Telemetry Monitoring

azrn22 · Dec 13, 2005

I work in an 18bed CCU in a very busy medical center. We have 2-3 patients most days with at least 1 new orientee with us during the day. We are under new management who has made the brilliant money saving decision to take away our telemetry techs. Of course we do not solely depend on the techs to do all the monitoring, but it does come in quite handy whe your are busy in one of your rooms and your other patient decides to misbehave. We currently have at least 6 phones attached outside rooms which the techs immediately call on when a patient has an arrhythmia. A few of us in the unit have been wondering what is the monitoring situation in other hospitals. Most of us find this upcoming change not to be for the better good of our patients. Is this common practice in all CCU's?

I work on a 15 bed CVICU with 2 pct's (cna's with tele certs) a ward clerk with tele cert. and our charge takes the same amount of pt's as the rest of the staff, unless census allows her to take 1pt.

We take 2 pt's at most. We have 4 groups of rooms with monitors in the rooms and two monitors outside each group of rooms that display ALL pt's in the unit. All monitors have audible alarms in the rooms and centrally located units alarms. This is nice, because if room 1, which can't be seen by rooms 5-15, has a 10 beat run of VT then EVERYONE knows because of the central alarm and monitors outside all rooms. We work as a team too, so if you're stuck in the middle of tx'ing a pt from the bsc to bed with all the lines and tubes, someone is there to get your back until you can get there.

cardiacrehab · Dec 22, 2005

Hi, in Canada we do not have "telem techs". We are responsibile for our own telems. Having said that we do have a charge nurse who is planted at the desk and can monitor all patients while she performs all her other duties. We have portable pagers which we input our patient room #'s and telem codes then if something delinquint occurs we run.... Interesting learning. thanks.

SarasotaRN2b · Dec 31, 2005

we have a 22 bed pediatric cardiology telemetry unit, the telemetry is monitored 24/7 by an experienced paramedic. there are also monitors at each end of the unit for nurses to view their patients rhythm/rate/ectopy.
i have noticed a trend to train secretaries and hucs (healthcare unit coordinators) to monitor telemetry...and this is a bad idea!!
okay...i fell a little better. first off, the unit secretary is many times the busiest person on the unit, working with lazies who constantly plead "can you page so and so for me so i can get back to surfing the net?" they don't have the time or the training to decide what is a genuine "alarm" and what constitutes a situation that can wait. but increasingly they are being made to split her attention between the monitor and her real job, keeping the unit from falling apart.

i both agree and disagree with this statement. as a health unit coordinate on a busy med/surg floor i am very busy at times. if i am asked to page someone, usually the nurse is trying to handle some very sick patients concurrently and not able to.

as i do hope to go into cardiology when i finish with nursing school, i am plainning on taking a cardiac monitoring course in the spring. while it should not be a huc's total responsibility (the whole team should spend some time monitoring), i think that a huc working on a cardiac floor should have some training in learning cardiac monitoring. jmho.

angelique777 · Jan 2, 2006

I work for an ICCU (intermediate critical care 55 bed unit) ratio is 5 pt to 1 nurse.

Pt is monitored and the signal goes to both the telemonitor located at the nursing station and to beepers. Each nurse has her patient on her beeper. And most of the time I put my partner's patient on my beeper as well, so when I cover her on breaks I can monitor her patient too. We also have someone as tech monitor but I do not rely on them since they really does not know or recognize rhythms. The Tech supposedly should let the nurse know if he/she see something unusual since on occasion our beeper do not alarm.(that is rare but it has happen hence the provision of a tech monitor) In addition if the alarm is a VT/Vfib/ tachycardias in the 120 or above/bradycardic or Asystole which are red alarms those alarms will go to all the beepers on the unit. For instance, I sometimes might be in a room with a patient and another nurse will get a red alarm on her beeper so she sees my patient alarm she will check on the patient. The beepers can be very annoying at times but I prefer to have a beeper show me my patient rhythm then rely on a monitor person. I find the tech monitor useful to replace batteries / replace leads that come off/ so that is helpful but to read rhythms well ...I wonder if the tech monitor really goes and checks the patient when she see a red alarm something I will ask the next time I go to work. I do not rely on the monitor so I never asked her since originally the monitors where there to ask use if our beepers beeped us to verify accuracy of the beepers sending us the signal from the telemonitors. The nurses on the unit who have been there a long time miss the monitors being in each patient room with a tech looking at the monitors. I only know the beeper system and feel naked with out the beeper. The patient has the option to also use a button on his monitor to call me in an emergency. I get a nurse call to the beeper. I like having that as a safety for the patient. Mind you there are days I would like to throw the beeper through a window especially when you know the alarm is false or this is a chronic problem. Despite these occasional urges to throw the thing away because it drives me nuts; I have to say that I do feel naked with out it. It helps me keep a closer eye on my patients. It also helps to have a good partner.

rhenmag9 · Jan 4, 2006

:uhoh21: It is unsafe, I am teaching in the tele area, heart institute....We have 6 telerooms, 2 tech.3 staff nurses...I agree with you, that is very scary...

tanner1334 · Feb 15, 2006

I work on a SDU. We currently have 21 monitored beds open and we have a monitor tech 24/7. Our ICU's also have Monitor Tech.

sushii · Feb 15, 2006

Reading everyone else's responses just make me realize how lucky I am. My unit has three techs upstairs that call us immediately there is an arrythmia in case the nurse's pager has run out of battery. We all carry a pager where our patients abnormal rhythms our immediately alerted to our pagers wherever we are. And we have the techs as a back-up who always calls and ask; "Did you see Mr XX just had three run of v-tach?

