Problems with ER

morte, LPN, LVN · Apr 11, 2015

as usual, follow the money.

nursej22, MSN, RN · Apr 12, 2015

My hospital has nurses transport telemetry patients, however they are resource nurses who know nothing about the patients. Thus, they arrive on the floor, pop the leads off the patient in 3rd degree heart block and let them ambulate to the bathroom, ring the call light to tell the desk the patient has arrived and leave.

Anna Flaxis, BSN, RN · Apr 12, 2015

I do have a question for all you ER nurses. There are patients that are on telemetry and brought up by a tech not on telemetry. These are the patients that go to the step down and medical surgical tele units.

Tele patients should be brought up on monitor because it's protocol. BUT- having said that, what difference will it really make?

If the patient becomes unresponsive on the way to the floor, the transporter has BLS and is going to check a pulse, start CPR, and call a code.

If the person has a rhythm change on the way to the floor, what is the transporter going to do? Nothing. Keep going to the floor. You'll assess the patient and see the rhythm when you put them on tele upon arrival to the floor.

So yes, even though it's protocol to transport tele patients on monitor, in reality, what is the transporter going to do other than call a code if needed?

To me, it's an example of the idea that we need to asses the *patient* not the monitor. Transporting patients on monitor is a CYA measure and not realistically going to make all that much of a difference.

Perhaps the ER doesn't have transport monitors, or maybe they don't have enough of them to meet the demand, and so sometimes patients don't go on monitor. If the hospital wants to make sure that this protocol is followed, they will look into the barriers that contribute to the protocol not being followed and remedy them.

calivianya, BSN, RN · Apr 13, 2015

If the person has a rhythm change on the way to the floor, what is the transporter going to do? Nothing. Keep going to the floor. You'll assess the patient and see the rhythm when you put them on tele upon arrival to the floor.

Both this post and the post above (about popping the patients into the beds and just leaving) are horrifying to me.

If a patient is on tele where I work, a nurse has to transport the patient. The transport nurse has to be in the room while the receiving nurse hooks the patient up to tele. The transport nurse is not allowed to take off her tele leads until the new tele leads are in place, so for a brief time the patient will be hooked up to two monitors at the same time. There are no exceptions to this rule. If a transport nurse leaves/unhooks the patient before the receiving nurse has a chance to glance at the rhythm, the transport nurse risks disciplinary action. Someone who is skilled in rhythm interpretation is always looking at the patient's rhythm, and they would be calling ahead to notify us if there was a rhythm change during transport.

People would seriously transport a tele patient to a room, dump them, and leave? Or send them with a regular transporter? Scary.

MunoRN, RN · Apr 13, 2015

Tele patients should be brought up on monitor because it's protocol. BUT- having said that, what difference will it really make?
If the patient becomes unresponsive on the way to the floor, the transporter has BLS and is going to check a pulse, start CPR, and call a code.
If the person has a rhythm change on the way to the floor, what is the transporter going to do? Nothing. Keep going to the floor. You'll assess the patient and see the rhythm when you put them on tele upon arrival to the floor.
So yes, even though it's protocol to transport tele patients on monitor, in reality, what is the transporter going to do other than call a code if needed?
To me, it's an example of the idea that we need to asses the *patient* not the monitor. Transporting patients on monitor is a CYA measure and not realistically going to make all that much of a difference.
Perhaps the ER doesn't have transport monitors, or maybe they don't have enough of them to meet the demand, and so sometimes patients don't go on monitor. If the hospital wants to make sure that this protocol is followed, they will look into the barriers that contribute to the protocol not being followed and remedy them.

That's exactly why a patient deemed to require continuous cardiac monitoring needs to be transported by an ACLS trained RN or someone otherwise capable of providing adequate emergent care in transport. This is a well established, but too often ignored, practice requirement.

The suggestion that it doesn't make a difference is concerning. If the patient isn't transported on monitor then it certainly does make a difference if an unstable rhythm occurs (which is often why the patient was ordered to be on continuous monitoring in the first place). When an unstable/hypoperfusing rhythm develops there are typically only a few minutes in which to do something to avoid serious complications, specifically anoxic brain injury. The idea that it won't make any difference since someone will eventually put them on a monitor, only to discover they've been in VF for the last 10 minutes, is flatly incorrect.

Nonyvole, BSN, RN · Apr 14, 2015

Then there are patients that are put on tele by the admitting doctor because of the patient's age. The patient that has been up ad lib and not on tele in the ER, being admitted for an overnight stay for something that a different doctor would send home. I do send those patients up with a tech, sometimes even in a wheelchair.

ICU patients, however, I take up myself on the monitor. My hospital doesn't have any policies about that - once they get on the floor then there is somebody keeping an eye on the monitor, but the transport modules we use don't have that capability. So my patient decides to crash in the hallway? Nothing I can do except pick up the pace and be thankful that it's a small facility.

Anna Flaxis, BSN, RN · Apr 24, 2015

That's exactly why a patient deemed to require continuous cardiac monitoring needs to be transported by an ACLS trained RN or someone otherwise capable of providing adequate emergent care in transport. This is a well established, but too often ignored, practice requirement.
The suggestion that it doesn't make a difference is concerning. If the patient isn't transported on monitor then it certainly does make a difference if an unstable rhythm occurs (which is often why the patient was ordered to be on continuous monitoring in the first place). When an unstable/hypoperfusing rhythm develops there are typically only a few minutes in which to do something to avoid serious complications, specifically anoxic brain injury. The idea that it won't make any difference since someone will eventually put them on a monitor, only to discover they've been in VF for the last 10 minutes, is flatly incorrect.

Again, it is protocol to transport tele patients on monitor- I'm not advocating otherwise. I'm simply posing a question that nobody has answered, but are only expressing horror.

My question is, how is it going to change your response if your patient has a change in condition during the transport?

What if the patient has been completely stable in the ED for the last six hours and only have tele ordered because they are 82yo with a history of A-Fib and they're a DNR, how is a transport monitor going to make a difference in their care?

I agree that someone who is critically ill and at risk for developing a lethal arrhythmia should be transported on monitor, but again, it's not going to change your response should the person become unresponsive/pulseless whether you have them on monitor or not. Your'e still going to start compressions and call the code.

What is horrifying to me is when nurses follow protocol without an understanding of why they are doing so.