remote telemetry and cardiac drips

RN1989 · Apr 7, 2008

Because of the liability and the problems with med/surg nurses not always being trained in EKGs/tele monitoring -what their role is, how to respond to problems, I have only worked in one facility where this was allowed.

The remote tele patients did NOT have gtts of any kind. The patients were very stable and required little cardiac care. Remote tele was usually used for stuff like "r/o arrhythmia" in a patient that had dizzy spells at home and the doc couldn't find anything wrong. Or DNRs that the doc wanted monitored but we weren't treating, CVA or pneumonia that was stable and the doc was just curious about the rhythm.

Make sure that there are P&P set up for every contingency. Remote tele in my opinion is ridiculous and dangerous. If a pt needs cardiac monitoring, then they generally need the expertise of a nurse trained in cardiac care/procedures/meds, etc. Have seen some bad situations with remote tele pt's when a tele tech calls the floor and the staff does not respond to the call appropriately or does go to the pt's room immediately but they don't know what to do after they get there because they are not familiar with tele protocols. I would recommend EKGk/med training for all staff on the floors where the remote monitoring will occur.

Blee O'Myacin, BSN, RN · Apr 7, 2008

I have never worked at a hospital where there were patients on drips who were on remote tele. Like a prior poster said, drips are for unstable patients and remote tele is for otherwise stable patients. I wouldn't feel comfortable taking low dose dopamine or non-titrating cardizem or insulin on a tele floor. These drips require closer supervision than the remote tele 6:1 ratio.

Keep the drips in the unit and the PCU. :twocents:

Blee

Bucky22 · Apr 7, 2008

Thanks for the replies so far, I would also be curious about your staffing in the remote telemetry units. How many RN's, CNA's, HUCS are used?

Currently we are 5 to 1 RN, 10 to 1 CNA, and 1 secretary for every 15 pt.

RN1989 · Apr 7, 2008

Wow, that's better staffing than most med/surg units that I've worked or managed!

The one place I worked that had remote tele was 5-7:1 nurse (RN or LPN), aides were whatever we got that day and 1 secretary for the floor regardless of number of patients.

Bucky22 · Apr 7, 2008

yeah, I think the ratios are good too. Night shift is a little rough though, because we have 5-6 to 1RN and no CNA, secretary, and the charge nurse takes 5 patients all primary care until 6 am. We also do not have IV thereapy, phlebotomy or respiratory support either.

Penelope_Pitstop, BSN, RN · Apr 8, 2008

in my experience, we had the occasional drip with remote telemetry. i remember taking care of an amiodarone drip patient, and i've seen a handful of others...albeit without titrating since it was a medsurg area. the ratios were up to 6:1 on day/evening, up to 8:1 on midnight. however, our stepdown floor also utilized such a telemetry system, and many of their patients had more than one drip, although i'm not 100% on the titration. their ratios were lower, of course.

jess

grandee3 · Apr 8, 2008

I work a Tele floor that has remote tele on another unit. When I get pulled down there, I feel so lost, I like to walk up to the monitor and look at my pt's rhythm. I also trust the monitor tech and think very highly of them. Also, on the remote tele floor, some of the nurses really do not know what they are looking at when they get their strips. Yes, their pt are mostly stable but I've seen that change, should I say, ...in a heartbeat. No drips on remote tele but Cardizem, Dob, Nat, on regular tele floor. LPN here, we cannot take pt's with drips where I work now, but other hospitals in the area, LPN's can take pts on drips.

Blee O'Myacin, BSN, RN · Apr 8, 2008

in my experience, we had the occasional drip with remote telemetry. i remember taking care of an amiodarone drip patient, and i've seen a handful of others...albeit without titrating since it was a medsurg area. the ratios were up to 6:1 on day/evening, up to 8:1 on midnight. however, our stepdown floor also utilized such a telemetry system, and many of their patients had more than one drip, although i'm not 100% on the titration. their ratios were lower, of course.
jess

*faints* over the idea of having a patient on an amiodarone drip without a monitor in front of me...

grace90, LPN, LVN · Apr 9, 2008

I have never worked at a hospital where there were patients on drips who were on remote tele. Like a prior poster said, drips are for unstable patients and remote tele is for otherwise stable patients. I wouldn't feel comfortable taking low dose dopamine or non-titrating cardizem or insulin on a tele floor. These drips require closer supervision than the remote tele 6:1 ratio.
Keep the drips in the unit and the PCU.
Blee

Hmmm... my facility does remote tele, and the non-cardiac nurses sometimes don't understand what the tech is telling them. And we do have non-titrating dopamine, insulin or bumex drips on the floors, as well as titrating heparin or argatroban drips, :down:sometimes not even on the med/tele unit. And no, having a pt like this does not mean lower pt load.

Bucky22 · Apr 10, 2008

Thanks everyone for the responses; I think we will need to add night shift CNA's as we don't have any right now. We will be doing low dose dopa and dobutimine, we already hang heparin and insulin drips on our units. We are considering administering IV cardizem for PO conversion only...no bolus.

I have been reading the forum and this place is great! :up:

dryhands · Mar 7, 2009

Remote telemetry - I am unsure of what exactly this means. Are the technicians in the hospital, or elsewhere? Do the nurses have no monitor anywhere on the unit to see the telemetry (even in the patients' rooms?)? Are they solely relying on the remote telemetry technicians?