Congress Abstracts 2004

52

IMPLEMENTING TELEMETRY: GETTING INTO THE RHYTHM. Sharon Siegelski, RN, MS, and Agnes Manka, RN, MSN, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL.

Many oncology patients have, at some point during their treatment, a rhythm disturbance that requires cardiac monitoring. These cardiac disturbances often require the patient to spend time in a critical care setting. At our cancer center, this caused anxiety for the patients and families, and resulted in census overload of the critical care unit.

Lack of availability of critical care beds caused a back up of patients in the operating room and occasionally resulted in cancellation of surgery. Patients assigned to critical care solely for the purpose of cardiac monitoring reported feelings of isolation due to the restrictive visiting hours dictated by critical care. Patients who were hemodynamically stable, requiring cardiac monitoring, posed a dilemma for the hospital and prompted the question, Are we maximizing use of our resources?

The purpose of this presentation is to describe the implementation of telemetry on an inpatient oncology unit for the purpose of offering routine cardiac monitoring to cancer patients requiring that service. At our NCI comprehensive cancer center, eight telemetry beds were designated on the neuro-oncology/blood and marrow transplant unit. The new service prompted anxiety about learning a new skill and created an expectation of greater patient acuity amongst the nursing staff members.

The change was implemented over two years. This time frame allowed for all staff to complete an ECG program and become advanced cardiac life-support credentialed. The nursing staff, along with nursing management, decided to bring up the telemetry service slowly, beginning with two patients. At first, admissions to telemetry beds were limited to two patients, admitted Monday through Friday, with careful screening by the nurse manager. Staff members are now responsible for screening patients and the number of telemetry beds has increased to five (with an ultimate goal of eight).

The cost of a telemetry bed is considerably less than the cost of a critical care bed, resulting in a cost reduction for patients and critical care beds for more appropriate utilization.

The implications for oncology nursing and nursing administration demonstrated that a team effort toward expansion of services resulted in more effective use of resources and satisfaction for all involved.