op pacer placements, that sort of thing).

What I can tell you is that we had a big poster on our wall above our monitor banks that said "When to Notify Nurse" and had specific criteria, and we were obligated to call when a patient did any of the things on the list, print the strip, and write a date and time and name of nurse notification on the strip - at the end of our shift the strips went in the patient's chart. We don't get to make judgment calls on what is significant for what patient - that is the nurse's job. We just provide information.

So, while I often felt like I was bothering the nurses with frequent pages and calls (and some of them told me so in less than professional manners ), I was just doing my job.

I can't answer your questions from a nursing point of view since I'm not one. I'm sure knowing what to do when will come with experience, though.

And just a PSA: be kind to your monitor techs :)

[RaziRN]

Our techs also print the strip out, put it in the chart and write on it that nurse so and so was notified. I always try to be nice to the tele techs because I sure as heck couldn't do their job nor would I want to! Though I know they can hear the strain in my voice sometimes. There's one particularly good tech that's empathetic especially when she knows that I have seven on tele and one pt. is going bad and if one more thing is added to my stressful load that I just might cry! (which has happened : /). Anyway, she's great! Thanks for the good advice and kind words. I guess this is just another one of those experience things because right now I don't feel like I have enough knowledge base to make a judgment call so I'll have to err on the side of pt. safety.

[CaLLaCoDe, BSN, RN]

First law after getting a call, check the patient. ;-)

A lot of times I will look at the tele strips from several days back to see if their is a trend. Sometimes the patient has a string of PVCs nightly, so not really a worry. But of course you are on guard for the next possible Vtach scenario.

It's when it's a new abnormal that has not been seen before, that's when I'm on the phone to the cardiologist.