Cardiac Monitoring/Strip Interpretation

Specialties Emergency

Published

Hey everyone,

As part of our performance improvement project we are attempting to increase compliance of printing and interpreting EKG rhythm strips for each patient with an active cardiac monitoring order. We are currently (very) non compliant. We have been working on this for almost 2 years and have had many barriers.

What does your Department do? Do you have a unit specific "policy"? How frequently do you print and interpret rhythm strips?

Is is this acceptable for TJC?

Any input is great!

Thank you!

We do not, but the previous tele floor I worked on would do this every shift. Print out the rhythm, interpret it, and place it in the patient's chart.

This was part of my change project for local facility. There was issues with printing and placing the strip in wrong persons chart. I created a campaign, "Print, Identify, Stick (PIS)" to incorporate using two patient identifiers when sticking it in the chart. Long-term goal involved having the strip directly/electronically sent from phillips to EHR and not requiring any printing whatsoever.

I do print strips (well, I save q30' strips to the EHR) - this is not a mandatory practice where I am, but is an ingrained personal preference from times past.

I wouldn't have inquired if I thought it were a personal matter; I thought we were talking about a JC standard which would apply to a lot of us, and judging by the replies so far doesn't seem to be something we're very aware of.

Specializes in Psych, Corrections, Med-Surg, Ambulatory.
But that doesn't make sense if there is documentation of what the rhythm is. Are you certain this is a Joint Commission requirement?

Or just some administrator's "good" idea.

Wouldn't be the first time a lame idea got blamed on the Joint Commission. OP, you said there are "barriers" to being compliant. What are the barriers? That would be the place to start.

Basically not having time. There's so much going on. Plus, nurses are not necessarily formally trained to interpret so many do not feel comfortble. We don't interpret EKG's so why interpret a strip?

I personally never made it much of a priority unless I was treating the rhythm.

Just wondering if anyone else is going through the same.

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We print and mount Q2hrs in our ED. Well...we're supposed to, at least. It makes sense, though, cause I've had pt's who I've gotten in report that they were RSR and then I go in, look at the monitor and see brady. So if the strips were there from the prior shifts, I could see where the pt was in that RSR spectrum - was the pt borderline RSR/brady or were they absolutely just RSR like 80's and 90's and suddenly is now in the 50's. But Q2hrs is really not feasible in the work environment that is our ED. You get a pt who crashes and that pt becomes the priority, and maybe you won't get to even see your other pts in the next 2 hrs let alone print and mount their tele strips.

Interesting. Ours is Q4h ... and we are in the single digits for compliance.

I work a Cardiac Progressive Care Unit, it is mandatory to print strips on every patient with telemetry every shift, it is also mandatory to review telemetry monitor Q4H and PRN. There is no getting around that requirement because we are a cardiac floor with cath, open heart, and general cardiac patients. We also have protocols in place that if there is a rhythm change or arrhythmia, EKGs can be ordered per protocol and STAT as well. Compliance is enforced, and disciplinary action results in non-compliance of unit protocols, this is for patient safety. :) hope this helps some!

It makes sense, though, cause I've had pt's who I've gotten in report that they were RSR and then I go in, look at the monitor and see brady. So if the strips were there from the prior shifts, I could see where the pt was in that RSR spectrum - was the pt borderline RSR/brady or were they absolutely just RSR like 80's and 90's and suddenly is now in the 50's.

I get what you're saying and it's related to the reason that I like to save strips (because I like the "proof") - but in reality we do have the information if vitals + rhythm is being documented.

If we don't trust that people are documenting accurate vitals or rhythms, that's an even bigger problem.

ETA: Of, course, that is dependent upon people documenting a HR as opposed to a pulse.

What kind of disciplinary action?

We print and mount Q2hrs in our ED. Well...we're supposed to, at least. It makes sense, though, cause I've had pt's who I've gotten in report that they were RSR and then I go in, look at the monitor and see brady. So if the strips were there from the prior shifts, I could see where the pt was in that RSR spectrum - was the pt borderline RSR/brady or were they absolutely just RSR like 80's and 90's and suddenly is now in the 50's. But Q2hrs is really not feasible in the work environment that is our ED. You get a pt who crashes and that pt becomes the priority, and maybe you won't get to even see your other pts in the next 2 hrs let alone print and mount their tele strips.

What is your nurse to patient ratio?

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