Telemetry Monitoring

[ccurn1]

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?

[mawlvn]

I work in a large teaching facilty. Ours is a 42 bed tele/imu/med-surg overflow. We have 6:1 patient ratio. We need that set of eyes just to be safe. All rooms are private and tele is in a central location. Juggleing post cath, po-op, post-intubation patients does not give you time the tele also. It is not a simple thing. When you ae in the trenches more help is better.

[Pedi-ER-RN, RN]

Some monitors have the capability to show the pt that is alarming in all rooms, at least someone can look up and aknowledge the alarm.

[Bermuda]

I work in a 46 bed tele unit in a large hospital. We have 5-6 patients 7a-7p no monitor techs... the RN's are responisible to check their strips q2h and document also run their own strips prn and we have PCT's ...minimal usually 2-3 for 46 patients. We have drips Nitro; Heparin; Amiodarone; Integrilin;Dopamine; Cardizem ;picc lines; central lines and the nurses start their own peripheral lines; do all their own assessments; give all their own meds; and when a monitored patient leaves the floor then the RN must go with the patient nurse & monitor. Your buddy( nurse working next to you) then watches your other patients while you are off the floor doing a procedure or whatever. Besides that it's GREAT... actually I love it but many a day I am frustrated. The team of nurses make it what it is and they are GREAT. So things get busy and I believe all tele floors are busy post cardiac caths on and on lots going on. You know that many a times the patients are high acuity and should be in the unit but no room so we sit on them. Anyway, so be it! Have a Great day!!! PS Forgot to tell you of course we all have phones in our pockets and beepers with our patients monitoring on them so if something does go on we see it and can respond ASAP...Forgot about the technology!!!

[LCRN]

I work in a 30 bed MICU/SICU where we watch our own monitors. We have a monitor in each room that displays the patient's rhythm however if another patient on the unit "red" alarms with an arrythmia/desaturation a box in a box will appear with the name and room number so you are able to establish if it's artifact or the patient needs immediate treatment. This allows many conveniences. We also can split the screen on the monitor and view our other patient while for example we're giving a bath in another patient's room.

LCRN

[Dinith88]

I think telemetry techs in any unit with a ratio of 3:1 or less is a waste of money. Perhaps i'm spoiled but the mixed ccu/icu i work our ratio is never greater than 2:1. Our unit does very well without them. It is my opinion that nurses who rely on tele techs are less capable at rhythm interpretation because they unfortunately leave the monitoring to others. It's kinda like the nurse who doesnt know anything about ventilators because "it's the rt's job"...c'mon, you all know nurses(poor nurses) like this.

Todays monitors are just as capable of alerting nurses when a bad rhythm, etc occurs (most have obnoxious alarms)...and can even cut out the whole middle-man caller step. Perhaps in a small or slow unit, having a tele tech might be useful...but any station that has at least one nurse within earshot of the station-monitors should suffice.

Perhaps i'm biased. Good cardiac nurses dont need tele techs.

And nurses who DONT use them are better at rhythm interpretation (as far as i'm concerned).

A unit would have to be poorly arranged, have bad(outdated?) tele monitors, or have a huge number of inexperienced nurses on staff to convince me that techs are needed...in an icu/ccu.

[dorimar, BSN, RN]

We try to have adjacent rooms or at least close. the moniter screens swivel so you can see your patient's screen weather your are in or out of the room. there is a central moniter screen as well. also each room's screen has a sqare for each room at the top so you can see who is alarming. If you are in bathing one patient you can tell if it is your other patient alarming. Where I used to work, you could pull your other patient up on the screen in the other patients room(that place was dangerous though, because noone EVER did this and many people ignored alarms) I saw a lot of scary things there.

Doris

[LuvToBeANurse]

I would BY FAR prefer an extra set of CNA/tech/NAT hands @bedside to care for pt's than a tele tech who yells out rhythm stuff... for many reasons other than just cleaning puke,poop, and snot (but thats mainly it...).

The tele monitors (dont yours?? ) have alarms that work just as well as a tele-tech...

if a tele tech wanted to impress me, he/she would have to go wipe a butt...

and i would be willing to wager that those nurses who dont have/never had tele techs are better at rhythm interpretation than those who do...

(i'd wager LOTS)

I agree with you! A critical care nurse- even a tele nurse should be able to accurately interperet a rhythm on the monitor ( in motion ) in 20 seconds or less.