From the 2019 HVPAA National Conference
Dr. Rabel Rameez (Cleveland Clinic Foundation), Dr. Bryce Montane (Cleveland Clinic Foundation), Dr. Tahani Atieh (Cleveland Clinic Foundation), Ms. Dianna Copley (Cleveland Clinic Foundation), Dr. Charlie Lin (Cleveland Clinic Foundation), Dr. Nicole Frerichs (Cleveland Clinic Foundation), Dr. Jessica Donato (Cleveland Clinic Foundation)
Studies estimate that $250,000 is spent on non-indicated cardiac monitoring in an average hospital each year. The American Heart Association (AHA) proposed guidelines in 2004 for cardiac monitoring, yet physicians continue to place patients on telemetry when it is not indicated. This is an issue because it is a waste of resources and leads to over treatment and alarm fatigue. This resident led multi-disciplinary quality improvement (QI) project aims to reduce inappropriate ordering of telemetry by residents rotating through general internal medicine (GIM) teaching service by 10% over 3 months by implementing interventions targeting nursing education.
Data was collected once a week at baseline and post intervention to ascertain the number of patients on telemetry as well as the indications for which they were on telemetry. We also checked the chart to see if the telemetry indications in the order were appropriate. This was by done going through notes as well as electrocardiograms. Nursing education was done by way of email as well as by putting up posters educating about appropriate indications for telemetry in nursing break rooms. We also added an educational section to the monthly nursing newsletter, educating about the costs as well as other cons of telemetry overuse.
At baseline, 29.3%% of patients were on telemetry, of which 40.9% were inappropriately on telemetry. Post-intervention (after nursing education via posters and the newsletter), 19.8% of patients were on telemetry of which 6.3% did not have an indication.
A significant proportion of general medicine patients are placed inappropriately on telemetry, this occurs despite institutional-level interventions to try to hard wire telemetry indications into the order set. The physician culture of ordering telemetry as a safety net, lack of awareness and knowledge regarding appropriate indications continue to serve as barriers. Our intervention was to improve nursing awareness about appropriate telemetry indications and use. This was achieved by putting up posters in nursing break rooms and using their newsletter as a simple tool to spread education. Our study showed that simple steps towards education of nurses reduced telemetry use by almost 10% and reduced inappropriate telemetry use by 34.6%.
Lack of physician and nursing awareness regarding patients’ telemetry status contributes to inappropriate telemetry use. This can be mitigated by empowering nursing staff with education regarding appropriate indications for telemetry use.