Medical Telemetry Units

[icunurse1955]

I need all the help that I can get! I am an ICU/telemetry director in a small rural hospital. We have a combined ICU/tele. unit and are considering moving our telemetry patients to the medical floor with remote telemetry monitoring. I have concerns about doing this. I think that our ICU (where the patients will be monitored) is too far away from the medical floor. I don't think our medical floor nurses have the critical thinking skills that is needed for many of our telemetry admissions.

For those of you who have monitored patients on medical floors, what guidelines, policies & procedures, etc. do you have in place. I am starting from scratch here so any thing that you can help me with would be greatly appreciated.

Thank you

[Tweety, BSN, RN]

When you say "medical telemetry" are you talking medical patients? Or are you talking cardiac patients? There's a difference. Medical floor nurses should not have cardiac patients in their mix, such as post-MI's, chest pain, etc. However a medical patient such as a GIB or Pneumonia, COPD, post-op surgical patient, that needs cardiac monitoring, surely they have the critical thinking skills necessary to care for these patients.

So if you truly mean "medical" telemetry and not "cardiac" telemetry then I don't see a problem. Don't underestimate the critical thinking skills of a floor nurse. They of course would need training in reading telemetry. They probably aren't thrilled with the idea either and are going to act like they can't handle it, or don't want the responsibility, but that could be a paradigm shift they can overcome.

Sorry, but I'm not familiar with the policies and procedures and guidelines you are asking for, just a few two cents.

[TazziRN, RN]

We are a rural place with 4 ICU beds, so our tele pts go to medsurg with remote tele. All of our staff are ACLS and know basic rhythm reading.

[DeepFriedRN]

The floor I work on is one like you're describing, with the pt population being mostly pts. who require cardiac monitoring (we also occasionally have regular med-surg pts). This can be both "cardiac" tele pts. with MI's, CP etc, and "medical" tele pts. who are admitted for pneumonia, COPD, CVA etc who need tele monitoring (generally because of a cardiac history). On our floor a tele pt is a tele pt. is a tele pt., I figure most likely because to try and sort out/differentiate cardiac vs medical need could, considering the histories/multiple system issues of some of our pts, be a nightmare. As such every nurse on our floor has to be trained in basic dysrhythmias and be ACLS certified. I'm not sure how else the hospital could cover themselves. I think most floor nurses would be up to the task if they were given the correct training. We have a monitor tech who watches all the monitors and lets us know if something is up, but ultimately it's on us to decide what we think a particular rhythm is and what to do about it.

[Celia M, ASN, RN]

WE have a med/surg/tele floor with the capabilities for 12 tele patients. The staff on the floor monitor and read the strips for all their tele patients. To be assigned tele patients you must have completed an arrhythmia class and have ACLS. The floor nurses have excellent critical thinking skills and know how to react in critical situations. The ICU staff are there as a resource for the difficult strips, but are rarely needed as the nurses on the floor are very knowledgable.