TITLE/DESCRIPTION: Admission and Discharge Criteria for Telemetry

Transcription

1 TITLE/DESCRIPTION: Admission and Discharge Criteria for Telemetry DEPARTMENT: PERSONNEL: Telemetry Telemetry Personnel EFFECTIVE DATE: 6/86 REVISED: 02/00, 4/10, 12/14 Admission Procedure: 1. The admitting or consulting physician may request admission directly to Telemetry from the emergency department or request a transfer to Telemetry from another unit. 2. All patients admitted to Telemetry must have an order stating admit or transfer to Telemetry. Purpose: Telemetry's purpose is to provide close observation and continuous specialized nursing care for the stabilization of the patient during the recovery stages of reversible life threatening disease. This may follow the patient's transfer from the Critical Care Unit or to provide close observation for the patient who requires cardiac monitoring and specialized nursing observation but does not require admission to the CCU. Admission Criteria: 1. The following broad categories of patients qualify for admission to the Telemetry Unit: A. Coronary: 1. Chest pain 2. Acute or suspected myocardial infarctions which are uncomplicated 3. Acute or suspected coronary disease with complications such as: a. Angina b. Arrhythmia's c. Post cardiac resuscitation in the recovery phase A. Pulmonary:

2 1. Acute respiratory distress 2. Pulmonary embolus in the recovery phase A. Endocrine disorders: 1. Moderate fluid and electrolyte imbalance 2. Uncontrolled symptomatic diabetes A. Multiple trauma: 1. Trauma to any organ system A. GI disorders requiring special tests: 1. GI Bleeding 2. Acute drug or alcohol overdose A. Any surgical patients with special conditions: 1. wound complications 2. medical complications which may compromise the surgical condition 3. surgical patients requiring specialized monitoring, e.g. cardiac monitoring, frequent vital signs A. Neurological - any patient with compromised system function: 1. head trauma 2. spinal cord injury 3. suspected/diagnosed cerebral aneurysm 4. cerebrovascular accident resulting in impaired or potentially compromised vital functions 5. meningitis/encephalitis 6. subdural hematoma/subarachnoid hemorrhage 7. seizures

3 Policy: The admission process and assessment will begin with the patient's arrival on Telemetry. All patients are to be weighed upon admission to Telemetry unless it is contraindicated by their condition. Patient weights are to be entered into the electronic medical record. As part of the admission process, the patient and family members are oriented to smoking regulations, equipment used in Telemetry, primary nursing personnel, meal hours, side rail positions, and linen change policy. The patient is also instructed in the use of the nurse call system, TV, and availability of telephones. Normally, electrical appliances brought in by the patient are not allowed in Telemetry. However, in special circumstances, any allowed appliances must first be checked for safety by the hospital engineering department before use in the unit. The Telemetry Unit is designed to provide maximum care for the patient requiring close observation and specialized nursing care. When the patient no longer requires constant and complex care, the physician will order the transfer out of the unit. This is to allow the best possible utilization of Telemetry beds. Discharge Criteria: 1. Medical A. Coronary disorders 1. Acute MI and/or cardiogenic shock a. absence of potentially lethal arrhythmia's in the past 48 hours b. arrhythmia's controlled by medication if necessary c. absence of significant chest pain d. vital sign within normal limits 1. Congestive heart failure a. improved chest x-ray b. normal respiratory rate and rhythm A. Pulmonary conditions:

4 1. arterial blood gases reflecting normal results for the patient 2. normal respiratory rate and rhythm 3. improved chest xray 4. stable level of consciousness A. Endocrine disorders: 1. fluid and electrolyte balance 2. vital signs stable 3. relatively normal blood sugars 4. adequate urinary output A. Multiple trauma: 1. stabilized vital signs and urine output 2. stable neurological status 3. absence of evidence of bleeding 4. arrhythmia's controlled or absent 5. stabilized lab values A. GI Disorders: 1. absence of life threatening bleeding for 48 hours 2. stable vital signs for 48 hours A. Acute Drug or Alcohol Overdose: 1. vitals stable and urinary output adequate 2. absence of lethal arrhythmia's 3. relatively normal level of consciousness 4. arrangements for psychiatric follow-up if ordered A. Surgical patients: 1. vital signs and urinary output stable 2. absence of significant wound complications

5 3. no evidence of excessive bleeding 4. any cardiac complications controlled or resolved A. Neurological patients: 1. absence of signs of increased intracranial pressure 2. vital signs stable 3. normal respiratory rate and rhythm 4. stabilized level of consciousness for 72 hours 5. absence or control of seizure activity for 48 hours 6. fluid and electrolyte balance for 48 hours