Telemetry Nursing Questions

BlueDawnRN, BSN · Jun 19, 2015

New telemetry nurse here. Great questions! My facility actually has written policies for each scenario you asked about and I believe every institution has different policies, which is probably why you hear conflicting things. For example we call the house doc at night for anything over 5 beats of v-tach regardless of whether there's a consult and labs ordered, but I know other hospitals differ. We also have policies on calling rapid responses and training on hipaa. The policies are always changing and we continue to get ongoing education and updates.

These would be good things to ask your preceptor, educator, supervisor, etc since the answer may be a little different depending on the facility and the patient's condition.

You're definitely off to a great start. I think telemetry is a good choice for a new nurse.

BlueDawnRN, BSN · Jun 19, 2015

Also I don't give novolog if the patient is npo but I will give lantus. If the sugar is really high I'll call the doc.

RescueNinjaKy · Jul 2, 2015

You want to page the doctor with a FYI I held insulin bc npo. If you're gonna hold a medication, especially insulin, you want to just give the doctor a heads up and cover your own behind. I had a patient on scheduled insulin and sliding scale with meals but he was npo for procedure. Dr wanted scheduled to be held and sliding scale to be given.

brownbook · Jul 3, 2015

Your questions are great....I don't understand why nurses are asking about what to do with isolation cases. A million years ago when I worked the floor every unit had an isolation manual with many laminated pull out signs that went on the patients door. They simply and clearly stated what isolation PPE was required and what to do if the patient needed to be transported outside the room.

You HAVE TO ask the Dr. about insulin coverage when NPO for surgery. It is a no brainer, you must ask. The anesthesiologist is actually the person who really wants to know. To put it bluntly all the surgeon cares about is the inguinal hernia. The anesthesiologist is the main one keeping the patient alive so the surgeon can take out that hernia! The patient's blood sugar, cardiac function, lung issues the anesthesiologist REALLY cares about. But regardless you have to ask a MD.

CocoaLoverFNP · Jul 4, 2015

1. If a patient exhibits say a 10 beat run or less of vtach overnight and already has labs for the morning, should I wake up the cardiologist or primary doctor if they don't have a cardiology consult to let them know? if they don't have labs, should I still call if the patient is asymptomatic or can this wait until the morning?
2. If a patient is on isolation precautions, how do I maintain safety from transmission of diseases when the patient is going for a test. obviously with airborne I would put a mask on the patient, but what about if they are contact or droplet and have to go for a test or procedure?
3. If a patient had surgery or a procedure and it is in the middle of the night and they start having profuse bleeding, would I call a rapid response to get a doctor right away rather than the surgeon?
4. HIPAA-How exactly should we be handling phone calls in order to maintain HIPAA? For example, if a patient is from another facility like a nursing home or group home and the nurse for the night calls to ask for an update, what exactly can I tell them without breaking HIPAA? Is discussing test results or medication the patient is on and any change in their status breaking hipaa?
5. if a patient is scheduled for surgery and is NPO, should you give any insulin coverage if they have a "high" blood sugar for their accucheck , or not because they are NPO and will not be eating anything?
6. When giving meds for a patient on a kangaroo pump, do I hold the feeding, disconnect the feed, administer the medications by pushing them into the tube, and then flushing and reconnecting and restarting the feed? I will ask to see a demonstration before having a patient with a feeding tube, I just wanted to have a better idea before I started.
Thank you for your time and I look forward to your responses!

Congratulations on the new job! These are great questions. Remember that each facility may differ. Each department may also have different policies and procedures, so may want to review those before following anyone's advice. Here are my answers to your questions:

1.First of all, I would check the patient (pt) and make sure he/she is asymptomatic. Then, if he/she is asymptomatic, I would reflect on why the patient is here in the first place. If pt has been stable all this time and it's a sudden new event, I would call the doctor at 5 in the morning. But it really depends, like for example, if the pt is a fresh CABG post-op, I would call the MD. We had a pt who had a short run of Vtach then code on us within the hour. There are on-call hospitalists (they are awake and ready to take calls anytime) that you can call if you are worried about a specific pt. Use your nursing juedgement. Check progress notes, PRN meds, and check with your experienced nurses on the floor. They are very good and knowledgeable about disease process and certain doctors who love getting calls in the middle of the night ;-)

If this is not new, nad if it didn't repeat throughout the night, I would tell the day shift nurse so he/she could notify the rounding MD. I would also request if the lab could draw the blood early, let's say at 2 am, then remember to check the values once ready.

2. If airborne or droplet, we would put a mask on the patient. If contact, i would disinfect the bed rails to avoid wearing gloves in the hall way while pushing the bed. Either way, I would let the procedure tech know that the pt is on isolation so they may initiate precautions once they are in the procedure room.

