Mixed Med/Surg unit with tele not being watched - page 2
I work at a state hospital at the only acute ward. On this ward we also have telemetry pts. On average # of pts range from 3-7, with maybe on or two of those pts. on tele. Most of the tele pts are... Read More
Jan 24, '07Occupation: Telemetry tech Specialty: 20 year(s) of experience in cna/unitclerk/telemetry tech ; Joined: Jan '07; Posts: 3Could anyone tell me what the legal ratio limit is for a telemetry tech in Florida. I've searched osha site and jacho sites to no avail. Right now I'm monitoring 70 pts running strips, recording for all of them. I really feel unsafe doing this. iIs just to many pts to be responsible for. Thanks
Jan 24, '07Joined: Jul '05; Posts: 66; Likes: 13I'd have to ask if there are monitors mounted in the hallways. I worked a 12 bed step down where you never had to leave the room, you head the 3 * alarm and stuck your head out the door immediately. The monitors were bi-positioned to face each direction two for each of the two hallways. Then I knew if I had to take off the gloves, sanitize and move on or not. It did take a bit to be comfortable with this but the 3* alarms could ALWAYS be heard and when you stuck your head out, the other nurse down the hall was looking as well, so in essence, CONTINUED MONITORING was in place.
The legal liability was for the one or two star non emergent beep, which was the same beep as a patient OFF MONITOR. This did become an issue once in the worst situation as you can imagine.... off monitor... soft non emergent beep and... yep ASYSTOLE!
So only YOU can decide where your comfort level is, personally I was comfortable on the stepdown because I was attuned and obsessed with the alarm sounds and checking... problem is I floated and stayed in tuned, when you do this day in and out, it seems natural to tune out the non emergent alarms, thinking sudden asystole is impossible... but it only takes once. Nationwide, the prevalence seems to be monitor=monitoring. In the court of law... you have a 50-50 shot..... Also know I had only 4 patients there and would stop and look at other alarms and interrupt care..... being a float I was never in charge.... that might have changed my outlook.
Either way, I can justify to you how under the circumstances it can be done under the BEST safe way, is it optimal or ultimately safe..... NOPE.
One lawyer asking; "did you feel safe with the current monitoring system? Did you voice concerns? Are you aware that other facilities have a tech who watches the monitors solely? Did you let the charge Rn know of your concerns?"..... basically hanging you out to dry for a facility that won't pay minimum wage to train an employee to sit there and protect your patients.... it would be UGLY.
I could sell you either way with this, depending upon how your monitors are set up and your comfort level. It's not ideal by any circumstances, but we work like this.... try speaking to management and researching nationwide monitoring tele style monitoring to solidify your gripe and bring in the documents to support you.
Jan 25, '07Occupation: RN Specialty: Neuro ICU, Neuro/Trauma stepdown ; Joined: Oct '05; Posts: 525; Likes: 54we carry pagers and i though all telemetry systems worked this way...is that not the case?
our shows us abnormal hr, bps, sao2 and will show the rhythm on the screen for our assigned pts. if its critical it goes across everyones pagers.
Jan 25, '07Occupation: Med Surg/Telemetry Specialty: Telemetry/Med Surg ; Joined: Jan '03; Posts: 8,773; Likes: 1,503work on a step-down telemetry unit and all our patients are on monitors which are hooked up to two computers at the nurses station. We check the monitors, print out strips, etc. ourselves but the monitors are constantly being manned by the charge nurse who stays behind the desk.
Jan 25, '07Occupation: Telemetry tech Specialty: 20 year(s) of experience in cna/unitclerk/telemetry tech ; Joined: Jan '07; Posts: 3Of the 70 pts I watch only 16 of those have additional screens at the nurses station in a 16 bed pcu unit. Which I know for sure is not even monitored in that department. So I have sole responsibility for 70 pts. I'm trying to find out what the laws are concerning this so I can bring it to administration. Without proof of laws they will say like it or leave it.
Jan 26, '07Joined: Jan '07; Posts: 17Quote from NewEastCoastRNYou're lucky. Not a night goes by where I don't see Vtachs and some kind of blockages. I've had 2-3 tele patients die on my shift the past 1.5 years (Even had one go into PEA).I work on a telemetry unit where I can have up to 5 patients at a time, all on monitors. We do not have anyone watching the monitors, we just check them when the alarm goes off. Never been a problem.
