Introduction: Ward telemetry aims to promptly identify cardiac arrest and life-threatening arrhythmia. The value of telemetry systems relies upon staff to regularly interrogate and action recordings. Several factors, such as alarm fatigue, system unfamiliarity or staffing pressures, can serve as barriers to regular interrogation and judicious discontinuation of telemetry. British Heart Rhythm Society (BHRS) and American Heart Association (AHA) guidelines advocate for formalised ward telemetry monitoring routines. These aim to improve frequency of checks and enhance telemetry initiation and discontinuation accuracy. UK centres lack comprehensive guidelines on telemetry initiation and discontinuation.
Aims: 1. To develop a multidisciplinary telemetry monitoring sheet (TMS) and study its impact on detection and actioning of telemetry events at a tertiary cardiac centre. 2. To develop a comprehensive guideline on the indications for telemetry initiation and discontinuation for use at UK hospitals, based on existing guidance.
Methods: A multidisciplinary taskforce of doctors, specialist nurses and education facilitators was created at a tertiary cardiology centre. A TMS was devised and underwent several test iterations. It consists of a single sheet of paper with stepwise instructions for documenting rate, rhythm, battery level, alarm settings, events and escalation plan. The TMS mandates four times daily interrogation of telemetry – all incorporated into the nursing and medical staff’s ward routine. Baseline characteristics of telemetry practice were studied prior to introduction of the TMS on three cardiology wards between March and June 2021. Rate of event detection and escalation were then recorded at 1 week, 1 month, 3 months and 6 months after introduction of the TMS on these wards. For the second aim, existing BHRS and AHA guidelines were expanded with local guidelines and literature searches to create a resource of telemetry indications and durations – called the telemetry initiation and discontinuation sheet (TIDS). The TIDS underwent review and confirmation by multidisciplinary cardiology management and clinical governance bodies.
Results: Recognition and/or actioning of telemetry events increased from 41.3% (19 of 46 patients) to 82.9% (34 of 41 patients) after introduction of the TMS (week 1 100%; 1 month 100%; 3 months 100%; 6 months 78.1%, where use of the TMS had decreased on one of the wards). The percentage of patients on telemetry without an accepted indication for continuous monitoring was 24.6% (29 of 123 patients) prior to TMS introduction and 25.5% (28 of 110 patients) post TMS introduction.
Conclusions: The TMS significantly improved detection and actioning of telemetry events. This supports BHRS guidance to formalise telemetry interrogation into ward routines. The TMS made no significant difference to rates of correct initiation and discontinuation of telemetry, suggesting a knowledge gap on existing guidance or limited implementation of BHRS guidelines. Staff surveys revealed poor knowledge of indications for telemetry initiation and discontinuation. The creation of comprehensive telemetry indication guidelines – TIDS – has the potential to bridge this knowledge gap and become a standardised BHRS document that is easy to implement at UK centres. Studies assessing the impact of TIDS, in combination with TMS, on telemetry practice at our centre are ongoing. ❑