Background: Continuous cardiac monitoring (CCM) is intended to capture cardiac events including ischemia and life-threatening arrhythmias. Guidelines created by the American Heart Association address the likelihood that a patient will benefit from CCM. While general ward medical-surgical populations are not clearly addressed, several studies have reported that the rate of clinically significant telemetry events in this population is very low. The University of New Mexico Hospital (UNMH) has no formal policy surrounding initiation or discontinuation of CCM. Purpose: The workgroup identified two major goals after collecting data on cardiac monitoring use at UNMH: (1) to decrease physician over-ordering of CCM and (2) to decrease the use of CCM in patients who do not have a physician order for this monitoring. Description: Initial steps targeted towards reduction in physician ordering included a presentation at the Internal Medicine Best Practice series to address indications for cardiac monitoring and the presence of physician overuse within our system, presentation of articles that highlight overuse of CCM at the Internal Medicine Journal Club, and the development of a tool that highlights whether patients have an active order for CCM within the sign-out tool (Cache). Our current data collection shows a trend towards decreased physician ordering of CCM. Initial steps targeted at reduction in placement of CCM by nursing staff without orders have included the recruitment of a nursing champion, a nursing survey to identify knowledge and attitudes surrounding CCM, development of an educational poster to highlight the disadvantages of overuse (alarm fatigue, tethering, cost), and a presentation to the RN executive council. Data collection continues to show approximately 10-15% of patients on CCM without physician orders. Conclusions: The CCM workgroup was developed to address the overuse of cardiac monitoring at UNMH. We have shown a small decrease in physician ordering of CCM with educational interventions and a small change to the CPOE. Identified next steps include involvement of other departments within the hospital, removal of CCM from powerplans that are not associated with guideline indications and, ultimately, requiring an indication and duration in order to initiate CCM. Our data collection identified an additional issue related to overuse without a physician order that has not been widely reported in the literature to our knowledge. Our approach has been to align with a nursing champion to explore the causes of overuse. We have begun an educational campaign with individual nursing units that we hope to expand hospital-wide.
Lacy, Mary and Patrick Rendon. "Development of a Multidisciplinary Approach to Address the Overuse of Telemetry." (2015). http://digitalrepository.unm.edu/hostpitalmed_pubs/1