Quick little rant about the tele room here.

All_Smiles_RN · Jun 29, 2007

A pt on my old tele floor passed while his monitor was off (battery died i believe).... May seem like a pain at times, but it can mean the difference between life and death.

kcalohagirl · Jul 5, 2007

Please understand, I'm not saying that knowing a batter is dead isn't

important, it's just that knowing that my patient has switched from Sinus Rhythm to a fast A-fib is just as important. I need to know about both situations so they can be dealt with.

nursechick06 · Sep 8, 2007

I have my own little story to tell about the telemetry room. We had to break out the crash cart earlier for a pt. So I went with another nurse to restock the crash cart. This nurse said she had a feeling that we needed to go ahead and do it. Anyways, I was sitting at the desk charting. I hear dinging on the monitor. I look at it and it didn't look good to me. I asked another nurse what's up with that and she said " i hope this pt is brushing their teeth". (See where this is heading?) This wasn't our pt but needed to check this out. Pt was unresponsive/not breathing. Brought the newly restock crash cart in there and called a code. 5 minutes after this, telemetry calls and says she is in VT. NO KIDDING! Anyways, she went to the unit and came back to our floor a couple days later. This was my first day on nights, still on orientation. Never saw a code before but saw 2 that night. Welcome to night shift!

CaLLaCoDe, BSN, RN · Sep 10, 2007

i'm just wondering regarding the telemonitor's role here, couldn't he or she slip away from the monitor fix the leads, adjust the battery on his/her own and so forth? just a thought! especially if your hitting heavy stuff early on your shift! or do you simply have only one monitor tech?

kcalohagirl · Sep 10, 2007

Unfortunately, they can't. They are on a different floor entirely.

However, when a couple weeks ago, when I was busy coding a patient and couldn't answer my pager (my hands were a little busy, obviously) and they couldn't get an answer at the desk because the other 3 nurses on the floor that night were helping (we were waiting for the code team to arrive) they did come down, stood outside the room, and ask, "Hey, did you know he just bradied down to thirty? Why didn't anyone answer the phone?" Um, yeah, Einstein, and now he's in V-Fib, and don't you have something else to do right now?

Sheesh.

I know they have their job to do, I just get frustrated.

hypocaffeinemia, BSN, RN · Sep 10, 2007

Howdy!

Posting as a first-year nursing student, EMT-B, and monitor tech for the last several years.

Thanks so much for taking time to let us know the minute someone has a lead off (even if the waveform is still visible)

Having only a single waveform is a threat to patient safety. First, there is no second and third lead to verify any abnormal findings. Things like a spiked T-wave really need multiple waves: If it's in a single lead, it's small fries. If it's only in similar leads (II, III, and AVF, for instance), it's possibly hyperacute and may suggest impending MI. If it's in all leads universally, it could be hyperkalemia. That's just one example.

Second, with only one lead available, more subtle changes can quickly go undetected. For instance, at our hospital we typically keep a I, II, and V1 lead available for viewing. This gives us a lateral, inferior, and anteroseptal window to what's going on at all times. If you just have the I lead present due to the rest of the electrodes being disconnected, an inferior, posterior, or anterior aMI might go completely undetected. Having multiple viewing angles gives us some chance to catch it.

and if a battery goes dead in a tele pack. We appreciate that, we really do.

Hey, it's only your license we're protecting and our butts we're covering. People coding while disconnected from telemetry or while the pack isn't transmitting due to a dead battery isn't exactly a rare occurrence.

But please understand that my guy being rapid responsed in room 8 may mean it takes me a little while to get into room 6 to replace that lead or battery. And when we are short staffed with no aides and only 3 RNs on the floor and we have 2 patients circling the drain, please don't call me 5 times to tell me the white lead is off.

Firstly, don't blame the monitor techs because your staffing situation sucks- especially for the acuity you describe. Secondly, we often are in other parts of the hospital and have no idea what exactly it is like on your floor that day. If you take 10 seconds to tell us what's going on, we'll leave you alone.

I heard you the first time, I've just been a bit busy.

