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Discussion

Who is Responsible

So I have patients that go up to a dialysis unit while still being monitered on telemetry. I am informed that my patient who is up in dialysis is doing all sorts of things that a cardiac nurse doesn't want to see on a monitor. The person behind the monitor calls up to the dialysis floor (usually to a secretary who answers the phone) to let them know of this and then informs me. I know for a fact though, that the RN doesn't always know of the frequent pvc's, runs of vtach or other heart blocks that I am currently seeing on the monitor. In addition to the fact about the RN not getting the message, some RN's don't know what to look for when these things happen because they have no cardiac training. So, what I want to know is what the policy of other facilities is to which RN would utimately be responsible for this patient if he were symptomatic?

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I'm no legal expert, but my understanding is that all the RN's involved in the patient's care would be responsible for insuring treatment sought and given for any sx's the patient might have.

If I were you I would check the policy of the hospital where you are working. You may find there isn't one, in which case you should bring that to the attention of the Managers or if you have a Professional Practice Team, or someone that can start the process of forming a policy.

Also, do you report off to the dialysis nurse? That would be an important difference, if you don't, which in my hospital we don't, than I would say you are just as responsible as if the patient was still in your unit.

Also, I would say, if a patient is having any type of abnormal tele monitoring it certainly doesn't seem like a monitor tech giving that info to a unit secretary via phone sounds sufficient.

You could probably use this experience to benefit your patients and other staff nurses by improving quality of care. I would follow it up, ask around, contact risk management, ask them. The policy of your hospital will be what is most important as far as your responsibility. But if your name is on that chart, you are responsible.

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