Telemetry Monitoring Questions

[firefighterjsh]

Just a couple of questions about telemetry monitoring. Just a little background, our telemetry monitoring unit consists of two monitor technicians. One MT watches the actual telemetry unit, a cardiac observation unit, and a progressive care unit (ICU Step-down). The first tech can watch up to 65 patients on their side alone at full capacity. The second MT watches 64 remote telemetry patients plus an 11 bed pre-admissions unit, 75 at full capacity. Our monitoring unit usually watches 105 to 140 patients at full capacity which has happened but not often between two techs. Our unit includes a bathroom, microwave, refrigerator, so we literally do not leave the room for anything, which includes breaks. We eat at our workstation (12-hour shifts). We do take occasional mental health breaks or a walk but those are short because we must leave a single monitor tech to all the patients. We monitor and complete all strips for all patients monitored. Nurses come in or call in once a shift to get a rate and rhythm for their documentation. We do everything else, from posting routine and event strips. We do not have anyone that checks behind us, except for some of the cardiologist that prefer to look at the strips themselves. Our monitors are the only monitors, except the PCU unit has a remote monitor for viewing only, and the pre-admissions unit has a monitor, but the nurses in the PA unit are not ACLS or know how to read them. So, telemetry nurses are required to come into the telemetry room to get their readings, but all the other units call us to get readings. We must deal with multiple calls from nurses getting their reports, doctors, we have walkie talkies that most of the nursing units use, so we are also constantly being called on those, plus text messaging from the nurses' phones.

Our director supports getting us a 3^rd monitor tech hired to split the workload and allow us real breaks, but keeps getting turned down from higher ups. Most of the posts I've seen in the past are old, but I'm curious if there are any regulations yet that I can't find on the patient to MT ratios to further support it?

We use the GE monitoring system (which I personally feel is outdated), and our PCU unit uses hardwired monitors at the bedside. Most of these patients are not required to be on constant SPO2 monitoring, but they will temporarily place them on the patients when completing vitals, then remove them. This causes the monitors to read SPO2 Probe off constantly. We can not centrally silence these alarms, so they are always alarming. It causes severe alarm fatigue, and causes us to miss actual alarms that are important. Does anybody have any policies on the use of the SPO2 probes or recommendations on how to silence them? We were told that they could be silenced from the bedside monitor, but the nurses don't know how to operate them except for getting the reading off the display screen.

The third question is, our hospital is trying to move toward paperless. Does anyone have any experiences with the GE system some how integrating with Meditech? I've been told it can't be done. This is another reason I would rather see another system used. Our director also supports this, but that route is expensive and probably will never be approved.

Sorry for making this so long but figured I'd try to answer all questions the first go-round.

[Been there,done that, ASN, RN]

You are asking nurses about a technical position. We will not have your answers.

I CAN tell you that your workload is outrageous and unsafe. I have been responsible for monitoring 30 patients, it was a handful. The nurses ran their own strips and any alarms went to their phone.

ANY job that works you to the point of no break is against labor laws.

Hate to tell ya this, but you work for a rinky-dink joint. Whatever new system they are thinking of moving to.. will NOT replace the number of personnel needed to safely monitor telemetry patients.

[vermillionsky]

I am a tele tech and I think your patient load is outrageous. At my facility, we have 2 monitor techs watching around 20-30 rhythms apiece. At full capacity, we have around 75 rhythms combined. We are a smaller hospital, so having that many patients is downright difficult and unsafe as critical changes have been missed due to too many people being watched and alarm fatigue. I can't even imagine watching 64pts each. I suppose it also depends on what sort of rhythms you get? If it is 60 pts who are in SR with very little ectopy then I suppose it would be pretty manageable for one tech. But if you are getting tricky rhythms like AV blocks, junctional, afib/flutter etc that are constantly alarming or if you have to watch closely for SVT or runs of VT then that sounds like a nightmare honestly.

But there are alot of similarities between our facilities. Our techs hardly ever get breaks and the higher ups still deduct a lunch break from their paychecks. We have had multiple meetings where we were told that it's our responsibility to find an ACLS trained nurse to come relieve us but they are too busy to ever help. As far as adding a third tech goes, good luck! We have been doing talks for years and nothing has ever come of it. It really comes down to management not wanting to have to pay for a third tech each shift, even if it would make the workload more manageable and safer. It's expensive and apparently not worth it to them. I can't answer the questions about your system as we do not utilize GE. Honestly I think the only way that things will change is if something really bad happens related to the ridiculous workload and lack of enough staff. A lawsuit or something like that would really get the ball rolling so you could see some much-needed change. Barring that, I highly doubt management will ever take your concerns seriously because in their eyes you are "just a monitor tech" and not as important as some of the other staff. Good luck to you though!

[jdub6]

Not being a tech i can't answer most if your questions. With the SP02 if the patient isn't ordered for continuous sats the bedside staff can simply disconnect the sat probe from the monitor when not in use (unplug where the cord connects to the monitor. it will remove the sp02 waveform and readings and stop sp02 alarms. plug back in when needed and it will automatically display in under a minute). The settings can be adjusted too definitely at bedside possibly centrally (for example turn off the probe disconnect alarm if not ordered for continuous sp02 or simply turn off the sp02 reading. This is more difficult and very possibly too complex to implement but everyone should be able to unplug the probes when not in use.