Jan 26, '07Joined: Feb '06; Posts: 229; Likes: 55I'll bet those patients are paying more than a non tele patient and they deserve to be monitored. I worked on a tele unit with 38 beds for 3 years. There was a monitor clerk and the monitors were NEVER unattended. Patients deserve to be monitored continuously when on tele. That is what they are there for. The hospital I work now, the tele patients are monitored on a different unit and this unit calls med surg if the alarm goes off. Quite the system. But that does not surprise me with some of the things that are going on in hospitals these days.
Jan 27, '07Occupation: Interventional Cardiac Cath. Lab Specialty: rehab-med/surg-ICU-ER-cath lab ; From: US ; Joined: Mar '06; Posts: 113; Likes: 48Years before tight UR, I worked in ICU and many times the MD's would keep patients a few extra days in ICU just to avoid sending their patients to the step-down unit that monitored it's patients just as you described. The following is a situation that I witnessed. Patient is a tele. patient c/o being sweaty, dizzy and weak. Assigned nurse checks tele. rhythm, calls for a 12 lead EKG without examining the patient or taking the BP. Then she calls the MD charge of ICU to review the EKG left all on its lonesome, tossed on the nursing station counter. Ah, yes an entire EKG of controlled VT! I was sitting at the ICU station, taking an ER patient report, when our pneumatic doors pop open and in flys said patient pushed in at quite the amazing speed by our ICU MD. He's screaming HELP! HELP! CARDIOVERT!!!CARDIOVERT!!! NOW, NOW NOW!!!! I grabbed the defibrillator, the crash cart, 10mg of IV Valium and sprinted after him. As I set up he gave sedation (Bad move he gives all IV push meds at the same rate - ASAP - so I am now bagging the patient and ready to _itch at him for the apnea when he tells me "the story". Well, we converted on the first try and all turned out well. But this was our step down unit's patient, were our patients graduated to, and this stuff made us sad and embarrassed. They needed the correct nursing and monitoring staffing and constant in-service to truly function. What it costs in settlements from situations like this and worse - a beloved patient found dead for more than an hour, on tele. because he liked to take his leads off for 5 minutes when he brushed his teeth - Why take the leads off? So the staff wouldn't call down to check on him each time he was brushing his teeth. (brushing teeth can appear like seizure activity on the monitor.) But 5 minutes turned into an hour due to human error. Firmly handled education for this patient could have prevented this nightmare. I give you so much of credit for working so hard to try make this situation work but be careful of protecting yourself! You sound too good to take the chances you are forced to make. Best of luck! :spin:Last edit by harley007 on Jan 27, '07
Jan 27, '07Occupation: RN Joined: May '06; Posts: 278; Likes: 41I wouldn't want to work there - sounds like your administration is poorly run, and you and your license could suffer for their errors.
We had a tele tech watch our monitors, but it didn't mean we were properly alerted to problems. We would have pts run Vtach, O2 sats in the 50s, and no calls. But then one lead would fall off a pt and they'd be calling constantly, harrassing the nurse. A bit backwards.
After facing issues similiar like these, I will never work on a unit with a pt ratio higher than 2:1. Even if they're more acutely ill, I still like having constant monitoring and the time to monitor them myself. I hated walking into a room and getting a surprise.
Sure, -realistically, it's not possible to have 2:1 ratios for every pt in the hospital. But I can still chose to not work on those units.
Jan 27, '07Joined: Feb '04; Posts: 1,715; Likes: 542We have 2 techs...one on tele & another in ICU. The ICU monitors show all tele pts...so they are always monitored.
Jan 27, '07Joined: Feb '06; Posts: 229; Likes: 55I feel that if a patient is on tele, they should not be allowed to come off the tele for showers, teethbrushing, etc unless a doctors order specifies this. It really sets the nurse up if something does go wrong. If the patient does take the tele off, the nurse would be auto alerted so there is really no excuse for a patient, on tele to have died an hour earlier. That is inexcusable. I also feel that if a hospital is going to charge a higher rate for a telemetry bed, that hospital should have a monitoring clerk, who is highly trained in reading monitors (and many are) sitting at that monitor 24/7. It is a disservice to any patient if this is not happening. Shame on our hospitals for taking advantage of a patient this way.