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RN Tele
Palmdale, CASCOPE OF SERVICE:
The Telemetry Unit provides individualized and age appropriate care of the population we serve. Direct care includes assessment, planning, intervention, and evaluation of the nursing process. In addition, patients receive diagnostic evaluation, cardiac monitoring, and patient/family education.
1. Unit Description:
The unit has 36 private rooms and is located on the first floor of the building. Four of the 36 rooms have negative pressure capability and two rooms are dialysis care equipped. There are two Nurses Stations, A and B, that serve the needs of all personnel, including nursing staff, physicians and any ancillary staff performing duties on the unit. Station A is the smaller of the two, and is located in the front of the Telemetry Unit by the visitors’ elevator. Station B, is bigger of the two, and is centrally located in the Unit.
2. Hours of Operation:
The Telemetry Unit operates continually, 24-hours per day, seven days per week.
3. Population Served/Services Rendered:
Population is comprised of adult and geriatric patients from different cultural groups experiencing chest pain, COPD,
coronary artery disease, congestive heart failure, pneumonia, morbid obesity.
Patients are admitted through the Emergency Department; direct admit from physicians’ offices, transfers from in-patient units, or from out-patient.
4. Volume, Average Length of Stay:
Telemetry Unit has an average daily census of 27.5 and the length of stay is 4.8 days.
5. Admission Criteria:
• Patients who require monitoring for potentially life threatening dysrhythmias.
• Patients requiring administration of specific intravenous drugs necessitating more intense nursing care or closer observation. These drugs include, but not limited to, Lidocaine, Pronestyl, Cardiazem, Natrecor, Dopamine/ Dobutamine without titration, and IIb/IIIa inhibitors.
• Post myocardial infarction or post cardiac surgical patients transferring from the Critical Care Unit when stable as determined by primary physician.
• Pre- and post-heart catheterization patients and patients admitted for cardiac surgery.
• Pre and post surgery of morbidly obese patients who are predisposed to complications.
• Patients in respiratory distress without acute respiratory compromise or severe cardiac decompensation.
• Patients requiring temporary or permanent pacemakers or generator changes.
D. CARE DELIVERY MODEL:
1. Description:
Care delivery model Is comprised of a modified team model consisting of an RN, LVN at times and CNA. The RN is responsible for clinical oversight at all times. Staff members are to consult Charge Nurses or Unit Director prior to undertaking an unfamiliar task.
2. Staffing Plan, Patterns, Acuity, Ratio and Grid:
Staffing is according to acuity levels as determined by the shift Charge RN which in turn determined the level of care required per each patient. Nurse to patient ratio cannot be more than what the California ratio Law of four patients to one nurse (4:1). Nurse Breaker, Unit Clerks and Nursing assistants are available to assist nurses in the care of the patients based on patient acuity and unit volume. Charge nurse and Monitor Tech are assigned every shift. See Attached Staffing Matrix.
3. Assignment Process:
The Director has a 24-hour responsibility for the Telemetry Department and is consulted for staffing and other issues as necessary. A peer director provides management coverage when the Director is not available. Charge Nurses is responsible for creating the appropriate assignment of the staff based on patient acuity, skill level of the staff, patient needs, and continuity of care and proximity of the patients’ rooms. Charge Nurse ensures compliance to Core Measures indicators, patient safety and quality care.
E. CLINICAL PRACTICE GUIDELINES, ORDER SETS, OR PROTOCOLS AND EQUIPMENT:
1. ANA Standards of Practice
2. Major Topics:
• Cardiac monitoring
• Licensed staff notification of abnormal patient rhythm by the Monitor Tech.
3. Order sets utilized include:
• Telemetry Admission Orders
• Wound Care Orders
• Hypoglycemic Orders
• Dialysis Orders
• Heparin Orders
4. Primary Reference Source: Lippincott’s Nursing Procedures (5th edition).
5. Equipment:
Equipment use is determined by manufacturer’s recommendation and users’ manual.
• Cardiac Monitors
• Vital signs machine
• Weighing scales
• Wheelchairs
• Oximeters
• Bariatric beds
• Hoyer Lift
• Glucose meters
• Suction machines
• Cardiac monitors
• Traction Equipment
• IV pumps
• Feeding pumps
• Overhead Trapeze
• PCA pumps
• Pyxis
• Cooling blankets
• Crash Cart
• Defibrillators
• Computers
• Assistive devices (walkers/wheelchairs)
• Commodes
F. STAFF COMPETENCIES:
1. Method of Determining Competency:
Competency is determined through written skills assessment during New Hire Orientation. Demonstrated skills are observed by a preceptor during the orientation period, annual written and demonstrated skills assessment validated by peers and experts, annual completion of tests and discussions on high-risk, low-volume skills as identified for the telemetry department and annual performance evaluations.
