ICU nurses assisting in monitoring Med/Surg Telemetry Rhythms

[sara525]

The Hospital I work at has decided since there is no monitor tech that the ICU nurses should also have eyes on the Telemetry pt. rhythms on their med/surg floor. the monitor is sitting at the desk with the nurses, but when the nurses enter a pt. room we are no longer able to monitor the pt.

On the med/surg floor the monitors are sitting at the desk with the unit secretary. There is no nurse at desk at all times.

the med/surg nurses are not required to have acls certification before monitoring the pt. They are anly asked to measure a strip once a shift and read it. when a pt. gets placed on telemetry they are not notifing the RN in ICU, we find them on our own through checking system for new pt. the rhtyhm does not automatically appear.

I am wanting to adjust our telemetry monitoring: Adult pt. policy. I have never written or edited a policy. Suggestions or assistance would be great.

[psu_213, BSN, RN]

There is a whole bunch of issues with ICU nurses charged to watch the rhythms in addition to caring for their own pts.

In my mind, every nurse that cares for a pt on telemetry should be telemetry certified--i.e. competent in identifying basic arrhythmias and knowing what the next step is, even if the next step is to call a code or RRT.

One situation I encountered: at my old job there were telemetry tech for the entire house. When I start their, some floors were telemetry capable, some were not. As part of an expansion, they also made all beds telemetry capable, but they did so without proper training of the nurses on those floors--the telemetry techs would still monitor the rhythms (I don't think there was even a telemetry monitor on some of the units ). One of the techs called up to one of these 'new' telemetry floors one night and told the nurse "You patient in room 12 just converted into fib." 5 minutes later he got the call "is that A fib or V fib." Needless to say, a bit of very basic arrhythmia training would have been helpful.

The telemetry techs were excellent, but they did have their limitations. A patient went into a fast, fairly wide rhythm in the middle of the night (this was on one of the 'tradition' telemetry floors that were better equipped to handle such a situation). RRT was called. I went into the telemetry room to ask what was happening on this floor. They told me about the rhythm and one the tech said "yeah, they must have pulled him off the monitor, we can't see what is happening. They are supposed to leave them on the monitor through the entire code." (No idea if or why such a policy existed.) I said, "well they may have taken him off the monitor to do a 12 lead." The tech, who was very good at what he did next said "there is nothing you can see on a 12 lead that you cannot see on this monitor. They would know it's a wide complex tachycardia, the can treat it based on that." At this point, it was not worthing getting into a conversation with him about just how wrong this was. Oh well, pt ended up being fine.

[Biffbradford]

That's a disaster waiting to happen. Hopefully it will only take one horrible event to rectify that problem.

[Bec7074]

This sounds awful for pts and nurses. Part of your assessment is assessing the rhythm. The ICU nurses are not caring for these patients and can't quite possibly know or have the time to see if something like frequent PVCs are normal or abnormal for the pt. You need monitor techs!!! Just curious...is this the way it's done around the clock or only at night??

[dah doh, BSN, RN]

That is such a bad idea! Our tele floors have pagers or iPhones attached to our monitoring systems that the tele nurses hold. When the tele system went down, we sent ICU nurses to float to tele floors to act as monitor techs.