Microsoft word - pm 90 2010-09-30.doc

University Medical Center Corporation
Tucson, Arizona

SUBJECT: Telemetry Management
Policy: PM 90
Originator: Heidi Costello, Michelle Ziemba, Jayne Matte-Wilson, Gina Ragonese
Responsible Person: Michelle Ziemba
Effective Date: September 30, 2010
Revision Date:
PURPOSE:
To outline the nursing management of the telemetry monitored patient.
SUPPORTIVE DATA:
To provide continuous cardiac monitoring of the patient at risk for cardiac
dysrhythmias and/or potential hemodynamic instability.
PROCEDURE:
1.0 Treatment

1.1 Identify areas of electrode placement per system design or physician order.
1.2 Preparation of skin for electrode application:
 Clip hair on appropriate areas of chest as indicated.
 Clean areas with alcohol. Allow to dry.
 Apply electrodes (assess for allergies to types of electrodes)
 Change electrodes every 72 hours. Note: date electrodes changed on LA
 Place lead wires as indicated per 1.0 above.
2.0 Assessment

2.1 Assess and interpret initial rhythm, and q 4 and prn, unless otherwise
indicated. Sign and post strip.
2.1.1 Correlate rhythm with physical assessment of patient.
2.2 The RN each shift will assure that patient’s with orders for Full Disclosure (all
arrhythmias stored in memory) are on Full Disclosure (if Full Disclosure available
on monitoring equipment).
3.0 3NE and Remote Telemetry Monitoring

3.1 Patients who are at low risk for cardiac dysrhythmias and for the need for
cardiac interventions may be admitted to a medical-surgical floor for cardiac
monitoring.
3.2 Criteria for 3NE and remote telemetry monitoring:
 Chronic stable atrial arrhythmias
 Arrhythmia's which are not being medically treated
 Stable

3.3 Patient's with a diagnosis of rule out MI will not be admitted to a medical-
surgical bed.
3.4 Intravenous cardiac medications or EMERGENCY IV push medications will
NOT be administered.
3.5 Any patient requiring medical intervention for cardiac instability must be
transferred to an intermediate or intensive care unit.
3.6 Rhythm strips are to be sent to the remote telemetry units every 4 hours and
prn with the PR, QRS and QT intervals measured by the monitor technician.
3.6.1 The RN caring for the patient will interpret the rhythm, sign the rhythm strip
and place the strip in the patient's medical record.
3.7 If the event of a significant change in the patient’s rhythm, the monitor
technician will notify the remote unit through the use of the emergency phone,
print a strip of the rhythm and send it to the remote unit.
4.0 Documentation

4.1 Rhythm strips are obtained and posted in the medical record.
4.1.1 PR, QRS, QT, rate, interpretation, lead, RN initials.
4.2 PRN strips to include rhythm interpretation, lead, and initials only.
4.3 For patients with Full Disclosure orders, the RN will document each shift in
the patient’s medical record that Full Disclosure is on. Any interruption to Full
Disclosure should be documented.
5.0 Safety Concerns

5.1 Telemetry batteries checked prior to insertion in pack.
5.1.1 If battery < 50% power, replace with new one. 5.2 Check all alarm settings, reset to patient needs and physician parameters. Alarms should not be turned off. 5.3 Telemetry packs will be appropriately protected (per manufacturer) prior to bathing. 5.4 All telemetry patients will be monitored by appropriate personnel when
leaving the patient care unit.
6.0 Transport

6.1 Stable patients who have been monitored in the ED or PACU may be
transported off telemetry when transferred to the admitting unit. This will not
apply for extended transport times in which a patient maybe taken to a diagnostic
testing area and followed by a transfer to an admitting unit. This does not apply
to Critical Care Patients. Criteria to consider a patient stable:

 Blood pressure and pulse within age-appropriate parameters for normal.
 Chronic
 Arrhythmias which are not being medically treated.  Stable  Chest pain without diagnostic EKG findings or elevated biomarkers
6.2 RN discretion may be used to determine the need for continuous ECG
monitoring for patient transport to an admitting patient care unit.
6.3 Other patient management protocols regarding continuous ECG monitoring
supersede the RN discretion (i.e. post conscious sedation monitoring
requirements, post escalating doses of Haldol)
6.4 If continuous telemetry monitoring is not required transportation services
may transport the patient to the appropriate floor or diagnostic area.
7.0 Patient Education

7.1 Patient instructed on purpose of telemetry.
7.2 Patient instructed on limitations of telemetry reception.
7.3 Patient instructed on the need for continuous telemetry monitoring and
removal/reapplication of monitor by appropriate personnel.
7.4 Patient instructed to call appropriate personnel before bathing/showering.

7.5 Patient instructed on adverse reactions/response to telemetry
electrode/monitor.
8.0 Reportable Conditions

81 Report significant changes in rhythm to the patient's physician.
8.2 Report to Biomedical Engineering any dysfunctional monitoring equipment.
REFERENCES:
Boggs, RL & Wooldrige-King, M. (1993). AACN Procedure Manual for Critical
Care. Philadelphia: WB Saunders.
Drew, B.J., Calitt, R.M., Funk, M., Kaufman, E.S., Practice Standards For
Electrocardiographic Monitoring in Hospital Settings. AHA Scientific Statement
2004; 110:2721-2746.
Smith & Duell. (1992). Clinical Nursing Skills. Norwalk, CT: Appleton & Lange.
Calgar, S., Leffler, S. (2006). Prevalence of life-threatening arrhythmias in ED patients transported to the radiology suite while monitored by telemetry. The American Journal of Emergency Medicine, 24, 655-657. Drew, B.J., Califf, R.M., Funk, M. Kaufman, E.S., Krucoff, M.W., Laks, M.M., Van Hare, G.F. (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, 2721-2746. Singer, A., Visram, F., Shembekar, A., Khwaga, M., Viccelio, A., (2005). Telemetry monitoring during transport of low-risk chest pain patients from the emergency department: is it necessary? Academic Emergency Medicine, 12 (10), 965-969.

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