HospitalInspections.org

Based on review of the clinical record and staff interviews the nursing staff failed to implement plan of care in a timely manner for medically prescribed Telemetry monitoring, for one of four sampled patients (Patient #2).

The findings include:

Review of the physician order for Patient #2 revealed an order dated 11/28/11 at 21:00 for Telemetry monitoring for 72 hours (continuous cardiac monitoring). A review of the patient ' s telemetry record revealed a cardiac rhythm strip and interpretation dated 11//29/11 at 04:00. The cardiac rhythm strip and nurses notes indicate physician order for telemetry monitoring was implemented seven hours after the order was received. A Registered Nurse reviewed the patient ' s clinical record and the telemetry log and verified there is prior cardiac rhythm strip for the patient.
Interview with a Registered Nurse and a Telemetry Technician at 3:30 PM on 11/19/12 revealed the telemetry order is usually implemented within thirty minutes. An initial cardiac rhythm strip is recorded and documented in the patient ' s clinical record. A telemetry technician continuously monitors the patient ' s cardiac rhythm at the telemetry monitoring station and informs the nurse of any changes. The cardiac rhythm strip is recorded, reviewed every four hours and documented in the patient ' s clinical record.
A review of the hospital policy titled Continuous Cardiac Monitoring (Telemetry) policy-PC-05-006, revised 05/2010, revealed the policy specifies (3) " Cardiac monitoring will be recorded, interpreted and documented on the initiation of telemetry monitoring, every four (4 hours) thereafter, and more frequently as indicated by the patient ' s condition. (4) The hospital maintains a log for the purpose of documenting all patients ' cardiac rhythms while on telemetry.
Review of the hospital telemetry log dated 11/28/11 and 11/29/11 revealed Patient #2 was placed on telemetry monitoring at 04:00AM on 11/29/11, the physician ' s order is dated 11/28/11 at 9:00PM. The Registered Nurse and Telemetry Technician stated they did not know why the physician order was not implemented timely.