ICU///CCU monitoring Med-Surg Tele pts.(Small hospital)

[GardenDove]

I've worked at this small, critical access hospital for 6 years now. One year ago I moved to icu/ccu. The two units are right next to each other and the icu is responsible to do the strips on the medsurg tele pts, and keep an eye on the monitors. Med-surg also has monitors at their nurses station, and last year they finally required them to take classes, but they aren't very interested in the strips, we do that, we have a book for their strips on our unit.

When I was on med-surg I wasn't very tuned into the rhythms either until I finally decided to take a class, which is what got me interested in switching units. Anyways, after switching units I realized that the ICU nurses didn't know anything about these pts, why they being monitored, and we weren't reporting off anything on these pts to one another. When I tried to initiate communication with some of the med-surg nurses, I often encountered resistance. I figured it might be a turf thing, it was the younger, more insecure nurses that seemed to resist this.

So I approached my manager, who is head of both units. I said that we need an official communication tool so we in the unit can have a few facts about these pts in the tele book, like code status, dx, hx, reason for monitoring. She came up with one, and now when they come get the tele boxes we have a few basic questions we ask, it's all official not just one nosy nurse asking a bunch of questions.

So, the other night I was the lone ccu nurse and med-surg got 3 admits, all with tele orders. I asked one young nurse, so why are they being monitored? What's their code status, etc. She had no idea, so I looked in the chart on this one lady. The only 'heart' med she was on was lisinopril, there was no H&P yet, no specifics on why we were monitoring her. I don't blame the med-surg nurse, she was having a busy night, and got the orders, was taking them off and saw the tele order. But, it seems to me that if a pt is being put on tele, shouldn't we know why? What do you all think of what I've described? I'm trying to improve our communications about these pts so we can all have more information about these pts.

[withasmilelpn]

It's really great how proactive you are being, and can only be a benefit to the patient ( and really the nurses too!) I think alot of times we get too task oriented and forget to address the 'whys' that can help us keep mistakes from happening (like what if the patient had been on cardiac meds and that had been missed ...) and what to monitor the patient for, etc. Unfortunately, lack of staff contributes to this task oriented focus which I find frustrating. Nursing is a job where you really need to be able to use your brains, but often it is on the fly.

Good thinking, keep up the good work and let us know how it goes!

[snowfreeze, BSN, RN]

Part of your problem is the doctors, they also need to communicate better. If the docs (ER, PCP, direct admit) would have to state a reason for telemetry then the nurses would know better what to watch for.

[GardenDove]

Part of your problem is the doctors, they also need to communicate better. If the docs (ER, PCP, direct admit) would have to state a reason for telemetry then the nurses would know better what to watch for.

That's what I was thinking, and it's very difficult to get docs to change their ways or habits.