Telemetry Monitoring

[DLovesNursing]

I work on a Cardiovascular Step-Down Unit; the patient population is mostly First day post op open heart, along with Stent/MI and other telemetry patients. We recently had new monitors installed on the unit. The old monitors had the capability to view the patient's rhythm at bedside and at a central monitor while on the telemetry box. The new system does not allow us to view the patent's rhythm on the bedside monitor while on the telemetry box, only while directly plugged into the bedside monitor. This is very frustrating to us because we are unable to assess and treat patient's rhythms' at the bedside without losing critical seconds to minutes of time to change the type of monitoring they are on. Our company is trying to tell us it is "outdated technology" to have constant telemetry at the bedside along with the central station. I am wondering if this is true or if the company purchased this system and do not want to admit they made a major mistake. Our unit also does not have monitors techs constantly watching the rhythms' at the station, so it critical we are able to assess this immediately.

[Esme12, ASN, BSN, RN]

I believe oops is in order....

[cb_rn]

I worked at a large hospital with a big open heart program that was like this. We had a view of the central monitoring screen in every room up toward the ceiling that you could look up at and view everyone's rhythm. It was darn inconvenient but you got used to looking for your patients' boxes while you were in the room with others and recognizing the blue alert highlights when something funky was going on. If you don't have a view of the central screens in each room, I'd start campaigning with management to either install them or hire a monitor tech.

[FancypantsRN]

It makes me wonder what the CV surgeons think about this - the CV step-down I worked on, I think they would have had a fit if they could not see the pt's rhythm when they were in the rooms rounding.

Also, having worked on both type units (with and without tele monitor physically in the room) - it does make it more difficult to treat with IV push w/out the monitor right there. Having to rely on the monitor tech to call me if the HR slows to much, etc.. Would make it much worse if there was no one to call you - there should be a devoted monitor tech at all times (in my opinion).

[classicdame, MSN, EdD]

get the surgeons to back you up - they are the ones pulling in the $

Personally, I think it is unsafe not to have monitor techs who are adequately trained.

[AgentBeast, BSN, RN]

Kind of defeats the purpose of even having a telemetry floor if you don't have a tech monitoring the screens 24/7 and/or have an easy view of the bedside monitor. Otherwise, why not just make rounds with a ECG machine?

[MunoRN, RN]

If the central monitoring can see a patient either on the wireless box or hardwired, I'm not sure why the room monitors would be able to as well, I think your rep is full of it, or they royally screwed up.

All our ICU rooms have in room monitors, but only some of our tele floor rooms have in room monitoring which is for the open hearts. We don't transfer an open heart to tele if one of those rooms aren't available, which is because checking and adjusting the sensing and capture on an external pacer is really difficult without the in room monitoring. Plus, when stuff goes bad...

[Jason Bourge]

The whole issue of monitoring alarms at the bedside, central station or a "war room" manned by techs staring at screens is a difficult one. Fortunately technology is improving. Check out one such solution from mVisum (http://www.mvisum.com/mvisumalert.php) which allows alarm details, waveforms and even a live stream of the monitor to be viewed remotely on mobile devices like smartphones. The whole system is configurable to existing workflow. I know of a few hospitals who have moved to this system and are very happy. In fact they feel that it has improved their ability to react to critical events.