Transporting Telemetry Patients off the unit

zambezi, BSN, RN · Nov 14, 2003

In our critical care unit, if the patient is transferred to another floor or to xray/ct/ etc...has to be on tele with acls provider as escort...

once the patient gets transferred to our tele unit, i think (but not sure) the patient can go down for am xray with a tech...i'll look into it tonite and find out for sure though...

CV CNS CCRN · Nov 14, 2003

Many Thanks, Zambesi! CV CNS CCRN

BarbPick · Nov 14, 2003

A monitored patient is a monitored patient. A portable monitor goes with the patient and an ACLS provider must be present. Most Radiology Nurses are ACLS providers. This question reminds me of being a little bit pregnant, either you are or you are not. My malpractice insurance is paid up and current.

XIGRIS · Nov 16, 2003

Hi,

In my hospital, all telemetry patients undergoing any procedures outside the unit has to have an RN accompanying the patients and a portable monitor ( I encouraged my nurses to use the crash cart monitor because it has all the capabilities just in case ).

It hs happened a few times when our patient arrested in units outside TELE.

In our ICU be it CVICU or just the other ICU's, we also have RN's accompanying our patients.

The only draw-back on this is when you have to go on an elevator. Patients on a Vent and al these invasine lines with all the pressors. accommodating 2-3 personnel and those IV poles is difficult. Then a patient codes in the elevator. I have been a crtical nurse for almost 14 years in a high CVICU acuity and I am telling you coding in the elevator was kinda difficult.

Anyway, I think if you think of patients safety, transporting all tele [atients outside the unit needs to be monitored and accompanied by a competent RN. Because you never know whats going to happen next.

chris_at_lucas_RN, RN · Nov 16, 2003

Funny you should bring this up.

I just finished Intro to EKG for RN's, and the instructor, a nurse I know enough to respect a lot, was teaching it and gave an example from her experience.

The old lady was having some odd rhythm (can't remember which, now) which really wasn't giving her any problems, but needed attending to, so she was admitted to tele. The procedure was put off and put off and finally, after she'd been in there for 36 hours or so, the appointed hour came. The PCT *took the monitor and leads off,* the nurse suggested she empty her bladder, which she did. As she is coming out of the BR, she says she doesn't feel so good and collapses in the RN's arms. Called for the paddles but she came out of it before they could get there.

My question. If she needed to be monitored lying in her bed, shouldn't she be monitored in transit someplace else?

When I worked ICU (nurse extern), all monitored patients had temporaries attached for transport and an RN HAD to go with them.

Thanks for bringing this up. I thought I was just nuts.

SCNuttyMeg · Nov 18, 2003

This Topic has raised questions in my head!!!! Im a new grad and really never gave this much thought till now. We send our patients to xray, ctscan, mri, for caths, to surgery WITHOUT a monitor on. Their is a nurse present when the patients is taken to cath or surgery. The transporter is the only one that is with the patient while going for a test. To be honest Im not sure if these transporters have any special training...Id like to hope so. Great topic ill have to figure out the reasons why we dont monitor or send RN's. :confused:

RNKPCE · Nov 19, 2003

part of our standing orders read "may leave unit without monitor if meets off the monitor criteria" That was implement at least 5 years ago and I would have to hunt for the "off monitor criteria" if I wanted to know exactly what it said. Basically if they have been stable on the monitor for 24 hrs they can go without, or if a doctor writes an order on admission they can go without. However even if a doctor wrote that order nursing judgement is always in order. EX I would never send a patient to get a pacemaker without a monitor and ACLS RN but that is common sense. I don't work for two more days I will try to find the criteria when I am there. We now can read our monitor everywhere in the hospital main building except the elevators. But that doesn't do good if they go into VF, you need to shock asap. And when a pt is taken to a test with monitor it is a ACLS Rn and meds and ambu bag go along.

We have some patients that are no codes and we are just watching their A-fib and it would be a waste of man power to send someone down with that pt since we aren't going to treat them if they go into VT or asystole anyways. Not even sure why some are on the monitor but that is another story.

cannoli · Nov 19, 2003

This doesn't make a lot of sense either, but at the hospital that I go to, I have seen patients sent for tests with the transporter only and no tele box, the staff takes it off before they go.

There is a tele floor but they also have patients on other floors on remote tele, the tele monitor is on the tele floor and a tech there does the monitoring. I have seen patients on both the tele floor and on remote go without monitoring.

I have never seen an order that the patient can be taken off tele for tests, though I suppose they may exist, I think it is just done that way.

Sounds like a situation just waiting to happen, doesn't it?

I don't work in the units though, only on the med-surg floors, so have no idea what is done in the units.

The next time I go, I will ask if there is a specific written policy. I wouldn't be surprised if there was not.

RNKPCE · Nov 19, 2003

We once had a cardiologist who would send patients in his office over to the hospital in private car(driven by a relative) but once they got to the hospital they had to go for every test on the monitor.(even if they were stable) When questioned why he said if I call paramedics to the office it sends all the other patients and staff in a tizzy.

Good rationale huh?

Rapheal · Nov 19, 2003

I usually call the doc and get an order for off tele for tests if the patient is stable. I have transported them with a portable monitor and I am not ACLS certified. I am going to review the policy tomorrow. If they need an ACLS certified nurse to accompany them - then I will have to make sure to get them one. Thanks for this thread. I have learned something new.

RNKPCE · Nov 21, 2003

Found our written criteria for leaving the floor without the monitor

1) Absence of ventricular couplets or uncontrolled supraventricular arrhythmias for a 24hr period without vasoactive or antiarrhythmic iv agents

2) heart rate 60-120 unless changed within 24 hrs

3) resp rate less than 25

4)o2 sat > or = 90% on O2 on 6l or less

5)absence of resp distress

6) no anginal pain or st, T wave changes within 24 hrs

7) no level of consciousness change within 24hrs

8) as always use your nsg judgement

Now this was written in 95 and is more conservative than we follow or most MD expect to be followed. For example some pt have ventricular couplets all the time so the docs let them go off the floor without the monitor. Freq we get a pt admitted with angina in the preceeding 24hr period and they go off unit without monitor. But they are guidelines