Implementing Quality into Practice: Nurse Driven Protocol to Reduce Unnecessary Telemetry Use

Author

Richard ClappFollow

Date of Award

Spring 5-9-2020

Document Type

DNP Project

Project Team Faculty Member

Dr. Mary Barron

Project Team Faculty Member

Dr. Frank Lyerla

Keywords

telemetry, quality improvement, high value care

Abstract

Abstract

Background: As part of the American Board of Internal Medicine's Choosing Wisely initiative, the Society of Hospital Medicine issued the recommendation to reduce unnecessary use of continuous telemetry monitoring in the inpatient setting. Outside of its primary purpose continuous telemetry monitoring rarely positively impacts clinical decision making and overuse can lead to unnecessary and costly diagnostic work-ups, cause alarm fatigue, lead to emergency department congestion, and increase institutional financial burden.

Objective: Pilot an evidenced based nurse driven protocol for discontinuation of continuous telemetry monitoring to reduce unnecessary telemetry use among adult patients hospitalized outside of the intensive care unit.

Methods: The project setting was 19-bed medical/surgical acute care unit. Inclusion criteria included adult patients admitted to the project site with a provider order for continuous telemetry monitoring. A nurse driven telemetry discontinuation protocol was developed using the AHA Monitoring Practice Standards and existing hospital policy. Charge nurses used the protocol to determine patient eligibility for discontinuation of continuous telemetry without requiring provider consultation. The primary outcomes measure was total number of telemetry monitors discontinued during the 92-day project period.

Results: In the 90-day project period, 45 telemetry monitors were discontinued using the nurse driven protocol. Based on the estimated average cost of $82.44 per day and average dedicated nurse time of 20 minutes per patient per shift, the net savings was $3,709.80 and 30 hours of nurse time.

Conclusion: A nurse driven telemetry discontinuation protocol was effective in decreasing unnecessary telemetry use.

Recommended Citation

Clapp, Richard, "Implementing Quality into Practice: Nurse Driven Protocol to Reduce Unnecessary Telemetry Use" (2020). Doctor of Nursing Practice Projects. 127.
https://spark.siue.edu/dnpprojects/127

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