Hardwire the Guidelines
According to Yeow and colleagues, incorporating AHA guidelines into the EHR provides the greatest success in reducing telemetry use. For example, hard-stops in the ordering process will force the provider to consider whether telemetry is needed.
Protocols or order sets that have telemetry pre-selected should be revised with options that include 12, 24, or 48 hours. At the end of that time, the care team can assess whether telemetry should be continued based on the patient's clinical status. According to the AHA guidelines, an "until discontinued" or "until discharged" option isn't clinically indicated for most patients outside of critical care units.
The ordering provider should be required to input a clinical indication, which presents an ideal opportunity to choose from a list based on AHA classes. When "Other" is an option, providers should be prompted to enter a reason, which can be reviewed later for quality improvement data.
Eliminating automatic telemetry orders and "until discontinued" options gives providers the opportunity to evaluate clinical indication for individual patients. The key is creating an intervention that's the least disruptive to providers' workflow.
In addition, telemetry should be included in a patient's status board along with date of order, length of application, and clinical indication chosen by the ordering provider. Pop-up reminders can encourage providers to address telemetry status, although pop-ups may be ignored because so many reminders for other issues exist in many EHRs.
Some organizations may have an audit process for telemetry information that's assigned to telemetry technicians or quality assurance personnel. However, making telemetry information easily accessible can aid caregivers in auditing telemetry data. This process also will help identify patients who should be on telemetry but aren't.
Am Nurs Journal. 2021;16(7) © 2021 HealthCom Media