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Telemetry: Less is More. The Application of Practice Standards to Electrocardiographic Monitoring of Surgical Patients

  • Author(s): Le Huquet, Cheryl Diane
  • Advisor(s): Doering, Lynn V
  • et al.
Abstract

Background: Effective utilization of resources and attention to a healthy work environment are at the forefront of nursing leadership agendas. The practice of telemetry stewardship supports a healing environment for patients and reduces alarm burden on staff. The literature is replete with studies in medical units regarding reduction of alarm burden using telemetry stewardship. However, there are no existing, prospective studies addressing the impact of telemetry utilization on alarms in surgical units. Objectives: This quality improvement (QI) project applied the best available evidence and provider preference to encourage telemetry stewardship and identified the associated impacts of appropriate telemetry monitoring on patients and staff. The unintended consequences of overuse of electrocardiographic (ECG) monitoring in the project unit included interruptions to care and alarm fatigue for patients and staff. Methods: A nurse-led interdisciplinary evidence-based QI project based on the 2017 American Heart Association (AHA) revised practice standards (Sandau et al., 2017) was implemented over ten weeks in a surgical unit in an academic medical center. Pre and post educational intervention aggregate data was obtained from the electronic health record (EHR) and standard reports. Perception of alarm fatigue and baseline adoption of standard practices were obtained using a nationally recognized survey. Results: The percentage of patients on the monitor did not change in response to the intervention (p = .12), and there was no significant reduction in alarms per patient per day

(p = .07). Results of the perception of alarm fatigue survey, while not clinically significant (p = .56), provided a baseline for the scholarly project and future QI projects. There was no increase in adverse patient events during the project. Conclusion: A nurse led interdisciplinary strategy using the AHA revised practice standards can be safely applied to a complex surgical population to create a common platform to address the burden of inappropriate telemetry monitoring on patients and staff.

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