Implementing an Electronic Telemetry Downgrade Score on a General Surgical Unit

Abstract

Problem: The problem at a Magnet® designated medical center was the continued use of telemetry monitoring when the monitoring was no longer indicated on adult non-intensive care patients. Continued telemetry past patient need, limits the availability of this monitoring for patients who require it when there is a limited supply of telemetry-monitoring packs. The hospital has a Clinical Decision Support (CDS) Telemetry Downgrade Score (TDS) tool in the electronic health record (EHR); however, it is underutilized. Evidence supports the use of both CDS and TDS by providers and nurse helps to yield fewer telemetry orders and less time on telemetry. Inappropriate ordering of telemetry monitoring may adversely affect both patient and staff satisfaction and increase the length of stay (LOS). Purpose: The purpose of this quality improvement project was to implement the use of the TDS tool for the providers and nurses to evaluate the patients need for continued telemetry. Methods: The providers and nursing staff were educated on the use of the TDS tool and the 2017 AHA guidelines. Mentoring and support were given to providers and nurses through emails, rounds, and meetings. During a 15-week implementation timeline, retrospective audits were completed collecting data on the duration of telemetry hours’ time stamps and indication for use, including pre and post intervention audits. Using run charts, measurement trends were analyzed. Results: Nurses and providers were educated on the intervention meeting the goal for day shift of 65 staff or 30% of the total staff. Over the 15 weeks, 415 patients were placed on telemetry. Telemetry hours for the pre-intervention period was 1034 median hours compared to 614 post-intervention period. Displaying evidenced-based guidelines and an electronic TDS, appropriate ordering improved by almost 20% and duration decreased by 422 hours. Moreover, this project provided more availability to monitoring packs for those patients’ requiring placement. Conclusions: When a TDS tool was used following education and active stewardship, more patients were appropriately placed as well as appropriately discontinued on telemetry, resulting in increased telemetry monitoring packs capacity.