Not a vent. . . . tele room.

[kcalohagirl]

I posted a few months ago about the tele room informing me about non-emergent conditions and missing the emergent ones.

Two nights ago, I was standing up by the tele monitors talking to the charge nurse, and my patient rang out with an asystole alarm. This can happen when the leads fall off, so the first thing I did was look at the monitor. Then I said, "Oh, ****!!!" and ran for the patient's room. By the time I got there, the patient was out of asystole, and into a third degree block. I got a set of vitals, talked to the doc, got orders, put a set of pads on the pt in case of emergency, etc.

A few minutes later, I was in the room doing an assessment, the patient jerked, looked at me with an expression of utter panic, I felt for the carotid pulse, and there was absolutely nothing there. Called the code, got him hooked up to the Zoll, code team shows up, we code the guy twice, he's intubated before we get him off the floor, and now he is in the ICU doing pretty well.

The tele room, who is supposed to call us whenever our patients go into a "potentially lethal rhythm". . . .didn't call until after we were into the middle of the second code.

And the call wasn't to let me know the guy was in a 3rd degree block, the tech asked the nurse who answered the phone, (I was in the code) "Um. . .what's going on with the patient in room A??? I can't figure it out."

A friend of mine works on the same floor where the tele room is located, and the tech in question pointed out the third degree block to my friend, but never called down to our floor.

No harm came to the patient because another nurse and I were sitting next to the monitor and saw the event as it happened. But had I been in another patient's room and been relying on my tele techs to advise me of emergencies, the patient would be in the morgue.

I wrote the tech up, emphasizing the fact that no harm came to the patient. Later that night, the tech called me saying he hoped the episode wouldn't result in a write up. I told him I had to do the mandatory paperwork required by the code and that I had recommended additional training to be provided to the telemetry techs as to what constituted an emergency and immediate notification of the RN.

I reassured him the patient was doing okay, but that his failure to call could have been a really big deal.

Is there something that I could have done or said differently?

[casi, ASN, RN]

You handled it a lot better than I would have...

How many people are the tele techs watching rhythms on?

[kcalohagirl]

that's a really good question. I will ask. I don't want to throw out an estimate without knowing for sure.

But their monitors alarm the same as ours. And I know for a fact none of our patients were alarming at the same time as mine was. . . .

[vamedic4, EMT-P]

It sounds as if you did what you thought was necessary. Problems arise however, when telemetry rooms are located "off site" (off the floor - or worse yet...not in the same facility as the patient). That's a stupid and inherently dangerous idea.

There's no mention of how many tele patients the tech is responsible for watching, but my feeling is that it's too many. This happens in some facilities, the tech watches all patients on cardiac monitors who aren't in a critical care area - yet another bad idea.

Something to consider is that the techs have no line of sight on the patient. They can't see that you're taking him to the bathroom - making it look like VT, or that she's having a coughing fit and her rhythm looks no better than VF. Sometimes what is "assumed" (it looks like Mrs. Duncan's got another lead off) can lead to trouble.

You did the right thing, and it sounds as if you explained it to them in a way so that they understood the seriousness of the error without alienating them.

Glad to hear the patient is doing okay.

[kcalohagirl]

I just don't see how anyone in the whole wide world could have looked at the rhythm, seen a complete heart block with ventricular beats at about 40 bpm, and not thought that was something worth notifying the RN about.

I realize missing the asystole, cuz it looked just like it does if someone knocks a lead off. It was missing the 3rd degree block for oh, about, 20 minutes!!!!!!! that had my knickers in a bit of a twist.

Where some things can be attributed to interference, a 3rd degree block is pretty obvious.

[vamedic4, EMT-P]

Yeah, I'd say that's pretty serious. 20 minutes??? Ouch.

[kcalohagirl]

Honestly, as much as the time factor bothered me, it was that the tech could point out the abnormality to someone else but not be bothered to call me.

I really like the tech in question. It always sucks to write up people you like.

[Bugaloo]

We coded a patient once that was on remote tele. We never received a phone call from the nurse watching the monitors. Instead, once the code was over, we took the "end result" strip to her. BTW, she was watching 6 monitors that shift. Scary.

[oramar]

I would say that patient was darn lucky that an excellent nurse was on the job. If an inattentive nurse backed up by undertrained tech had been there that day the outcome might not have been so good.