The design, implementation and evaluation of telemetry waveform alerts for cardiac patients in an acute care hospital setting’
Summary
This project entailed to increase the clinical knowledge and understanding regarding design, implementation and evaluation of Care event telemetry waveform alerts for cardiac patients in acute care setting. The CareEvent Telemetry alert system is implemented in Cardiology units of William Osler Health System two sites Brampton Civic Hospital and Etobicoke General Hospital.
Telemetry monitoring is the wireless monitoring of heart activity and analyzing of data that is received at a distance from their source. The patient is fitted with a transmitter, which sends the data to the area monitor. The project included collaboration between the Fellow and team members -Program Director, Managers, Physician leads, Nurse Educators, Project Management Specialists and Professional Practice teams. The fellow and team support to build the principle design and cross- site transferability expertise which included practice guidelines, policy care paths developed.
Each unit has 37 telemetry packs connected to the Central station. Approximately 165 patients are on telemetry per month per site. Prior to the project there was no line of sight for nurses to see or monitor arrhythmias when they are away from the central monitor. The Resource nurse, primarily located at the nursing station responds to alarms heard, in addition to maintaining unit responsibilities. The Resource Nurse role is not available for evening and night shifts. A Team lead with their independent patient assignments add this task of monitoring the desk to their role. Staffing numbers reduce over the evening and night shift.
Significant risk occurs when fatal arrhythmias alerts and no one is at the central station actively monitoring. Critical care reviews have identified missed events and occasions where timely management was delayed, increasing patient length of stay and increased utilization of telemetry. To mitigate this risk with 24/7 line of sight of the waveforms and care events, the project involved the design utilization for CareEvent software with hand-held devices for nurses. It enabled timely alerts, view of the alarm, prompt nursing triage and management. The nurse acknowledges abnormal rhythm, reviews it in real time and cares for the patient using the care paths developed.
Overall Learning:
The learning goals of this Fellowship was ‘To increase my clinical knowledge and understanding regarding the design, implementation and evaluation of Care Event telemetry waveform alerts for cardiac patients in an acute care hospital setting’. I have developed a deeper insight and increased understanding of a multifactorial project design. I have cultured the process of collaboration and developed communication and networking skills due to the planning with multiple placeholders within organization and external collaborations. Reviewing and comparing like versus similar care paths were part of the learning gained. Risk strategizing and mitigation were concepts learnt as part of this project.
I conducted systematic reviews, summarized key concepts of evidence-based practice applicable to the clinical settings and embedded them within the existing care paths. I have enhanced my knowledge of remote telemonitioring. The expertise to develop and transfer new information and bring about change in practice was learnt during the implementation-education phase of the use of the hand held devices.
I have sharpened skill in processes of building policy and knowledge of integrated care paths. Through the course I have coached development of learning plans, education material and handouts. The skill to use new technology with the current Telemetry system was enhanced. Ability to discern Care event triggers, gaps and set system defaults were sharpened thus improving my expertise in care of cardiac patients. With this fellowship I have set process for comparative reviews of care events notifications and response times to use of care paths by team members to demonstrate the change in practice.
Outcomes
Patients were provided with information at the time of admission regarding telemetry monitoring and process used to review notifications. Patient are involved in care plans and are a part of the transfer of accountabilities at shift change. This promoted better engagement, ensuring keeping ECG leads on and reporting any change in their health pattern.
The enhanced monitoring and early response to an event reduced the gap in care process significantly resulting in a decreased number or potential harmful events and safe quality care delivered. Patients and family member’s satisfaction levels increased as captured by anecdotal responses as they were involved in the care management. Patients were reviewed for appropriate use of telemetry, resulting in discontinuing telemetry if indications were not met improving patient satisfaction and appropriate care paths followed.
As processes for telemetry monitoring were being reviewed, new care paths were embedded within existing care paths and plans. Redundant practices were reviewed and eliminated. There is enhanced collaboration with care teams via bullet rounds, bed side transfer of accountabilities and shift assessments.
The workflow considered review of the flow map for acknowledging alarms at the central station versus at the patient bedside. The decisions to permit access and acknowledge and accept alarms at the patient bedside transmitter was much appreciated. The time gained enhanced both nurse and patient satisfaction.
As the project is in its early stages, robust review of change in response time is not well established, however is to be captured at the 3 months of implementation. Anecdotally, staff satisfaction responses have been captured post education sessions and refresher days. There is narrative description on less time spent walking towards the central monitor versus assessing the patient immediately as they view the alert on their personal hand-held device (phone).
Team collaboration with IS team, project management teams, nursing advisory councils has improved. Organizational risk assessed for the gap to care prior to the use of the secondary alert system has significantly reduced due to the early assessments, defined roles and responsibilities. The cross site integration has enabled shared practices and additional resource availability while in need.
Refresher training for Telemetry monitoring and code scenarios identified service and knowledge gaps which were addressed immediately. This enabled to develop trust and reliability with teams, encouraging stronger Team dynamics.
Overall experience
Patients were provided with information at the time of admission regarding telemetry monitoring and process used to review notifications. Patient are involved in care plans and are a part of the transfer of accountabilities at shift change. This promoted better engagement, ensuring keeping ECG leads on and reporting any change in their health pattern.
The enhanced monitoring and early response to an event reduced the gap in care process significantly resulting in a decreased number or potential harmful events and safe quality care delivered. Patients and family member’s satisfaction levels increased as captured by anecdotal responses as they were involved in the care management. Patients were reviewed for appropriate use of telemetry, resulting in discontinuing telemetry if indications were not met improving patient satisfaction and appropriate care paths followed.
As processes for telemetry monitoring were being reviewed, new care paths were embedded within existing care paths and plans. Redundant practices were reviewed and eliminated. There is enhanced collaboration with care teams via bullet rounds, bed side transfer of accountabilities and shift assessments.
The workflow considered review of the flow map for acknowledging alarms at the central station versus at the patient bedside. The decisions to permit access and acknowledge and accept alarms at the patient bedside transmitter was much appreciated. The time gained enhanced both nurse and patient satisfaction.
As the project is in its early stages, robust review of change in response time is not well established, however is to be captured at the 3 months of implementation. Anecdotally, staff satisfaction responses have been captured post education sessions and refresher days. There is narrative description on less time spent walking towards the central monitor versus assessing the patient immediately as they view the alert on their personal hand-held device (phone).
Team collaboration with IS team, project management teams, nursing advisory councils has improved. Organizational risk assessed for the gap to care prior to the use of the secondary alert system has significantly reduced due to the early assessments, defined roles and responsibilities. The cross site integration has enabled shared practices and additional resource availability while in need.
Refresher training for Telemetry monitoring and code scenarios identified service and knowledge gaps which were addressed immediately. This enabled to develop trust and reliability with teams, encouraging stronger Team dynamics.
