Progressive care unit and telemetry improve quality by reducing the number of times that patients are off telemetry monitoring

What made the unit-based team engage in this project? “The key for staff was seeing the data collected by the telemetry techs. No one realized how bad it actually was, and then how relatively easy it was to correct. This process has really helped our unit and our patients,” Dozier explains.

Benefit: "Working on this project together with the PCU is something that's needed to happen for a while, and the results we've seen have been very good for our patients," says Jeff Royse, an OFNHP member and a cardiac surveillance technician with the telemetry unit

Background: Patients on the Progressive Care Unit at Kaiser Sunnyside Medical Center frequently are cardiac care patients or patients just out of the intensive care unit. Many of these patients have doctor’s orders to be on telemetry monitoring—a best practice in the industry that allows heart rhythms to be monitored remotely using a portable tracking device. Cardiac surveillance technicians remotely monitor patients in a centralized location at the hospital.

According to patient safety guidelines, patients should not be off telemetry monitoring for more than three minutes, since possible brain damage may begin to occur within four to six minutes if a patient is without oxygen.

However, during the course of the day, telemetry monitors were routinely off the patient for more than the three-minute window. Taking the patient to the bathroom or bathing the patient were common times when the telemetry monitoring was off. There also were issues with dead batteries on the equipment, and the pads that affix the wires to the patient’s chest sometimes would not stick. In addition, sometimes patients refused to have the monitoring despite a physician’s order—they were too restless and would pull off the pads, or just didn’t like it. In those cases, nurses would alert the physician and the family.

When a patient who was not being monitored went into respiratory arrest due to neurological complications, the situation got more attention and the unit-based team partnered with the cardiac surveillance technicians to address this problem.

Getting the data
The first step was determining the magnitude of the problem—the unit-based team needed data and information. When the cardiac surveillance technicians started tracking the numbers and brought the information to the UBT, staff members were amazed. In the course of a month there were 22 incidents of a patient being off telemetry monitoring for more than three minutes.

Telemetry and the PCU worked on the problem together and put some simple reminders and processes in place. Monitors were promptly turned back on if they were removed from the patient and turned off, issues with batteries were quickly solved, and different pads were used if necessary.

The following month, the number of patients who were off telemetry monitoring for more than three minutes decreased to five incidents.

Systems problem improves through awareness
Education and awareness were at the root of this process problem. Using huddles and shift reports, staff was briefed on the situation—and the frequency of the equipment being removed from the patient decreased significantly. Through awareness and ongoing monitoring, staff members became more aware of the length of time patients were off the monitoring.

Ongoing reminders will continue, as well as continued monitoring by cardiac surveillance technicians when patients are off telemetry monitoring for more than three minutes. Co-leads will follow up to ensure ongoing focus.