Reducing Overuse of Telemetry

Rachel Rotramel, MSN, CCRN, RN

Disclosures

Am Nurs Journal. 2021;16(7) 

In This Article

Daily Communications

Quality control measures frequently include discussions of urinary catheter use, fall risk interventions, and central line infection prevention, but seldom do they include telemetry use. Nurses should note which patients are on telemetry by way of report or inclusion on a safety huddle board. Next, during rounds, the nurse can ask the attending physician, "Does this patient require telemetry?" Supporting the need for discontinuation can include nursing assessment and that the patient meets discontinuation criteria.

A clinical decision-making tool or checklist created in collaboration with stakeholders on the interprofessional team can support nurses when approaching physicians or in a nurse-led discontinuation protocol. Nurses can use the tool to critically examine a patient's situation and advocate for continuation or discontinuation as appropriate.

The nurse should begin by considering the indication for telemetry (arrythmia detection, ST-segment monitoring, QT-lengthening) and then review patient information, assessments, lab results, medications, and telemetry rhythm strips. Next, the nurse should ask: Is there still an indication for telemetry? Is the patient adherent? How long does the patient require monitoring? Can telemetry be discontinued? After careful consideration, the nurse can communicate with the attending physician about discontinuation orders. If telemetry is discontinued, continual observation and assessment will take place for any change in patient status. Afterward, reflecting on the decision-making process can help inform future decisions.

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