"Continous" Telemetry Monitoring

[starrigaven]

Hello,

I am an ICU nurse in a 6 bed unit at a small hospital. We have telemetry capacity for 12 monitors, six hardwire, six tele.

Our staffing ratio is 1:2 patients, as our state law mandates.

Yet, we do not have a telemetry technician, secretary or CNA, causing the monitors to be unattended a majority of the time. Rhythm changes go undetected until rhythm strips done q 4 hrs, and then not often enough where earlier detection would have made a difference in treatment.

I would appreciate hearing from other small ICU nurses, as to having/ or not having a tech/secretary and their experiences. We are gathering data to lobby for safety, timely treatment, and providing support services at all levels of activity in the ICU to ensure that the nurses can focus on direct patient care.

Thanks for your input!!!!

[GilaRRT]

Can you not set your monitors to alarm with sudden changes in rate and rhythm? Some can even be set to alarm when specific interval length parameters are not met?

[Jason Bourge]

the whole issue of monitoring alarms at the bedside, central station or a "war room" manned by techs staring at screens is a difficult one whether your unit is small or large. fortunately technology is improving and can be applied inexpensively to your situation. check out one such solution from mvisum (http://www.mvisum.com/mvisumalert.php) which allows alarm details, waveforms and even a live stream of the monitor to be viewed remotely on mobile devices like smartphones. the whole system is configurable to existing workflow. i know of a few hospitals who have moved to this system and are very happy. in fact they feel that it has improved their ability to react to critical events. there are other systems out there that send out "text" alerts but it seems like this system gives tremendous flexibility and i haven't seen any other than this one that includes waveforms.

[rogerthatRN]

dude, I feel ya. I moved from an ancient & poor inner city hospital ICU with monitors in each pt room that I could see and watch while in the pts rooms, to a nice but old suburban hospital Tele unit with NO monitors in the pt rooms... just remote Tele transmitters on each pt, and a Tele room w/a Tele tech constantly watching their rhythms. Which I have no problem with, since I suspect some of them (who have been doing this for a decade or two) are better at identifying rhythms than I am (I've only been a nurse for 6 yrs).

What bothers me is I'm supposed to go down to the Tele room at least once during my shift (twice if it's a 12 hr shift) and sign off on *their* Tele sheet of identified rhythms. Now, I wouldn't sign off on a med I didn't give... I wouldn't sign off on ambulating a patient that someone else ambulated... why I should have to sign off on rhythms I didn't myself identify, I don't know. It makes me very uneasy. Not being able to see the monitor in the patient room, and see what their hearts are doing, makes me very VERY uneasy... especially the patients on drips.

The stratification of care (and of patients' bodies and body systems) into different areas and levels of care by staff of different levels of education/training may be cost effective for hospitals, but I don't think it's ultimately beneficial to the patients when it results in the kind of missed information that can occur when one person is not seeing/doing everything. That said, there is no way I could get through a shift without my PCTs (or the Tele techs, for that matter). As hard as I work, they work just as hard covering more patients and doing the thankless tasks like getting them on bedpans and commodes, and for way less pay. And the Tele techs always call me when there's any sudden change in rhythm so I can go to the patient right away and assess them.

But I sure wuold like it a lot better if the patients had monitors in their rooms AND we had a remote monitor in the nursing station, so I could see what they were doing while I try to catch up on charting.