Telemetry Monitoring in the Hospital Setting: A Review of the Evidence

Tuesday, 8 July 2008: 8:50 AM
Cecelia L. Crawford, RN, MSN , Regional Nursing Research Program, Kaiser Permanente, Southern California, Pasadena, CA
Nancy Tankel, RN, MN , Patient Care Services/Woodland Hills Department of Nursing, Kaiser Permanente, Woodland Hills, CA

Learning Objective 1: discuss two actions affecting the safe delivery of care to telemetry patients.

Learning Objective 2: describe three key elements to ensure safe and effective telemetry monitoring of the hospitalized patient.

This presentation is an investigative discussion of the results of an integrative review of the evidence associated with telemetry monitoring in the hospital setting. A web-oriented database search conducted on CINAHL, MEDLINE, Ovid, and Yahoo used the terms “dedicated monitor watcher” and “telemetry monitoring.” The final search yielded 14 articles, which were reviewed in detail, and 10 selected as relevant for inclusion. The strength of the research evidence ranges from insufficient to good, with a final grade of fair. Published clinical trails surrounding hospital cardiac monitoring are almost nonexistent. The relevance of research studies from the mid-1990s is questionable, as the clinical practice environment and monitoring technologies have evolved tremendously over the last 15 years. The evidence reveals no clear telemetry monitoring guidelines. The lack of concrete guidelines creates wide variation in telemetry monitoring practices and puts patients, nurses, and healthcare organizations at risk. Additionally, a shortage of clinical experts has spurred the implementation of remote telemetry monitoring, with and without dedicated nurse monitor watchers. Research suggests that the simultaneous tasks of remote telemetry monitoring, coupled with patient care, places unnecessary demands on nursing time and workload. The coupling of these tasks negatively affects patient care and offers multiple opportunities for communication errors or breakdown. Observing the patient through the technology itself forces the nurse to plan care interventions based on readily available but possibly incomplete information. Research evidence emphasizes the need for medical and nursing leadership to evaluate individual monitoring environments and unique patient populations when choosing a telemetry monitoring system.