2. Certifications / Education required for staff include:
BLS certification is required upon hire, ACLS class required
The Telemetry Unit provides individualized and age appropriate care of the population we serve. Direct care includes assessment, planning, intervention, and evaluation of the nursing process. In addition, patients receive diagnostic evaluation, cardiac monitoring, and patient/family education.
1. Unit Description:
The unit has 36 private rooms and is located on the first floor of the building. Four of the 36 rooms have negative pressure capability and two rooms are dialysis care equipped. There are two Nurses Stations, A and B, that serve the needs of all personnel, including nursing staff, physicians and any ancillary staff performing duties on the unit. Station A is the smaller of the two, and is located in the front of the Telemetry Unit by the visitors’ elevator. Station B, is bigger of the two, and is centrally located in the Unit.
2. Hours of Operation:
The Telemetry Unit operates continually, 24-hours per day, seven days per week.
3. Population Served/Services Rendered:
Population is comprised of adult and geriatric patients from different cultural groups experiencing chest pain, COPD,
coronary artery disease, congestive heart failure, pneumonia, morbid obesity.
Patients are admitted through the Emergency Department; direct admit from physicians’ offices, transfers from in-patient units, or from out-patient.
4. Volume, Average Length of Stay:
Telemetry Unit has an average daily census of 27.5 and the length of stay is 4.8 days.
5. Admission Criteria:
• Patients who require monitoring for potentially life threatening dysrhythmias.
• Patients requiring administration of specific intravenous drugs necessitating more intense nursing care or closer observation. These drugs include, but not limited to, Lidocaine, Pronestyl, Cardiazem, Natrecor, Dopamine/ Dobutamine without titration, and IIb/IIIa inhibitors.
• Post myocardial infarction or post cardiac surgical patients transferring from the Critical Care Unit when stable as determined by primary physician.
• Pre- and post-heart catheterization patients and patients admitted for cardiac surgery.
• Pre and post surgery of morbidly obese patients who are predisposed to complications.
• Patients in respiratory distress without acute respiratory compromise or severe cardiac decompensation.
• Patients requiring temporary or permanent pacemakers or generator changes.
D. CARE DELIVERY MODEL:
1. Description:
Care delivery model Is comprised of a modified team model consisting of an RN, LVN at times and CNA. The RN is responsible for clinical oversight at all times. Staff members are to consult Charge Nurses or Unit Director prior to undertaking an unfamiliar task.
2. Staffing Plan, Patterns, Acuity, Ratio and Grid:
Staffing is according to acuity levels as determined by the shift Charge RN which in turn determined the level of care required per each patient. Nurse to patient ratio cannot be more than what the California ratio Law of four patients to one nurse (4:1). Nurse Breaker, Unit Clerks and Nursing assistants are available to assist nurses in the care of the patients based on patient acuity and unit volume. Charge nurse and Monitor Tech are assigned every shift. See Attached Staffing Matrix.
3. Assignment Process:
The Director has a 24-hour responsibility for the Telemetry Department and is consulted for staffing and other issues as necessary. A peer director provides management coverage when the Director is not available. Charge Nurses is responsible for creating the appropriate assignment of the staff based on patient acuity, skill level of the staff, patient needs, and continuity of care and proximity of the patients’ rooms. Charge Nurse ensures compliance to Core Measures indicators, patient safety and quality care.
E. CLINICAL PRACTICE GUIDELINES, ORDER SETS, OR PROTOCOLS AND EQUIPMENT:
1. ANA Standards of Practice
2. Major Topics:
• Cardiac monitoring
• Licensed staff notification of abnormal patient rhythm by the Monitor Tech.
3. Order sets utilized include:
• Telemetry Admission Orders
• Wound Care Orders
• Hypoglycemic Orders
• Dialysis Orders
• Heparin Orders
4. Primary Reference Source: Lippincott’s Nursing Procedures (5th edition).
5. Equipment:
Equipment use is determined by manufacturer’s recommendation and users’ manual.
• Cardiac Monitors
• Vital signs machine
• Weighing scales
• Wheelchairs
• Oximeters
• Bariatric beds
• Hoyer Lift
• Glucose meters
• Suction machines
• Cardiac monitors
• Traction Equipment
• IV pumps
• Feeding pumps
• Overhead Trapeze
• PCA pumps
• Pyxis
• Cooling blankets
• Crash Cart
• Defibrillators
• Computers
• Assistive devices (walkers/wheelchairs)
• Commodes
F. STAFF COMPETENCIES:
1. Method of Determining Competency:
Competency is determined through written skills assessment during New Hire Orientation. Demonstrated skills are observed by a preceptor during the orientation period, annual written and demonstrated skills assessment validated by peers and experts, annual completion of tests and discussions on high-risk, low-volume skills as identified for the telemetry department and annual performance evaluations.
2. Certifications / Education required for staff include:
BLS certification is required upon hire, ACLS class required