CocoaLoverFNP · Jul 4, 2015

3. If a patient had surgery or a procedure and it is in the middle of the night and they start having profuse bleeding, would I call a rapid response to get a doctor right away rather than the surgeon?
4. HIPAA-How exactly should we be handling phone calls in order to maintain HIPAA? For example, if a patient is from another facility like a nursing home or group home and the nurse for the night calls to ask for an update, what exactly can I tell them without breaking HIPAA? Is discussing test results or medication the patient is on and any change in their status breaking hipaa?
5. if a patient is scheduled for surgery and is NPO, should you give any insulin coverage if they have a "high" blood sugar for their accucheck , or not because they are NPO and will not be eating anything?
6. When giving meds for a patient on a kangaroo pump, do I hold the feeding, disconnect the feed, administer the medications by pushing them into the tube, and then flushing and reconnecting and restarting the feed? I will ask to see a demonstration before having a patient with a feeding tube, I just wanted to have a better idea before I started.
!

3. Initiate interventions for bleeding STAT. Then, I would call rapid response and charge nurse. Call the other nurses on the floor (you would feel a lot better when everyone else is helping you with the situation). Stabilize the patient first. Then yes, I would call the surgeon. Make sure that the post-op standing orders for bleeding have been initiated before calling. The surgeon will ask you about it ;-)

4. If the nurse from the other facility is currently on duty, and the patient is to go back there once stable, I would share the minimum necessary information only. For example, say "the patient is stable and expected to go back to your facility in 2 days. He will need oxygen equipment and a wheelchair." Or say "the pt is stable but we do not have any discharge plans yet at this point." Rule of thumb is to ask permission from the patient before releasing any information to anyone if you are not sure.

5. Follow your NPO sliding scale. If there is no NPO sliding scale, then the MD should have been called last night or you can call early morning. These NPO orders are standard at our facility and should've been ordered the day before.

6. Sounds good, but if this is a PEG tube, meds/free water should go in by gravity. Again, follow your facility's P&P so you are able to cover your behind, just in case something wrong happens (clogged tubes, etc.).

Good luck!

valx92 · Oct 4, 2015

1. If a patient exhibits say a 10 beat run or less of vtach overnight and already has labs for the morning, should I wake up the cardiologist or primary doctor if they don't have a cardiology consult to let them know? if they don't have labs, should I still call if the patient is asymptomatic or can this wait until the morning?

Some hospitals have policies for this, but at my hospital it's more of a use your judgment kind of thing. Generally we already know that the patient is having these runs of VT and that's why they're in the hospital anyway. So if the patient's asymptomatic, it can probably wait til morning. I might ask to have their morning labs drawn early if I'm really concerned and then go from there based on what the labs show. Or if the patient is having consistent runs of VT and there's no known history of it, I'll probably go get a pressure to see if it's worth waking up the doc over. Either way I'd say check on your patient and give the doc a call in the morning just to let him know what was going on.

2. If a patient is on isolation precautions, how do I maintain safety from transmission of diseases when the patient is going for a test. obviously with airborne I would put a mask on the patient, but what about if they are contact or droplet and have to go for a test or procedure?

Pretty sure there are different policies at different hospitals for this too. Our patients have to put on a clean gown before they leave the room, and anything they touch gets wiped down really well. If it's airborne they have to wear a mask when they leave the room too. That's about it.

3. If a patient had surgery or a procedure and it is in the middle of the night and they start having profuse bleeding, would I call a rapid response to get a doctor right away rather than the surgeon?

Depends on what kind of surgery/procedure it is and what's going on. Did they have a cath and now they're bleeding from the groin but otherwise stable? I'd apply pressure and call the doc. Did they have a cath start bleeding from the groin and now SOB low spo2 with a pressure of 60/30? Call the RRT. Same thing with a surgical patient. Just depends on how stable they are really. If it can wait for you to call the surgeon, call the surgeon. If the patient's critical, call the RRT.

4. HIPAA-How exactly should we be handling phone calls in order to maintain HIPAA? For example, if a patient is from another facility like a nursing home or group home and the nurse for the night calls to ask for an update, what exactly can I tell them without breaking HIPAA? Is discussing test results or medication the patient is on and any change in their status breaking hipaa?

At my hospital they have to sign a release stating who can get information, so if they came in from a nursing home, we ask if it's OK. But in such a case, they're usually going to return to the nursing home anyway, so for continuum of care purposes, it's pretty important for the people at the nursing home to understand what's going on so we encourage the facility to be added to the list. I've never had anyone say their nursing home can't get information.

5. if a patient is scheduled for surgery and is NPO, should you give any insulin coverage if they have a "high" blood sugar for their accucheck , or not because they are NPO and will not be eating anything?

At my hospital our parameters say hold the metered dose and give the sliding scale coverage for NPO. If I know this patient pretty well and I was concerned about the patient's sugar dropping too low with the ordered sliding scale dose, I'd probably hold both and let the doc know what I was doing. We aren't supposed to hold basal insulin for NPO either, but sometimes, again, if I know the patient tends to drop when they're NPO I'd discuss it with the doc and maybe decrease the Lantus dose. I'd never hold/decrease an insulin dose without discussing it with the doc first though.

6. When giving meds for a patient on a kangaroo pump, do I hold the feeding, disconnect the feed, administer the medications by pushing them into the tube, and then flushing and reconnecting and restarting the feed? I will ask to see a demonstration before having a patient with a feeding tube, I just wanted to have a better idea before I started.

Yes.