Question: There are times when there is an overflow of telemetry patients and another floor is opened to accommodate the overflow... nurse has to call tech to see what pattern patient is presenting...

Complete Question: I work on a telemetry unit. There are times when there is an overflow of telemetry patients and another floor is opened to accommodate the overflow. These patients are monitored on the main floor but nurse caring for these patients is unable to see tele patterns...nurse has to call tech to see what pattern patient is presenting. I have been told that this is acceptable but I would feel comfortable if I could see pattern, especially if patient is complaining of pain or is ambulatory. 

Answer: Upon investigation of your clinical question, members of the committee have provided their expertise in regards to whether a telemetry patient can monitored via remote assessment.

The AMSN does not have one standard practice in relation to telemetry monitoring, remote monitoring or not.

A variety of facilities utilize different approaches-some offer remote monitoring with the use of a telemetry technician, some utilize the traditional method of the nurse being the primary monitor, and thirdly, some facilities use a blended approach, in which the patients are monitored on the unit, however, are monitored mainly by telemetry technicians.

The process at one large multi-facility health system has developed an evidenced-based policy for remote telemetry monitoring.

Under this policy, the recommended role of the RN includes: initiation of monitoring per order, setting and checking the alarms, responding to changes in rhythm (as reported by the central monitor technician), assessing the patient, documenting the assessment, and communicating with the provider.

The recommended role of the monitor technician includes: setting and maintaining alarms per order or as appropriate for patient condition, continuously monitoring rhythm, immediately notifying appropriate personnel for changes in rhythm, and documenting per facility policy. The policy then describes in detail of when the nurse must also be providing an immediate response to the technician.

Also included in this policy would be recommendations for staff education, ongoing competency, and quality improvement related to remote telemetry monitoring (George, K.J., et all, 2015).

The American Heart Association (AHA) has also performed an extensive evidenced-based practice approach to this practice and has stated that there are both pros and cons to using remote monitoring of telemetry patients.

The pros include: early detection of subtle signs that may indicate further intervention; immediate response to alarms; more time for nurses to perform other nursing care.

Cons include: cost to hospital for hiring additional staff; smarter monitoring systems may not warrant human monitoring; possible fatigue and decreased vigilance due to monitoring multiple monitors (Drew, 2004).

Regardless of however monitoring is performed, it is imperative that the staff are trained appropriately, not only initially, but continuously as well and their competence in monitoring different rhythms are assessed on an ongoing basis.

References:

1. Drew, B. J., et. al. (2004). Practice Standards for Electrocardiographic Monitoring in Hospital Settings An American Heart Association Scientific Statement From the Councils on Cardiovascular Nursing, Clinical Cardiology, and Cardiovascular Disease in the Young: Endorsed by the International Society of Computerized Electrocardiology and the American Association of Critical-Care Nurses. Circulation, 110(17), 2721-2746. Accessed online July 2015 at: http://circ.ahajournals.org/content/110/17/2721.full.pdf+html

2. George, K.J., Walsh-Irwin, C., Queen, C., Heuvel, K.V., Hawkins, C., & Roberts, S. (2015). Development of evidence-based remote telemetry policy guidelines for a multifacility hospital system. Dimensions of Critical Care Nursing, 34(1), 10-18. doi: 10.1097/DCC.0000000000000084.

(Published November 2015)


About the AMSN Clinical Practice Committee (CPC)

The CPC responds to questions clinical queries. The CPC members are clinical nurses, educators, faculty, and advanced practice nurses from across the country. We perform brief literature reviews and query our member hospitals to determine best practices in order to address your question.