First, the question: do you rely on the computer interpretation printed on the twelve lead or do you do your own interpretation?
Now the rant:
A couple of evenings ago, as charge nurse on our cardiac floor I get a request for an asap transfer from the medical tele floor. Apparently the patient had developed a serious arrhythmia just as they were transferred from ED, admitted with weakness, or near syncope, or some such thing. Ok fine, we have staff and housekeeping is just finishing a room so we take her in a few minutes or so. I look her up on the EMR, history, labs and her 12 lead done in ED. The 12 lead interpretation is benign but wrong. The same arrhythmia that is transferring the patient to our unit is clearly visible. According to the EMR, the ED RN, the ED MD, and the admitting provider all felt she had the benign rhythm described on the 12 lead. The tele tech was the first person who correctly identified the patient's rhythm, later confirmed by a cardiologist.
Wow, just wow. I know its been crazy busy, but how the heck did all 3 miss this? This thing was textbook perfect, right out of Dubin's, right off the ACLS test.
I read all of my EKGs; the computer is normally decent but I disagree once a week at least. Even more important is I always look in comparison to one on file (if available) and the computer can't do this.
A few weeks back I had to call a patient urgently because the computer read sinus brady and it was clearly a Mobitz II. The MA had looked at the EKG assumed it was correct and sent the pt home.
HIPAA does not have to apply for something to be a privacy violation either/or/and state or facility. If the OP has ever posted something to identify where he or she works that narrows it down.. The forums are also not that anonymous since the IP is know as well email identifiers. If you post something that a co-worker might pick up on, you could expect to be questioned about it. As some say....small world.
Narrowing it down to a specific rhythm narrows it down to a few hundred thousand patients, not anywhere near what any facility specific policy prohibits.
Discussing a specific incident which could be identified by a co-worker or someone who knows your workplace and they know people to ask "out of curiosity" can place this in the same category as facebook. Identities are very easily found by IP addresses which can be shared. This is also why posting of email addresses are discouraged. It really does not take that much effort to find out who is posting these days just as much of your info is available to be used by others. There are no guarantees to privacy on these forums.
Discussing a specific incident which could be identified by a co-worker or someone who knows your workplace and they know people to ask "out of curiosity" can place this in the same category as facebook. Identities are very easily found by IP addresses which can be shared. This is also why posting of email addresses are discouraged. It really does not take that much effort to find out who is posting these days just as much of your info is available to be used by others. There are no guarantees to privacy on these forums.
Thank you Trauma! This is exactly my reason for not wanting to go into further detail.
I work in a cath lab. Frequently our machine says incorrect things - it's a machine, and its parameters can be wrong and miss things. Just last week it said it was atrial fibrillation, and it was actually, clearly, atrial flutter.
The differences can be minute, and one patient can vary from another... always get it checked.
During my training I had a patient that came in, fit as a horse, who had a pulse of 42-45, so his pulse was naturally low. When I had him back in recovery, his pulse rate hadn't changed but I missed during my care post-pulmonary vein isolation that his P wave had suddenly disappeared and was in heart block. Lucky it was temporary, but it scared the crap out of me.
BostonFNP, APRN
2 Articles; 5,584 Posts
I read all of my EKGs; the computer is normally decent but I disagree once a week at least. Even more important is I always look in comparison to one on file (if available) and the computer can't do this.
A few weeks back I had to call a patient urgently because the computer read sinus brady and it was clearly a Mobitz II. The MA had looked at the EKG assumed it was correct and sent the pt home.