TELEMETRY &

DETERIORATION
Objectives
At the conclusion of this educational activity, participants
should be able to:

Define Telemetry
Distinguish the responsibilities of a telemetry nurse
Define alarm fatigue and describe potential errors that
can occur due to alarm fatigue.
Assess the deteriorating patients and early detection.
Case: Harm From Alarm Fatigue
• A 54-year-old man with hypertension, diabetes, and end-stage renal disease on
hemodialysis was admitted to the hospital with chest pain. His initial
electrocardiogram (ECG) showed no evidence of significant ischemia but cardiac
biomarkers (troponin T) were slightly positive. He was admitted to the
observation unit, placed on a telemetry monitor, and treated as having a
NSTEMI.
• Overnight, the patient's telemetry monitor was constantly alarming with warnings
of "low voltage" and "asystole." The bedside nurse initially responded to these
alarms, checking on him several times and each time finding him to be well. The
resident physician responsible for the patient overnight was also paged about the
alarms. He came and checked the patient and the alarms and was not concerned.
Both clinicians felt the alarms were misreading the telemetry tracings
Case: Harm From Alarm Fatigue
• The nurse and resident decided to silence all of the telemetry alarms (this
observation unit did not have constant or centralized monitoring of telemetry
tracings). The patient was not checked for approximately 4 hours.
• When the bedside nurse went to perform morning vital signs, the patient was
found unresponsive and cold with no pulse. A code blue was called but the
patient had been dead for at least a few hours. The cause of death was unclear,
but the providers felt the patient likely had a fatal arrhythmia related to his
NSTEMI.
Background: Telemetry Monitoring
• Hospitalized patients often monitored using telemetry
• A standard electrocardiogram (ECG) acquires data from 12 different leads
• Telemetry monitoring is a 5-electrode configuration
• A computer algorithm then continuously analyzes a limited number of leads
(usually 1–2)
• The algorithm monitors for arrhythmias or other significant changes
What you mean by Telemetry

It is the measurement of date at a remote source and transmission of the data to a

monitoring system
BENEFITS
Early detection of changes
Maximization of health care workers time
Detecting discomfort
Patient satisfaction
This Case
• Silencing all telemetry alarms in this patient was an error that contributed to his
death
• This patient was at risk for an arrhythmia due to his acute myocardial infarction
• Presumably an arrhythmia would have triggered an appropriate alarm had the
alarms been functioning
• This adverse event reveals a clear hazard associated with hospital alarms
Misreading Asystole
• Telemetry devices often misidentify heart rhythms as asystole
• Most common cause is failure to detect low-voltage QRS complexes
• In this case, telemetry monitor was "misreading" the patient's heart rhythm
• True asystole would have been clinically apparent
• The nurse appropriately checked on the patient and contacted the physician
• However, the correct response should have been to search for another lead with a
larger QRS complex
Dangers of Excessive Alarms
• The biggest harm from alert fatigue is that a patient develops a life-threatening
problem that is missed because of excessive false alarms
• Many factors result in excessive cardiac monitor alarms including:
• Alarm settings not tailored for the individual patient
• Presence of certain patient conditions like low ECG voltage, pacemaker, or a
bundle branch block
• Deficiencies in the computer algorithm
Take-Home Points
• Alarms should never be completely silenced; clinical staff should instead
problem-solve why an alarm condition is occurring and work to resolve it
• Cardiac monitor devices have a high sensitivity for detecting arrhythmias and
vital sign changes but a low specificity
• Therefore, they generate many false positive alarms
• Clinicians should learn to tailor alarm thresholds to individual patients to avoid
excessive alarms and alarm fatigue.
• Customize alarm setting to individual patients.
• Determine default alarms.
Deteriorating patients
• What is the most reported patient safety risk?

 Failure to rescue
Deteriorating patients
Deteriorating patients
Deteriorating patients
Deteriorating patients
THANK YOU