Did you just say, "Ok". Or did you explain that it would be a while and you're busy? I often just chart a timed note in such situations that states "leads off/battery dead/etc at 1532, RN Name notified" and leave it at that, if you're busy.

Oh yeah. And since you are obviously watching the monitors closely enough to tell me within 5 seconds that a battery needs replacing, why were you not watching the monitor closely enough to tell me my patient in room 10 flipped into rapid A-fib an hour prior? And after I mentioned that to you, why did you further neglect to inform me when he later flipped back into sinus?

Agreed, but I can almost assure you the monitor tech you are question doesn't post at allnurses, so this is something you should talk to him or her about.

These are things that are just as important, if not more so, than my patient who has been stable for the past 3 days needing his white lead replaced. (While I can still see a decent wave form)

If he's been stable w/o ectopy for three days, he needs to be downgraded and moved out, in most cases.

It is not your job as a tele tech to tell me what is and is not important.

Perhaps for the tele and the ICU nurses, this is true. However, a good half the telemetry packs at my hospital are on med/surg patients and most of the nurses there rely on me to tell them what is important or not. We are what you take from us. If all you care about is rate+rhythm, you can go ahead and replace us with a computer. If you care about context and seek additional information which you can include in your assessment, we are glad to share our experience. Our central monitoring room is in the middle of the ICU and even here I daily have ICU nurses coming to me with strips and 12-leads asking for a second opinion. It's not because they aren't competent at reading them; it's because they value my experience and can utilize my thoughts to better care for their patients.

All the best,

Matt

gracie05 · Sep 10, 2007

Hey...how about we cut the OP some slack...she had a bad night...let her vent!!

kcalohagirl · Sep 10, 2007

Matt, I just wanted to point out that the original post was labeled as a rant and should be viewed as such. I'm sure as an EMT, and in the future as a nurse, you will also have cruddy nights.

Secondly, you do not know the type of floor that I work on, so to assume that a patient with no ectopy for 3 days should be downgraded and moved out is pure assumption on your part. I work on a unit that is a dedicated post CTS unit, we get all CABGs and valve repacements, for example, and they are here and they stay on tele until they go home. Period. One of my patients is now on day 45. Stable as all heck, cardiac-wise, it's his lungs that are the issue right now, among other things, but he has one of the prettiest sinus rhythms you could ever hope to see, and has for about 39 days now. *grin*

You are also assuming that issues have not been addressed with the monitor tech. They have been, the original post was posted as a "rant", i.e., a way for me, the OP to blow off some steam. I notice that you are fairly new to all nurses, but this does happen quite a bit here. Allnurses tends to be a "safe" environment, where a lot of us can find a friendly ear when we want to say something that would frankly be inappropriate in a work setting.

The reason I was ticked at the umpteenth call during the rapid response is that the tele tech in question had in fact, been informed of the situation, is quite familiar with how we are staffed, was asked not to call, that we would get the lead as soon as the rapid response team showed up and we could spare a second, and still continued to call through on vocera about the same lead off on the same patient.

As far as our staffing goes, we aren't poorly staffed, per se. Our unit takes up to 16 patients. At 4 patients per nurse, that means when we are full and fully staffed, we have 4 nurses on the unit. When we have a rapid response or a code, all 4 of us are usually busy in the room, at least until the code team gets there. And unfortunately, that can take a few minutes. As soon as I can get out of the room (or anyone else, for that matter) we'll go around and replace leads and batteries. But we CANNOT leave the code.

We have some great tele techs! And lord knows that every so often, I take a look at a rhythm and call upstairs to see what one of them makes of it. They are a huge asset and we really couldn't do our jobs without them.

I had just had a really rough night where the techs had managed to call a gazillion times if a lead had been off for two seconds or a battery had been off for two seconds, (and I was generally on my way in to change it at the time if I noticed it). And then calling back within 30 seconds if it wasn't changed immediately. Sometimes, I have to walk to the supply room to grab another couple AAs before I go to the room. Please do not presume to think that I am neglecting my patients because a battery replacement took more than one minute. At the same time this was going on, a patient flipped into A-fib and I was not notified. When I called up to the tele room to ask why I wasn't, I was told, "Oh, I didn't think that was important to tell you, he just does that." I'm sorry, but that was not the tech's call to make. And after a review of the patient's strips, he did not have a history of "just doing that".