MQ Edna · Feb 15, 2006

I am a nursing student who has worked as a specialty tech in ICU for six years. One of the specialty techs jobs is to watch tele monitors. We have 12 beds in our unit and we monitor their heart rate, spo2, and BP. We also watch teles from throughout the hospital. We used to do this with one tech, but recently we upgraded and added some more teles and now we have 2 techs in the tele room at all times. We watch 46 teles besides the 12 in ICU. The nurses in our ICU don't even like to sit for us so we can have a break. I don't know how they would react if they took away their techs. I don't think it would be safe at all. Even with 2 of us watching tele, we are usually pretty busy.

nursejohio, ASN, RN · Feb 15, 2006

I work in a step down unit. We have the statview (aka spawn of satan) pagers. In theory, they only alarm the nurse assigned to that pt for small alarms like spo2 of 87, lead fail, pvcs etc and if the primary nurse doesn't respond by pushing a button quickly, the alarm will go out to all the pagers. Crisis alarms like asystole, vtach and the like go out to all nurses with a different alert. In reality, the little alarms go out to most nurses, and the computers version of a "life threatening arrhythmia" is completely different from a real one. The only thing I've noticed the statviews accomplishing is creating a "boy who cried wolf" syndrome. Most of the time, we hit the button to silence the alarm without so much as a glance for the normal alert. If the vtach alarm goes off and you come out of the isolation room to check it only to see a perfect complex and rhythm, how likely are you gonna be to jump at it the next time? If a spo2 of 68 comes across when you're 2 steps out of the room and you go in only to see a sat of 98 and NO history of it dropping on the monitor, what are the odds of running in when it happens again 20 minutes later? All the nurses that were around in the days of the monitor tech say they were 100xs better.

shortsteph12 · Feb 26, 2006

I work on a 32 bed tele floor. We do get many med surg patients who have some cardiac history also. Our ratio is 5:1 max. ( the last time we had 6 patients was the day I had my "telemetry nightmare.") since that day we are not allowed to have 6. We do not have a tele tech but we all try to take turns checking the monitors and we carry the pagers.

kstockdaleRN · Feb 26, 2006

I have to say, I just don't get it. I work on a 31 bed cardiac stepdown unit, We have 4, sometimes 3 nurses on nights, with 2 NA's. No secretary, no monitor techs. We are all dysrhythmia and code-blue, ACLS trained. We monitor our own rhythms, pass all meds, etc. I have had as many as 11 patients on nights. The mix is usually like this - maybe 2 A-fib on cardizem drips, 2 or 3 CHF on dobutrex and lasix, 2 chest pain waiting for an angio or stress test, 2 post-angio/stents, etc. We also have patients waiting on pacers, EP studies, etc. Patients waiting on CABG and valve replacements. If we have a code, a nurse from the unit on the other side runs down and watches our monitors and call lights. We do the same for them. It works fine. No beepers, no telemetry techs, and we don't use our overhead paging system at night except in a code. Am I just used to a lot of hard work? I would think 5 or 6 patients was heaven! On any given morning we might have 8 accuchecks to do, all the 6:00 meds to pass, a first-case angio to get ready and a 1st-case CABG. this is normal. Comments?

mart18642 · Feb 27, 2006

I have to say, I just don't get it. I work on a 31 bed cardiac stepdown unit, We have 4, sometimes 3 nurses on nights, with 2 NA's. No secretary, no monitor techs. We are all dysrhythmia and code-blue, ACLS trained. We monitor our own rhythms, pass all meds, etc. I have had as many as 11 patients on nights. The mix is usually like this - maybe 2 A-fib on cardizem drips, 2 or 3 CHF on dobutrex and lasix, 2 chest pain waiting for an angio or stress test, 2 post-angio/stents, etc. We also have patients waiting on pacers, EP studies, etc. Patients waiting on CABG and valve replacements. If we have a code, a nurse from the unit on the other side runs down and watches our monitors and call lights. We do the same for them. It works fine. No beepers, no telemetry techs, and we don't use our overhead paging system at night except in a code. Am I just used to a lot of hard work? I would think 5 or 6 patients was heaven! On any given morning we might have 8 accuchecks to do, all the 6:00 meds to pass, a first-case angio to get ready and a 1st-case CABG. this is normal. Comments?

Well if you feel safe this way good for you...........