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

Several members of the Clinical Practice Committee reviewed and investigated an answer to this question.

Answer: Many units use monitor technicians because they want continuous patient monitoring and, in some cases, to interpret strips.

In a recent practice standard for cardiac monitoring in hospitals, the American Heart Association (Sandout, et al, 2017) acknowledges that there is wide variation in education and use of monitor technicians. They also state that there is little evidence to guide practice in this area. They don't provide guidelines specifically aimed at the role of the monitor technician.

Here are some of their recommendations for ensuring safe patient care and appropriate response to dysrhythmias which apply to all individuals who are responsible for caring for a monitored patient, including a monitor technician:

  • An interprofessional team should oversee cardiac monitoring alarm management. The team should include nurses, physicians, administrators, and experts in quality, safety, medical equipment and informatics.
  • Alarm data needs to be analyzed to guide decisions about patient care and alarm management. This can be done by direct observation (ex: monitor technician), video recording, or medical device data systems.
  • Default alarm settings should be evaluated and adjusted for each individual patient.
  • The hospital should have clear policies for alarm management, including when alarms can be turned off or modified, which personnel are permitted to modify alarms, etc. 
  • Skin should be prepped before electrodes are applied.
  • Electrodes should be changed at least every 48 hours.
  • Documentation should be timely and generally includes rhythm, rate, PR interval, QRS and QT duration. In some cases, QTc is also recommended. Patients with pacemakers or ICDs require additional documentation. 
  • Education for staff (including monitor technicians) should include goals for cardiac monitoring, skin preparation, electrode placement, waveform interpretation and appropriate response to abnormalities. The guideline includes more detailed information about waveform identification. Education needs to be ongoing.  (Sandou, et al, 2017)

In 2014 K. J. George et al reviewed telemetry-monitoring policies from 75 VA hospitals across the country. They came up with the following recommendations:

  • Monitoring staff prints a baseline strip, which are reviewed by appropriate staff. 
  • Monitoring staff maintains appropriate alarm parameters.
  • Monitoring staff continuously watch the patient's rhythms and immediately notify appropriate staff to address any alterations in the patient's rhythm
  • Facilities should clearly define how often strips are printed and assessed.
  • A shift handoff is recommended for all personnel involved in monitoring (RN & tech)
  • Ongoing annual competencies should be completed by all personnel involved in monitoring.

References:

  • Sandou, K.E., Funk, M., Auerbach, A., Barsness, G.W., Blum, ,K., Cyach, M., …Wang, P.J. (2017). Update to practice standards for electrocardiographic monitoring in hospital settings:  A scientific statement from the American Heart Association. Circulation, 136(19), e273–e344.  doi: 10.1161/CIR.0000000000000527
  • George, K.J., Walsh-Irwin, C., Queen, C., & Hawkins, C. (2014).  Development of evidence-based remote telemetry policy guidelines for a multifacility hospital system.  Dimensions of Critical Care Nursing, 34(1), 10-17. doi: 10.1097/DCC.0000000000000084
  • Funk, M., Fennie, K., Stephens, K., May, J., Winkler, C., Drew, B., and The PULSE site investigators (2017).  Association of implementation of practice standards for electrocardiographic monitoring with nurses' knowledge, quality of care, and patient outcomes findings from the practical use of the latest standards of electrocardiography (PULSE) trial. Circulation: Cardiovascular Quality Outcomes, 10(2), e003132. doi: 10.1161/CIRCOUTCOMES.116.003132.

(Updated January 2019)
(Published January 2015)