I'm sorry if I offended you, but this was clearly labeled as a rant, was a way to blow off steam, and though you may have made some points, the snide and condescending tone you used to make them (sorry if that wasn't your intention, but that's how I read it. The printed as opposed to spoken word can be a rotten way to pass on the tone of a post) really took away from anything constructive you may have had to say.

Please don't assume that because I post a "rant" and you don't have the blow-by-blow account of what actually ticked me off, that I am a bad nurse that doesn't know jack about telemetry, or that I am somehow neglecting my patients.

Peace.

al7139, ASN, RN · Sep 11, 2007

Hello,

I was reading this post because it caught my eye. I work on a telemetry unit and have had both frustrating days and good days. Our hospital has tele monitors that are responsible for the entire hospital, not just the tele unit. As an RN on a cardiac care floor, I am required to be competent in recognizing the more common ECG abnormalities. I still rely on my tele monitors to call me with issues since I cannot be everywhere at once. A pt with a lead off may need close and accurate monitoring. Yes, I had a situation once where I called the monitor to find out when my pt converted to SR (the telly monitor was very apologetic that they did not catch it, since it happened while they were giving report). Like us nurses, our telemetry monitors are human, and therefore not perfect. They do perform a very valuable service to us nurses who cannot always be watching the screen. So, if a TM calls me to say a battery is weak, or a lead is off, I thank them for calling, and let them know if there will be a delay in taking care of it. After all, they cannot know how busy you are, or what is going on, so they do not deserve rudeness or sarcasm. When I oriented, I had to do a shift with the TM to see what they do. They do not just sit around waiting for alarms to sound. They are highly educated people who can really make a difference in a situation where a pt is in trouble. Their job is to be your eyes and ears since you cannot always be with every pt you care for. Please treat them with the respect they deserve! Our TM's have alerted me to a potentially fatal situation more than once with my pts.

Amy

SarasotaRN2b · Sep 11, 2007

i'm just wondering regarding the telemonitor's role here, couldn't he or she slip away from the monitor fix the leads, adjust the battery on his/her own and so forth? just a thought! especially if your hitting heavy stuff early on your shift! or do you simply have only one monitor tech?

as a cardiac monitor tech, the answer is no...what if during the time you go into the patient's room to change this, another patient goes bad? who is going to watch the monitors then?

also as a monitor tech, we are only seeing what is going on with the monitors. i can't tell you how frustrating it is at times to see something going on on the monitors and we let the nurses know who may know that their patients' are nonsymptomatic...i never realized how stressful it can be having to sit in front of the monitors watching a patient's heart rate going up, with the alarms going off and getting little response from some of the nurses. if the patient is known to have a higher heart rhythm, why not just up the heart rate limit.

i work with a great bunch of nurses (night shift), but it can still get kind of hairy.

i also work in a remote tele room in which we are monitoring patients throughout a very large hospital...only seeing the monitors, we can't see what is going on with that particular patient. our protocol is that we are supposed to call every 3 minutes if the leads are either off or the battery needs changing. if a patient has been in normal sinus rhythm throughout their stay, then we may stretch that slightly, but if a patient has a known dysrhythmia, then i'm sorry, but i will call until i see the monitor go back on. if there is some change in the patient's condition, i always bring it to the attention to the nurse.

having been on this side, i will make sure that when i am a nurse, i will be attentive to what the monitor techs are telling me and if i know that the patient is asymptomatic, i will let the tech to know. the tech's primary responsibility is to let the nurse know when there is a problem or change in status asap. what the nurses do then, is their responsibility.

kris

CrazyPremed, MSN, RN, NP · Sep 12, 2007

I've worked as a Tele Tech, and I will soon be starting as an LPN on a tele floor (can you believe it!).

I appreciate this thread - and those who have contributed - so I can see both sides of the story. This will help in my career as a telemetry nurse.

Hopefully, no feelings have been hurt.

CrazyPremed