Brilliant policy number 456: Thou shalt put all patients who are on cardiac monitors on a portable monitor who have to leave the department for CT or xray and have them accompanied by a nurse. A nurse with portable monitor shall acommpany any patient being admitted to their room post haste. This is thine edict from above henceforth from this day.
The scathingly billiant designers of our ER decided when they renovated 20 years ago to have our patients be on hardwire connected to the monitors. In other words, there is no tele pak. Now xray does not want wires on the patient especially for CXR because they will interfere with the picture. So that won't exactly fit with the put on monitor to go to xray or CT.
So you are telling me that a couple of nurses will be gone from the department with their patients in xray leaving the other nurses to watch their other patients. Makes sense to me. Nurses will also be gone transporting their patients to tele floors.
Xray and tele are across the hall from the ER. We have always removed the monitor from stable tele patients while they spent the 5 minutes in xray or CT. We have also sent stable tele patients up to their rooms with non nursing personnel. But no more....Joe Smith might have a PVC or something.
More assinine changes by those who don't actually DO the job. Of course all of this has to be done with the same amount of nurses. Guess I'll have to take less patients and that things are going to slow down to accomplish this task...how does your ER handle this?
Sorry, don't understand this. Do you mean you don't monitor patients who go to CT or are admitted?
ReplyDeleteIn my department if a patient is monitored Xray come to them (we have XR machine on roof and it is slid to patient) and monitor leads stay in situ. If a monitored patient is transferred anywhere - wards or CT then they are monitored on a portable monitor and a nurse goes with them.
People in my department GO to xray, except if a portable xray is ordered. The noncritical tele patients have always gone to xray or CT unmonitored. They are also taken up to inpatient rooms unmonitored. These people are STABLE. The new policy requires that a nurse put them on portable tele pak and go with them to xray or CT and up to inpatient rooms.
ReplyDeleteI always forget the differences in UK and US in that you use CT way more than we do. Not a criticism, merely an observation.
ReplyDeleteMy thinking is if a patient needs monitoring in the ED then regardless of how stable they are they need monitoring in transit. And if you are monitoring a patient then a nurse has to go with them to observe monitor. Had too many stable patients arrest in lifts (elevators) or corridors en route to a bed.
Our patients go on monitor...strung with wires - normally all in a huge mess to xray. CT and xrays done with wires pulled to the side as much as possible. If the pt is a stable tele then we will remove the monitor. Nurses do not go unless the patient is dramatically unstable at the time of transport. It sounds like your ED is short staffed just like the one I am at and I can not imagine nurses leaving the floor with every tele patient!!!!
ReplyDeleteI'm surprised you folks are only starting this now. We've been doing this for years in my ER. Personally I have always thought it is a massive waste of time and nursing hours.
ReplyDeleteWe do that too. Our nurses hate it.
ReplyDeleteWe only do this for ICU patients, or shit would come to a screeching halt, although thanks to a write up pissing contest between the radiology department and our day shift, radiologists are no longer allowed to reconnect patients to the cardiac monitor. So, if you're in a code and your teammates aren't helpful/listening, your chest pain patient may be off the monitor for an hour or so. Brilliant.
ReplyDeleteHave to admit I am hugely surprised about this. From what I have read on various blogs, in US you take baseline obs on everyone who comes through your doors even the most minor of injuries. So it is interesting that you don't feel the need to monitor patients in transit who required monitoring in your department. Curious as to what happens if a stable patient arrests en route or deteriorates and what would be the consequences?
ReplyDeleteMonitored patients are monotored with a nurse or paramedic on any transport out of the department; ICU patients must have TWO to transport, one of which needs to be ACLS certed. That is more of a shameful waste of resources in my estimation.
ReplyDeleteOur regular tele floor patients go to floor unmonitored. Those that go to the unit go on portable monitor with RN.
ReplyDeleteOnly unstable patients have RN go with to CT with portable monitor on.
Of course- our hospital is small in comparison to the corporate mecca in the big city.
All of our patients who get IVP narcs get put on monitors, but they are not required to be on one once they are on the floor.
Is this just an ER polciy or housewide? On the floor unless some is on a drip or extremely unstable they go unaccompanied. We leave the monitor on so we can watch the screen on the floor.
ReplyDeleteAnd just as an side I see a lot of overuse of telemetry.