Central monitoring - convince me that this is a good thing!

purplegoose · Dec 28, 2005

Personally, I could not imagine working in a hospital that did not have central monitoring. Without central monitoring it seems that it would be very difficult to leave the patients beside for even a very brief time, being that if you were even gone for 3-4 minutes your baby could have a prolonged decel and no one would have any idea it was taking place.

Central monitoring really works great when there is good teamwork on your unit. If you are in your room, or elsewhere, it provides a way for your co-workers to know that you (and your pt) may be in need of some assistance. Our central monitors "alarm" to settings we program and start beeping when we have a decel greater than 1 min, baby is tachy, off monitor, etc. I still try to spend a large amount of my time giving hands on pt care. I don't think central monitoring takes away from my patiets but provides them with a higher quality of care.

Kate

SmilingBluEyes · Dec 28, 2005

It IS a very good thing, if used properly. If you have multiple laboring or NST patients who need monitoring, it helps enormously. But being lazy and letting the monitors do the work for you----bad thing. (and many do this).

It can foster a false sense of security in some---and some become too reliant on them to warn when something is wrong. THIS OFTEN FAILS.

Example: I had a patient come in to rule out labor, no troubling history or report other than contractions for several hours------routine enough start, you would think. It OF COURSE, was at change of shift, on a VERY busy shift, when there were multiple things going on, babies on low sugars, another woman pushing and tearing horribly and a fresh csection being recovered. This lady could not have come at a worse time, staffing wise.

Well, NO warning bell went off, yet I happened to glance up at the monitor screen and see the baby looked "a little flat" (there were 2 others on monitors---so it was hard to see the true pattern going on). Anyhow, I felt I should check it out, went into the room, pulled out the strip and had a look----- and not only was baby flat as hell, but there were subtle late decels occuring with EVERY contraction and baseline was rising rapidly from 140 to 160. The lates never dipped more than 5-10 below baseline. THIS IS THE WORST KIND OF PATTERN and one the system did not have built in it to warn us, nor was it easily seen on the screen cause it was so small a picture. The system saw this as "normal" based on the numbers, alone. What presented as a routine labor ruleout turned into a stat csection. (baby, which was bathed in thick, particulate meconium and whose pH had started to drop, was ok after a few days in our SCN.)

The moral of story is, nothing replaces a vigilant and attentive, well-trained nurse/health care provider on the job.[/] Central monitoring is wonderful, when used right----but you still need trained and attentive eyes looking at things and seeing the WHOLE picture, the whole patient, from head to toe, or it does not mean a hill of beans. It's just a tool in our toolbox, period. Not a babysitter.

SmilingBluEyes · Dec 28, 2005

Also, monitors are being used for people who maybe do not need so much monitoring. If a person is laboring naturally and has no risk factors, there is no need to keep her on a monitor. Again, it's a tool only-----in the wrong hands, it's not always such a great tool.

SmilingBluEyes · Dec 28, 2005

You are also right; central monitoring CAN decrease face-to-face interaction w/mom and nurse, in some cases. Unfortunately, for me, the thing I think does this the most is NOT central monitoring, but very high epidural rates. I have noticed women who have epidurals early in labor dont' want or need their nurses nearly as much as those going naturally, which makes sense. It does seem to take some of the heart out of labor and delivery when a person is too numb to feel anything---I will take a natural labor over early and inappropriate epidural use anyday. Like I said, central monitoring is a great tool, one of many in our toolbox. It should never replace meaningful interaction and assessment by the labor nurse.

babynurse2001 · Dec 28, 2005

I also work in a very small rural LDRP. We went to central monitoring about 5 years ago. We also were concerned that it would decrease the time we spent in the room with moms, really it hasn't happened that way at all. Like SBE said, it is just a tool, and if we use it appropriately it can be very helpful. Now, after 5 years, I can't imagine going back. I LOVE being able to see what's going on in multiple rooms, and I sure don't feel like our hands-on philosophy of care has changed one bit. We don't do epidurals so we are all very hands on... Remember just because you have new technology doesn't mean you have to change the way you nurse.

midwife2b · Dec 28, 2005

Central monitoring also has a big benefit for your medical records department. All strips can be archived on a disc, eliminating the need to save thousands of strips in big boxes that take up a huge amount of space. Even if you work in a small facility archiving can save a lot of time and money.

It can be difficult to locate a strip when a chart has been requested for review. Tracings can (and have) "walked off", making any kind of defense nearly impossible. Archiving capabilites eliminate this as well; you can pull up the strip and copy it if needed. Our hospital wanted to do away with paper in the monitors altogether but we protested (we write on them, then transfer the info to the archived strip and/or the chart).

The ENTIRE second floor of my office (over 4,000 sq ft) is crammed full of boxes of monitor strips. They have to be kept for at least 18 years. In 2020 the last boxes will be thrown out as discs replace those papers. Over 10,000 hours of monitoring can be kept on just one disc.

I personally pay more attention to the paper coming out of the monitor than the actual system itself. We have a lot of false alarms, but when the alarm sounds, somebody goes to the room to see about the patient!