UNIVERSITY HOSPITAL AND CLINICAL PROGRAMS
PROFESSIONAL NURSING ORGANIZATION
POLICY STANDARDS

This policy provides guidelines for implementation of telemetry monitoring for any patient requiring consistent cardiac monitoring, but not requiring intermediate or intensive care.

Policy:

Cardiac telemetry may be provided for individual patient on all patient care units with a physician order.  Units 6B (CVICU) and 4E (Intensive Care) will be responsible for oversight of the central telemetry monitoring staff and for consultation with staff regarding cardiac rhythm interpretation.   The staff responsible for continuous centralized telemetry monitoring may be RN's, Monitors Techs (MT), LPN's, PSA's, and other trained staff who have been trained, attended the "Basic Dysrhythmia Course" and passed the competency exam.  All personnel who perform centralized telemetry monitoring will be required to complete a yearly competency exam.

Procedure:

I.      Initiation of Telemetry Monitoring

A.     A physician order will be required for telemetry monitoring.

1. An order must be placed in the electronic order entry system

2. A request form must be completed by the requesting unit and sent to the 6B MT. 

Nursing Procedure 163 - Procedure for Telemetry Monitoring

B.     For new admissions/New telemetry orders:

1.     Bed Management will notify the MT  (686-7665)

2.     Patient's name, date of birth (DOB), gender, medical record number and room assignment will be provided.

3.     Patient’s unit will call the MT upon patient’s arrival to the unit.  This will validate the reception of the telemetry unit.

4.     The patient’s unit will send five (5) patient labels to 6B MT.

C.     Monitoring

1. Monitor boxes will be maintained on 6B.

2. 6B MT will send with each telemetry box: A form stating "This box is being monitored on (6B or 4E).  Please call (686-7665 or 614-2496) if you have any questions.

3. The 6B and 4E MT and CDF will collaborate on effective distribution of telemetry monitoring, reviewing staffing and numbers being monitored. 

4. 6B will monitor patients on 6C when at all possible.

5. 4E will monitor all patients on 4A.

6. 4E will monitor telemetry patients when all 6B monitoring capabilities are no longer available on 6B.

7. The 6B MT will inform the 4E MT (614-2496) when a 4E telemetry box is being activated. 

8. The receiving unit is responsible for obtaining/maintaining telemetry unit (from 6B), start kit, battery, EKG patches, etc. 

9. If bedside visual monitoring is being used, the patient is placed on telemetry by the receiving unit & reception is verified with the MT before bedside visual monitoring is discontinued.

10. The ED, when admitting a patient on telemetry, will obtain the telemetry box before transporting the patient to the receiving unit.  If the ED has a patient in ADH hold (686-7925), which uses a portable monitor, they may order and obtain the telemetry box for use in the ED until the patient has an assigned room.

      II.         Telemetry Availability

1. In the event the need for telemetry exceeds availability:

1.     An order must be written when a physician desires to admit the patient to the floor before a telemetry unit becomes available.

2.     6B MT and Bed Liaison will maintain a list of patients awaiting telemetry. 

3.     When a telemetry box becomes available, the MT will provide the telemetry box to the first name on the list. 

4.     When there are less than five boxes, the MT will notify the Bed Liaison and/or ADON (Assistant Director of Nursing).  One of these staff, or his/her designee, will assign the telemetry box based on patient needs.

5.     If two or more patients need the next available telemetry unit, the ADON and physician will collaborate to determine which patient receives the unit.

B.     6B Monitor Tech Responsibilities:         

1. Maintain a log book on 6B which includes:

1. List, location, transmitter number of telemetry patients

2. Available transmitters. 

2. Informs Bed Management of any changes on the number of telemetry boxes available, e.g.   new order or discontinues order for telemetry on inpatient.

3. Keeps record in Maintenance book of all telemetry units needing repair

C.     4E & 6B Monitor Tech Responsibilities:

1. The MT or designee will fax, tube or take strips to floors at 5am, for the previous 24 hours.  The strips are run for the patient record at 7am , 7 pm and as condition warrants.

2. Log all communication and communication attempts

      III.         Responsibilities of Telemetry Patient’s Nurse

1. The Patient’s Nurse must promptly notify the MT for the following:

1. For admissions or transfers, the MT must be called upon the patient's arrival to the unit to validate the reception of the telemetry monitoring.

2. When the monitored patient leaves the floor or performs any task that requires taking the telemetry box off for any period of time. 

3. When telemetry is resumed, verifying reception. 

4. When the patient has been removed from telemetry per physician's order.  The floor will be responsible for cleaning the transmitter and returning it to 6B within 30 minutes.  The telemetry units must be hand delivered or wrapped securely in a towel to prevent damage and sent by pneumatic tube to 6B.

       IV.        Telemetry Monitoring Abnormal Events

1. The MT promptly notifies the patient’s RN of monitoring events by the following process:

1. The patient's unit will be promptly notified of telemetry monitoring issues by the MT via the walkie/talkie phone system. 

2. The RN will read back the interpretation to the MT.

3. A strip will be delivered or faxed as soon as possible following an event. 

4. After two (2) unsuccessful attempts to contact the patient’s nurse at five (5) minutes intervals for a non-lethal dysrythmia, the MT will call and speak with the 6B or 4E CDF.  The CDF will assess the patient's problem with the MT. 

5. All communication and communication attempts will be logged by the MT.

6. When the MT does not receive a response, or receives an inadequate response, he or she will contact their CDF.

7. The CDF will contact the monitored patient's unit CSM or the ADON for further action. 

8. All units will provide a list of the walkie/talkie phones assigned to the patients being monitored on a daily basis.

9.  If a lethal or potentially lethal dysrythmia is detected, as signified by ventricular fibrillation, asystole (checked in 2 leads with no indication that a lead is off),  the 6B/4E MT will immediately call the RN or the designee of that patient care floor via a walkie-talkie phone system.  The monitor tech will then notify the 6B/4E CDF as well.

     V.    Maintenance of Telemetry Equipment

A.     Each unit will be responsible for maintaining start kits, extra batteries, EKG patches, and any

additional supplies.

B.     Telemetry charges will be the responsibility of 6B or 4E MT.  Patients will be charged daily for

telemetry monitoring. 

C.      In the event a telemetry box or walkie/talkie phone was lost while monitoring a patient, the

unit last having this equipment will incur the cost of replacing the equipment.

D.     Broken telemetry equipment will be reported immediately to the 6B MT.  The MT will be

responsible for completing a work order and placing the appropriate information into the

maintenance book.  This book will be the resource for all telemetry box locations and the

specific time they have been out of service.

E.      Palm Tops and Telemons are available to be checked out through the 6BCDF.  These provide

the ability to visualize a monitored patient's rhythm at the bedside.  If a palm top or telemon is

lost, the unit last having this equipment will incur the cost of replacing the equipment.

Education for the telemon is on the Staff Education Web site.

Telemetry box # _____ is being monitored on 6B. If you have any questions please call the Monitor Tech at 686-7665.  ALL BOXES ARE TO BE RETURNED TO 6B WHEN THEY ARE DISCONTINUED.

Telemetry box # ______ is being monitored on 4E.  If you have any questions please call the Monitor Tech at 614-2496.  ALL BOXES ARE TO BE RETURNED TO 6B WHEN THEY ARE DISCONTINUED.