Question: Can you please provide acceptable standards for use of a telemetry technician? I have reviewed an issue where the technician is not trained in reading rhythms, but would alert the RN if an alarm rings...

Complete Question: “Can you please provide acceptable standards for use of a telemetry technician? I have reviewed an issue where the technician is not trained in reading rhythms, but would alert the RN if an alarm rings.

I am concerned about the RNs liability in that circumstance. Some RNs are asked to be responsible for the monitors plus charge responsibilities, so cannot watch the monitors consistently and could easily miss an early change in rhythm.

Some floors have the secretary or an aide "watching" the monitor- while performing other tasks. I cannot find a standard for telemetry and the responsibility of observing the monitor is doled out very differently in some facilities.

It seems the nurse is ultimately responsible for a change in the patient's condition, but is not afforded the help s/he needs to be able to properly assess that patient. Do you have any guidelines?”

Answer: Upon investigation of your clinical question, members of the committee have provided their expertise in regards to the recommendations for telemetry technicians. While querying members of the committee, there is a large array of what each facility utilizes in response to telemetry monitoring.

This type of monitoring is extremely important and it is imperative that the individual who is monitoring the patient on telemetry monitoring, is adequately skilled and is competent to do so. Without training, early rhythm changes could be missed and be detrimental to a patient (i.e. a patient who slowly deteriorates to 3rd degree heart block).

Many institutions employ telemetry technicians, however most are trained for a period of time based on the type of environment that they will be working in. Some institutions instill a course that provides education over a number of days as on the job training, and then they will take an initial and annual competency on rhythm recognition.

Some organizations instill a 3 or 4 day course, while others instill that monitor technicians must attend the same ECG and rhythm interpretation course that RN's attend. The individual must pass this test to be able to sit at a monitor at all, ever, for even a short time. They also have to retake the test yearly to maintain competence proof.

A non-skilled employee should not "watch" the monitor. Rhythm recognition is a skill and can only be performed by a person who is trained. There is no state board exam for monitor techs so competency and use of these individuals is up to each facility.

In some facilities, there is even a Central Monitoring Unit (CMU) which is staffed with 2 telemetry technicians per shift for the all Med-Surg units.

The telemetry technicians for this unit go through a formal certification class and training for telemetry reading. The telemetry technicians are critical in maintaining patient safety among different units in our hospital.

The process of having CMU had actually helped our charge nurses among telemetry units. Likewise, the CMU is one way to address National Patient Safety Goal of The Joint Commission on safety of clinical alarm systems (Lukasewics & Mattox, 2015).

A 2011 Joint Commission report highlighted safety issues related to alarms and physiological monitoring systems. The Joint Commission (2011) identifies risk factors that are associated with monitor-related adverse events include communication breakdowns and training issues.

If staff are not trained adequately patient safety can be compromised. In a January 2015 report, The Joint Commission identified a National Patient Safety Goal to reduce the harm associated with clinical alarm systems. Universal solutions have not been identified, it is essential for organizations to develop a safe approach to alarm system management. However, The Joint Commission (2015) does recognize that solutions may need to be customized for specific units or patient populations. 

Reference:

  • The Joint Commission. (2015, January 1). National Patient Safety Goals Effective January 1, 2015: Hospital Accreditation Program. Retrieved from  http://www.jointcommission.org/assets/1/6/2015_NPSG_HAP.pdf
  • The Joint Commission on Accreditation of Healthcare Organizations. (2011). Sound the alarm: Managing physiological monitoring systems. The Joint Commission Perspectives on Patient Safety, 11(12), 6-11. Retrieved from: http://www.jointcommission.org/assets/1/6/Perspectives_Alarm.pdf
  • Lukasewics, C.L., & Mattox, E.A. (2015). Understanding clinical alarm safety. Critical Care Nurse,35(4) 45-47. 
    Retrieved from http://search.ebscohost.com/login.aspx?direct=true&db=c8h&AN=109826172&site=nrc-live" Patient Safety. Understanding Clinical Alarm Safety
  • Zaremba, J., Carroll, K., and Manley, K., Electrocardiographic Practices: The Current Report of Monitoring and Education in Veterans Affairs Facilities. Dimensions of Critical Care Nursing. 2014;33(2):82/87 
  • Crimlisk, J., Johnstone, D., and Winter, M., Cardiac Monitoring Hospital-wide Education and Staff Competence. Dimensions of Critical Care Nursing 2015;34(3):170/175.
  • Alspach, J.G., (2006). AACNs Core Curriculum for Critical Care Nursing, 6th Edition, St. Louis, Mo: Saunders AACN Book & Tele practice guidelines.
  • Cvach, M.M ., Biggs, M ., Rothwell, K.J ., Charles-Hudson, C . (2013) Daily electrode change and effect on cardiac monitor alarms: an evidence-based practice approach. Journal of Nursing Care Quality. Jul-Sep;28(3):265-71. Drews, B.J., Califf, R.M, Funk, M., Daufman, E. S., et al. (2005) Practice Standards for Electrocardiographic Monitoring in Hospital Settings, AHA Scientific Statement, Journal of Cardiovascular Nursing.; 20(2), 76-106.
  • Sendelbach, S., & Funk, M. (2013). Alarm fatigue: a patient safety concern. AACN advanced critical care, 24(4), 378.
  • Walsh-Irwin & Jurgens (2015). Proper Skin Preparation and Electrode Placement Decreases Alarms on a Telemetry Unit. Dimensions of critical care nursing: DCCN.

(Published January 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.