MARSHALLTOWN MEDICAL & SURGICAL CENTER Marshalltown, Iowa

Transcription

1 MARSHALLTOWN MEDICAL & SURGICAL CENTER Marshalltown, Iowa CARDIAC SERVICES POLICY & PROCEDURES Policy Number: N-15 Subject: Policy: Purpose: Cardiac Event Monitoring Cardiac Services will apply and inform patients of reasons to wear a cardiac event monitor. To provide care to patients wearing Cardiac Event Monitors for the purpose of diagnosing or ruling out cardiac dysrhythmias that cause transient symptoms. Level: Interdependent and dependent. Interdependent roles: 1. Cardiac Services Department is responsible for placing the monitor, educating the patient, providing supplies to the patient, taking calls from patients regarding the monitor itself, logging the exam, billing for the exam, routing the rhythm strips, maintaining the equipment, the quality monitoring, and coordinating the activities related to this exam. The Cardiac Services Department will instruct the patient on how/where to return the monitor when testing is completed. 2. The ICU is responsible for taking the event calls from patients, evaluation of rhythm strips, notification of the physician of critical dysrhythmias, and advising patient of action when appropriate. 3. The physician will interpret the rhythm strips and diagnose and treat the patient. Supportive Data: A cardiac dysrhythmia may preceed symptoms. The Cardiac Event monitor will allow a recording of a pre-symptom EKG. Content: Assessment: Please refer to the Cardiac Event Procedure. When a patient calls ICU to report they are ready to play back a recording, the nurse or monitor tech will: 1. Begin the Record of Transmission Form 2. Review the playback procedure with the patient. 3. Ask the patient to stay on the line following the transmission. 4. Verify the rhythm strip was generated with the call. Intervention by nursing staff: See the attached algorhythm for decision making. Emergency Interventions: See "Interventions by Nursing Staff" Physician Notification: See "Interventions by Nursing Staff"

2 Cardiac Event Monitoring Page 2 Safety: See "Interventions by Nursing Staff" Infection Control: 1. Handwashing prior to placing device on patient (Cardiac Services) 2. Disinfect pouch with hospital grade germicide after patient use. 3. Alcohol to wipe off the electrodes and recorder between patients. 4. The surfaces must remain wet with the germicide the contact time set by the manufacturer. Patient Teaching: Cardiac Services: 1. Purpose of the exam 2. Care of the monitor 3. How and when to change electrodes 4. How and when to change batteries 5. Recording an event 6. Playback the recording 7. When to return the monitor 8. Answer patient questions ICU: 1. Review the playback procedure 2. How to reach the physician if appropriate 3. How to reach the Emergency Department if appropriate 4. Answer patient questions Documentation: 1. Cardiac Services staff will: a. complete the Event Monitor Enrollment and History Form. A copy of this form will be sent to the ICU. This will include a baseline rhythm strip generated during enrollment. b. make copies of all transmissions and send original to the physician for interpretation. c. fill in log book at time of enrollment. 2. The ICU staff will: a. complete the Record of Patient Transmission Form b. route the Record of Patient Transmission Form and rhythm strips to Cardiac Services or the Emergency Department as indicated. Originated by: Cardiac Services Effective date: February 1996 Authorized by: ICU Cmte 10/10 Authorized by: Nurse Executive Date Revision date: 9/01, 6/04, 10/10 Review date: 7/07 Distribution: ICU, Cardiac Rehab, Cardiac Services

3 References: Instromedix, Hillsboro, Oregon. (Extensive bibliography used by Instromedix is available in Cardiac Services) Interventions were recommended by the ICU/EKG/Treadmill Committee.

4 Cardiac Event Monitoring Page 3 CARDIAC EVENT MONITOR CHECKLIST 1. FIND PATIENT S ENROLLMENT FORM. 2. PULL A TRANSMISSION FORM. 3. FILL OUT TOP PORTION OF TRANSMISSION FORM. 4. TURN ON THE RECEIVING UNIT AND CHANGE MODE TO AUTO. 5. REVIEW TRANSMISSION PROCEDURE WITH PATIENT. 6. TELL PATIENT TO UNPLUG LEAD WIRE FROM RECORDER AND PLACE MOUTHPIECE OF PHONE ON RECORDER AND PUSH SEND. THEY MUST LEAVE THE PHONE ON THE RECORDER FOR 1 ½ MINUTES THEN GET BACK ON PHONE. 7. PLACE YOUR PHONE ON THE COUPLER, AND COMPLETE THE TRANSMISSION. *WHEN NOISE QUITS PICK UP PHONE AND CAN TALK WITH NURSE. 8. NURSING USES PROTOCOL ALGORHYTHM FOR DECISION MAKING. 9. INFORM PATIENT OF OUTCOME OF TRANSMISSION, AND TO REPLACE THE LEAD WIRE BACK INTO RECORDER. 10. WRITE NAME AND DATE ON RHYTHM STRIPS. 11. SEND TRANSMISSION FORM WITH RHYTHM STRIPS TO THE E.D. OR CARDIAC SERVICES AS APPROPRIATE. 12. IF SENDING TO E.D. PLACE A NOTE ON THE FORM REMINDING E.D. TO SEND TO THE CARDIAC SERVICES DEPARTMENT WHEN PATIENT HAS COMPLETED THEIR VISIT. P:\Cardiac Services\carN-15r3crk.doc

5

6

7