Do you chart on your tele patients

[racing-mom4, BSN, RN]

Here is a dilema I recently encountered. I am watching the Med Surg teles and I see a patients heart rate continue to rise, approaching 160 during ambulation and 130-140 at rest. I call the patients nurse and inform her of this, she reports to me she is fine. I continue to watch it rise and I pull up the patients med list, nothing for heart rate but does have Ativan PRN. I call the nurse again and report the ever raising heart rate and suggest she either give the Ativan as well as call the Dr for an order. She wont give Ativan as it "makes the pt crazy" and wont call the Dr cause "patient is sched to go home today"

I called and went out to the floor 3x about this heart rate, patient has been in the 78-80 range entire stay. We have computer charting and it was all I could do not to log and and chart that I informed the nurse of the heart rate...but knowing the nurse was NOT going to do anything I figured that was only setting that nurse up for trouble if something happened.

We do have tele charting where we document heart rates and rythem changes every hour and I did complete that, but I still feel like I should have documented somewhere that I did make suggestions. But was that something I should have charted in patients perm record?

[mpccrn, BSN, RN]

our tele tech's run a strip and document on the strip that nancy nurse was aware. then it's up to the nurse to explain her actions or lack of them. the strips go into the patient's chart upon discharge so it's part of the medical record for all to see

[racing-mom4, BSN, RN]

I did print off a report with calibrations and did time it, sign it and place it in the chart. So I guess that is all I can do, I just found my self frustrated wanting the other nurse to do something.

[Tweety, BSN, RN]

I did print off a report with calibrations and did time it, sign it and place it in the chart. So I guess that is all I can do, I just found my self frustrated wanting the other nurse to do something.

It's frustrating not knowing what's going on on the other side. I would just keep doing what you're doing. Maybe write on the strip "Nancy Nurse, RN notified" and leave it at that, or if you're seriously concerned about the patient, the use the chain of command and let your nurse manager, or someone of authority know. Be persistent if it's an unsafe situation.

I don't always call the doc if I know the problem. Sometimes people are indeed tachy when up. I usually notify the doctor if I think maybe they need their blood checked or a fluid bolus. But sometimes my trauma patients who've been in bed for 4 days and are just getting up for the first are indeed going to have some tachycardia as their body adjusts. Sometimes after a day or two this equalizes and they are o.k. But it's docuemented in the PT notes and I tell the doc on rounds.

We have remote telemetry on my unit as well. Every now and then their manager calls me, "how come you're not doing ANYTHING about this patient". I can just hear the conversation between the monitor tech and her "I've called the nurse four times....blah blah blah...and they aren't doing ANYTHING (or enough)". My response was "I presume you've been down to read the chart, talk to the nurse, and assess the patient?" Answer "um no I haven't, but their rhythm strip says...........". Me: "Thanks for giving me that piece of information, if you'd like presume we're not treating the patient, that's your perogative, but if you'd like to come down and read the chart and talk about the patient, we can also do that and you can give me your recommendations." This particular patient had a cardiac consult.

Keep up the good work. It's obviously you know they are not just rhythm strips but human beings there.

[HouTx, BSN, MSN, EdD]

Racing,

Listen to your gut instinct. As an ICU nurse, you are held to a higher standard of responsibility based on your deeper knowledge of cardiac physiology. If you fail to to 'push' and make sure that the physician is notified, it will certainly increase the hospital's (& your) liability exposure.

In the short term, I would imagine that the tele nurse may not have felt comfortable talking to the physician about an issue that she did not fully understand. You should have offered to call the physician yourself to relay pertinent information. Long term, I would encourage you to approach this issue systemically - by establishing a protocol to handle these situations in the future. It should clearly outline the responsibilities of the ICU nurse and the tele nurse.

After all, I am sure you agree that the safety of the patient is much more important than interpersonal issues among the staff.

[Tweety, BSN, RN]

Gee, I didn't notice you were in ICU RN. Odd you would be watching monitors, but I guess things are done differently in different places.

[racing-mom4, BSN, RN]

Gee, I didn't notice you were in ICU RN. Odd you would be watching monitors, but I guess things are done differently in different places.

In our facility that is part of ICUs job to watch the tele monitors on the Med Surg floor. Thanks for all the input, I did go out to the floor and asses the pt myself (she had just left our unit a few days prior) in hind site I should have called the Dr myself vs asking the MS nurse if she was going to.

I think by my asking her that it put on her the defensive.

[Virgo_RN, BSN, RN]

What about drawing the rate to the charge nurse's attention? It's not like "tattling" or anything. The charge on a tele unit should be aware of what's going on with the patients, and since they receive charge nurse report, they may know something about the patient situation that could help determine if any intervention is needed. Just based upon what you've posted, the MD indeed should have been notified. I'm wondering if the nurse was expecting the MD to round on the patient at any time, since the pt. was to discharge that day, and since the pt. appeared to be tolerating the rate, thought it would be better to bring it to the physician's attention at that time, rather than making a separate call?