AACN News—August 2008—Practice
Vol. 25, No. 8, AUGUST 2008
Practice Resource Network: Telemetry Monitoring Standards
QIs there a standard for the number of telemetry channels one monitor technician can safely monitor? Are there any education standards for personnel who monitor cardiac rhythms??
A Over the past two decades, the number of acutely ill patients requiring cardiac telemetry monitoring has grown. In response, the use of remote telemetry monitoring has also grown. The use of remote telemetry monitoring with dedicated monitor technicians allows patients in virtually any location in the hospital to benefit from continuous telemetry monitoring. Dedicated monitor watchers are frequently used to observe cardiac rhythms for dozens of patients, to document rhythm strips, measure ECG intervals and communicate any changes in the patient’s cardiac rhythm to the registered nurse caring for the patient.
In 2004, the American Heart Association published the Practice Standards for Electrocardiographic Monitoring in Hospital Settings. These practice standards provide a look at the “best practices” for in-hospital ECG monitoring. The recommendations include information on the indications for monitoring, mechanisms for improving the accuracy of cardiac arrhythmia identification, ischemia and QT-interval monitoring as well as staffing, training and quality improvement recommendations.
There are no recommendations to delineate the specific number of patients one monitor tech can safely monitor. This number will vary from facility to facility and even within an organization. Answering some of the following questions will help determine the number of channels that may be safely monitored.
• What are the capabilities of the current monitoring system? What is the extent
of the arrhythmia and ischemia detection and alarms?
• Do the monitor techs have other duties that can cause a distraction such
as secretarial duties?
• What type of communication system is present for the monitor tech to communicate with the caregiver directly?
• Are the monitor techs in close proximity to assistance if needed?
Monitor techs must be educated in their roles and the equipment they are using. The 2004 Practice Standards for Electrocardiographic Monitoring in Hospital Settings states, “Staff members who are responsible for ECG monitoring should receive formal orientation and training that is specific to the type of monitoring system being used and to the goals of monitoring for the patient. Appropriate training must include both didactic content and hands-on practice with return demonstration. Being able to demonstrate accurate electrode placement is especially important because inaccurate lead placement is common in hospital units and can result in misdiagnosis.” Among the recommended skills are:
• Operation of monitoring system used in hospital unit (arrhythmia, ST monitoring)
• Recognition of limitations of computer algorithms
• Proper skin preparation for applying electrodes
• Accurate electrode placement for system used (e.g., reduced lead sets)
• Setting heart rate, ST alarm parameters appropriately
• Measurement of heart rate and intervals (use of ECG calipers)
1. Barbara J. Drew, Robert M. Califf, Marjorie Funk, Elizabeth S. Kaufman, Mitchell W. Krucoff, Michael M. Laks, Peter W. Macfarlane, Claire Sommargren, Steven Swiryn, and George F. Van Hare. Practice Standards for Electrocardiographic Monitoring in Hospital Settings: An American Heart Association Scientific Statement From the Councils on Cardiovascular Nursing, Clinical Cardiology, and Cardiovascular Disease in the Young: Endorsed by the International Society of Computerized Electrocardiology and the American Association of Critical-Care Nurses. Circulation, Oct 2004; 110: 2721 - 2746. (accessed 6/29/08 at http://circ.ahajournals.org/cgi/content/full/110/17/2721#SEC5)
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