Centralized Telemetry

First thing I'd wanna know is, what type of training/education does your monitoring techs have?

Yes, we have centralized telemetry but we also have slave monitors where we can see pts in real time. And some of our rooms have monitors at the bedside. We get called a lot, especially by the newer techs. I try to give them some parameters-like call me if a rate stays above 110 for greater than a minute, or whatever. Otherwise I am constantly getting called for what I call "pee tach". And if I remember, I try to let them know before I disconnect wires, or ambulate a pt.

Our techs mount strips at least every 4 hours, plus an example of each kind of alarm. But if they are missing Vtach, sounds like some education is in order.

We are always having the same problem. The website sounds nice, we havent gone that far. we get called all the time for "off the monitor" or all the time when we have called the techs already telling them they are off the floor, etc. I once got the same call 3 times about a pt who was in CT, same tech after i called her as the pt was being wheeled out the room. its not safe and very frustrating. we brought the issue up several times and get nowhere. I absolutely hate the fact that our techs are not on the floor with us

We swithed to central monitoring about a year ago. It has taken some getting used to, and there have been some growing pains. However, our monitors are in real time. I like the central monitoring, but only use it as a back up. I've found that working with them (rather than against them) has paid off. I try and call them before I take my pts off monitor. If I'm starting someone on a gtt I give them a call and let them know what I'm up to and what the parameters are that I'm looking for.

Hopefully it will get better as time goes on. It did for us.

Back when I worked cardiac at the hospital, we made the switch to centralized telemetry. I did not like it! Various reasons. For one, you can't see the techs - are they goofing off or doing their job? The centralized tele room (that was on a different floor) did have a little window in the door so someone could look in and see what the tech's were doing. Guess what the techs did? They covered it with paper so no one could look in!! This was nipped in the bud pretty quickly though and they were told that they could not cover the window.

And you don't know WHO the techs are. When the techs were on the unit, you knew who your tech was. This was helpful. For example...Sometimes I'd come on and see "Susie" and I knew Susie was a very reliable, on-top-of-things tech that I could trust. Other times I'd come in and see "Erika" and knowing she was less-than-reliable and prone to nod off (nights), I knew I'd need to more frequently check my own monitors throughout the shift. With the central monitoring I had no idea who the techs were and this made me very nervous!!

A team spirit was also lost. If "team spirit" is the right phrase. With the tech on the unit with us, we were a cohesive unit. The tech knew what was going on on the unit because she was right there with us. If there was a irregular or lethal heart rhythm, we were all there together. But with centralized tele, more of a "us" vs "them" attitude sometimes developed. The blame game would occur. Etc.

Oh- with the switch to centralized tele, we also had a big increase in pts being accidentally left off the monitor for hours. Well, the monitor was physically on them, but the monitoring was not turned "on". With the tech on the unit with us, this rarely happened. The tech was right there and could see the pts come and go and knew what was happening. Not so with central tele. I worked nights (7p-7a) and soon learned with the central tele that one of the first things I HAD to do was make sure all my pts monitors were really "on". Fairly frequently, I'd find a patient that had come back from a procedure at 2pm, and here it was 7:30pm and the monitoring had never been turned back "on"!! Scary!! True- this was more the nurses fault for not calling the tele room. But the tele room also should have wondered why the pt was off for so long and made a call to check. That never happened.

So, those are my from a few years back....

They're about to start that with us, and we're all saying we're just going to hang out in the tele room for charting and getting our tele strips -- an empty nurse's station is going to be SOOOO reassuring to the patients.....

That way, day shift can come in and have plenty of room to put their coffee down....(only reason we can think of for the move...)

Our tele monitoring is "somewhat" centralized.

There is a tele tech who sits at a station and watches all the monitors. This station is in the stepdown nurses station, which is near the ICU nurses station. So there are ICU and stepdown nurses around, and the ICU charge nurse has to sign off on all the strips and any major or repetitive alarms.

We also have monitors in our nurses station (the medical floor) and there are monitors in every ICU room, and in every physician's dictation room.

We used to only have monitors at the ICU nurses station, and the tele tech sat there. We wanted to be able to see what was going on; but frankly, the tele techs we have are for the most part very, very good. They can identify it much better than *I* can. But it is nice to be able to see the strip yourself.

I guess I don't know another system. I don't know how it would work with tele pts spread throughout the hospital to NOT have centralized tele. What if you are busy taking a pt to the BSC, and no one is at the nurses station, and one of your pts went into vtach? Who is watching to know? I like having the tech's eyes watching at all times.