SBAR

Situation:
The SSMC HDU ECG monitors for telemetry are not being continuously observed 24/7.

Background:
HDU located in Tower D 5th floor has full capacity 10 beds. All patients admitted to HDU are currently monitored,
continuous Heart Rate/Rhythm, Blood pressures, Continuous Oxygen saturation. Standard of care in HDU for all
patients to have vital Signs documented one hour or more based on condition and treatment. The Nursing to
patient ratio is 1:2, so if the nurse is busy with their second patient, then possible first patient (ECG Rhythm) will not
observed. Previously Charge Nurse has been assigned to actively monitor those other patients via two screen placed
in the Nursing station. Now with the combined MICU/HDU role of the Charge Nurse this monitoring is not possible.

Assessment:
Options discussed:

a) Possibility hire new ECG technicians to Monitor, which could mean up to three new staff.
b) Move the wiring for HDU Monitors to already available MICU screens or to the Tower B 5 th Floor (Med-Tele
section) Screens. We discussed this with BioMed/IT team they reported movement of the wiring of this kind
is not possible.
c) Utilize already available ECG technicians in Tower B 5th Floor (Med-Tele) to observe HDU patients ECG
rhythm and saturation remotely.

Recommendation:
Given our available resources, a Pilot was started (13 th Jan) for HDU patients with the portable telemetry device that
can transmit ECG and Pulse Oximetry. HDU nurses will still be responsible to round and do Blood pressure and
Respiratory rate using the HDU monitors.

ECG technician will do communication directly to Assigned nurse if any change in Rhythm, and generate a report
only if any changes occur. Using Vocera to communicate directly with Primary Nurse “Call D509 Nurse”. Staff can
reach the Technician through Vocera “Call Telemetry Tech”

In situations as code blue or anytime Physicians/Nurses want to see rate/rhythm in the room, the nurse can re-
attach GE Monitor leads. Heart Rate and Lead II rhythm is available also on the small remote monitoring device at
the bedside.

For the remote telemetry monitoring to start a Physician needs to place a Remote Telemetry Monitoring order.
Currently the order will need to be renewed every 48 hours. Once order placed the ECG technicians will come to
attach the remote monitoring device on the patient.

There is a request for nurses to be able to place an order for Remote Monitoring with Physician co-sign, and once
order is placed it continuous runs until patient discharged form HDU.

We need communication to all Internal Medicine team, Nursing team, ICU team and the CMO office about this new
Pilot.