Michigan State Council

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  • 1.  Telemetry Monitoring in the Emergency Department

    Posted 02-25-2022 09:31 AM
    Good Morning All,

    Just reaching out to see what Emergency Departments do for Telemetry Monitoring?

    Some of my questions/thoughts include:
    - Do you have someone that is responsible for constant viewing of ED patient Telemetry, such as Central Telemetry Techs that notify ED RNs of rhythm changes, etc.?
    - What protocols do your ED nurses follow in regards to monitoring telemetry? 

    I am just curious what other EDs are doing around the state-- we have an opportunity to improve the way we monitor our telemetry patients, but just seeing what practices are in use.

    Thank you,

    ------------------------------
    Brendan Franklin
    Manager of Nursing Services-Emergency Dept
    Munson Medical Center
    Traverse City MI
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  • 2.  RE: Telemetry Monitoring in the Emergency Department

    Posted 02-27-2022 01:44 PM

    Hello Brendan,

    We have a culture of exceptional team work, responsibility and accountability to help manage all patients within our areas of operation.  We are a very busy (e.g. high volume & acuity) level 1 trauma center in an urban setting. That being said, we have wall mounted telemetry stations strategically placed within the ED. They are in plain view of our nursing staff to read, record,  and respond if required. We do not have a central monitoring station staffed by a telemetry tech or nurse. Again, it is the teamwork where we look, listen and monitor the various cardiorespiratory monitors throughout the area we are working.

    We do have default alarms that can be adjusted with nurse discretion based on the patients' baseline and response to care. We document rhythm within the EMR. Once the patient is discharged, transferred or admitted, we "end the case" on the monitor so patient data does not get pulled into the next patients chart if using that function of BDMI (e.g. pulling vital sign data).

    Do you have someone that is responsible for constant viewing of ED patient Telemetry, such as Central Telemetry Techs that notify ED RNs of rhythm changes, etc.?

    No. It is the nurse and nursing team responsibility to pay attention to the cardiorespiratory monitors. Our staff is very astute on rhythms changes and manages accordingly. Everyone takes ownership of this practice.

    What protocols do your ED nurses follow in regards to monitoring telemetry?

    Many patients require cardiorespiratory monitoring. If a patient is placed on the monitor, it has been our practice and culture to document the rhythm noted. Many patients also get a 12 lead EKG which would be ordered by the provider. We do have guidelines that allow ED nurses to order 12 lead EKGs for various patients.

    Please let me know if you need anything else.

     

    Thank you.

     

    Sincerely,



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    Mark Goldstein, MSN, RN, EMT-P I/C
    Emergency Department
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    Original Message


  • 3.  RE: Telemetry Monitoring in the Emergency Department

    Posted 03-02-2022 10:38 AM
    Hello Brendan. 

    We are a 42 bed ED with 3 trauma rooms. We have telemetry clerks with centralized monitoring at our main desk with our MDs. Our clerks or an RN covering will call monitor check to the room or if a lethal rhythm is shown will call a stat monitor check and notify the coordinator on duty to assess patient. ( most often a lead fell off) but will still have a quick assessment. 

    As for protocols we have MD orders that state  "Cardiac Monitor" or "Continuous pulse ox". We also chart if the patient is on tele. Many of our abdominal pain or chest pain or abnormal lab values will have these orders. 

    Our central monitor will show cardiac rhythm and rate, pulse ox and blood pressure. We can adjust the rates to fire alarms as well. 

    Hope this helps. 

    Chelsea

    ------------------------------
    Chelsea Meixner
    Registered Nurse
    DMC Harper Hospital
    Windsor ON
    (519)984-7902
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    Original Message