Critical Care Stepdown/Telemetry Unit

Critical Care Stepdown/Telemetry UnitAndrea Scott, Gary Webster, Laura ZwagermanFerris State UniversityMecosta County Medical Center74 bed acute-care hospital

4 bed Critical Care Unit (CCU)

27 bed Medical Surgical Unit (Medsurg)

Telemetry patients(10 beds or 5 rooms) are in Medsurg, but monitored by staff in CCU

MCMC is a 74-bed acute-care hospital serving the needs of Mecosta County and the surrounding West-central Michigan area (mcmcbr.com).2Risk Associated With Untrained Staff Monitoring TelemetryStudies have shown that nurses often monitored in a single lead, regardless of the diagnosis, did not properly prepare the skin, misplaced electrodes, and were unable to differentiate wide-complex tachycardias, all of which could lead to false alarms or misdiagnoses.Nurses working on monitored units need to know how to monitor patients' dysrhythmias effectively.(Schultz, 2011)

Medsurg nurses can have increased anxiety when caring for telemetry patients. This increased anxiety can cause the nurse to overlook non-telemetry patients. The nurse may also not look for signs of distress because someone else is also monitoring the patient.

Schultz, S.J (2011). Evidence-based strategies for teaching dysrhythmia monitoring practices to staff nurses. The Journal of Continuing Education in Nursing, 42(7), 308-314 Retrieved from https://fsulearn.ferris.edu/courses/1/80448.201208/groups/_785_1//_85952_1/Evidence-Based%20%20Strategies%20for%20Teaching.pdf3Risks Associated with CCU Nurses Monitoring Remote TelemetryTelemetry patients are currently monitored by the CCU nurses who are located in a separate unit

CCU nurses evaluate patient rhythms & call Medsurg staff with any changes or concerns

CCU nurses can be busy and unable to call Medsurg nurses when the monitor shows a change

Medsurg nurses are untrained in proper arrhythmia management

CCU is staffed with one or two RNs depending on the type and number of patients. When one or both nurses are with a patient when the monitor alarms, there is a delay before the nurse can stop, review the alarm and notify the Medsurg staff. When called, the Medsurg staff require direction from CCU staff. This can be a request to check EKG lead placement or notify medical staff urgently. Few Medsurg nurses currently have the knowledge to act alone on the information provided by the CCU nurses. 4Safety increased bySpecifically trained staff to monitor and treat telemetry patients

Monitor trained nurses will have smaller patient assignments & will be able to respond to monitor/heart rhythm problems faster

New unit will be close to CCU in case major problems arise

Staff trained in basic and advanced EKG and monitoring classes will be able to identify heart rate or rhythm changes themselves and also know what needs to be done for the rate or rhythm change.5SolutionCreation of a new Critical CareStepdown/Telemetry unit

Challenges of a New UnitChallenge: Availability of spaceSolution: Create new telemetry unit by repurposing 5 current Medsurg rooms each containing 2 patient beds

Challenge: Availability of staffSolution: Staff with current CCU nurses & Medsurg nurses who wish to complete monitor training, hire from outside hospital as needed. Current hospital staff can be moved into the needed positions & unfilled positions can be filled by new staff who can be recruited from the area including new FSU graduates

By decreasing the current Medsurg by 10 patient beds, thus creating 10 telemetry beds, Medsurg staffing will also be reduced by 2-3 nurses per shift and one health care tech per shift. This staff can potentially work in the new telemetry unit, thus reducing the cost of hiring new staff. Few new staff members will need to be added. 7Challenges of a New UnitChallenge: Staff training in telemetry monitoringSolution: Train staff who desire to work in new unit in basic & advanced EKG classes and basic medication drips. Increase the current number of available EKG classes to support the increased need for certifications and re-certifications.

Challenge: Financial impact on hospitalSolution: Start-up cost and increased staff costs are off set by increased patient safety and increased reimbursement rate

Mission StatementTo provide high quality, safe, patient centered care to patients requiring advanced cardiac monitoring in a community hospital by nurses with advanced training

9Philosophy Respect for all people

Commitment to excellence

Continuous quality improvement in all areas of service

Commitment to the health and well-being of people in our service area

Successful adaptation to technological, medical, and social changes

10Goals and objectivesGoal: provide advanced cardiac monitoring and direct patient care by nurses educated and trained in advanced cardiac monitoringObjective: To institute a new independent stepdown/telemetry unit at Mecosta County Medical Center located near the Critical Care Unit and the Medical Surgical Unit providing ten telemetry beds for cardiac patients Objective: To have 14 advanced cardiac monitoring educated nurses by June 1, 2013Objective: To provide on-campus educational support for all nursing staff members who work in the stepdown/telemetry unit in the forms of basic EKG classes and advanced EKG classes, with evaluations to ensure competency before these nurses are allowed to care for patients

11Location within the hospitals organizational chartThe new telemetry unit will be managed by the current manager of the Critical Care UnitThe new unit will be part of Clinical ServicesThe manager reports to the Chief Clinical Officer (CCO)The CCO reports to the Chief Executive Officer (CEO)

Mecosta County Medical Center has a detailed organizational chart of where each department falls and who reports to who. The new unit will fall in line with the other nursing units by being part of clinical services and reporting to the CCO.12Job PostingsJob Title: Staff RN - Telemetry

Location: Mecosta County Medical Center

Regular full-time 12 hour shifts

Schedule: 7 pm to 730 am or 7 am to 730 pm

72 hours per pay period

13Job PostingsJob Title: Health care tech/Unit secretary

Location: Mecosta County Medical Center

Regular full-time 12-hour shifts

Schedule: 7 pm to 730 am or 7 am to 730 pm

72 hours per pay period

This is a dual position where the health care tech can also do the secretarial functions as needed.14BudgetNurses - 14 full time nurses Health care techs/unit secretaries 11 full time techs

TotalBudgetNurses$838,656Techs$308,880Benefits$375,000Supplies$75,000Total first year budget$1,597,536

The new unit will be staffed with 3 nurses for each shift throughout the week. The day shift will have 3 health care techs and the night shift will have 2 health care techs. The health care techs will also be able to function as unit secretaries when needed. Weekends will be staffed with 2 health care techs on days and nights. Staff will have the ability to float to other units when the telemetry census is low. Salaries are estimated based on the top of the pay scale wages at Mecosta County Medical Center. Benefits include insurance, vacation hours, and educational assistance. The first year operating expenses includes a budget for remodeling a current waiting room to create a desk area for the telemetry unit staff.15Hours of OperationReimbursementThis unit will be open 24 hours a day, 7 days a week and maintain staffing adequate for the census levelReimbursement will come from private pay, insurance, and state and federal funds

The initial construction costs for the first year will be financed through private donations, grants, and the hospitals improvement funds16ConclusionThe citizens of Mecosta County and its surrounding areas deserve to have the most advanced medical care and cardiac monitoring available to them without having to travel farThe new stepdown/telemetry unit will provide this care and monitoring locally while maintaining the hospitals motto of advanced care with a personal touch (mcmcbr.com)

17ReferencesAbout MCMC (n. d.) In Mecosta County Medical Center. Retrieved from http://www.mcmcbr.com/Schultz, S.J (2011). Evidence-based strategies for teaching dysrhythmia monitoring practices to staff nurses. The Journal of Continuing Education in Nursing, 42(7), 308-314 Retrieved from https://fsulearn.ferris.edu/courses/1/80448.201208/groups/_785_1//_85952_1/Evidence-Based%20%20Strategies%20for%20Teaching.pdf