POLL: Should telemetry techs need to know patient Dx?

Hi All,

I've been working as a tele tech for almost 7 years. Recently I moved to a new hospital (Providence to Kaiser). While learning the ins and outs of the new job I was told we as techs need to be writing the patients Dx, along with their Name and Age on our hourly patient tracking forms; that this is status quo. In my experience our main function as a tele tech is to simply observe and report to the RN; changes in rhythm, rate, if a patient comes off the monitor, batteries, leads off, etc...

To have us write the patient Dx seems unnecessary, irrelevant and clearly outside our scope as a tele tech. Consider the fact that in most cases the tele tech position requires zero education beyond a basic ecg interpretation course.

The way I see it is, it isn't my job to speculate, make assumptions about a patients condition or be anything but completely objective in the way I handle each rhythm on the screen. Think about the buzzilion diagnoses a patient could have upon admission. Does your tele tech with no education need to know that the patient whose rhythm they are watching has pancreatitis, abdominal pain, colon cancer, prolapsed uterus? What about TIA, PNA, crani, chole, appy, lami, spondy or diverticulitis? What about femur fx, sepsis, hematuria, CAD (any diagnoses imaginable). How would this information shape the way I react to the rhythms I see tracing along my screens? "You don't treat the rhythm, you treat the patient", right?



So, to put the question directly: Should your tele techs be privy to patient diagnosis's? Would you as a nurse feel better if your tele tech knew the Dx of your patient?

Why or why not? Last edit by mycoholic1 on May 3
I can see that someone who is monitoring rhythms would need to know diagnosis, if only to remind the nurse when reporting changes. For instance, if the patient is admitted after converting out of a-fib for observation if they go back into a-fib, then that original diagnosis would be helpful to know. If they are admitted with a low K, again, something for the nurse to be reminded of if you report off to them a change.I would also think it difficult to figure out a baseline if you really have no idea why they are there. So if a tech continues to report the patient is tachy, for instance, that may or may not be what the patient was admitted for. Then there's the almighty buck. Monitoring, and having someone monitor is a charge-able function. Therefore, to have information handy on one sheet helps billing to not have to look more than one place for the information they need to bill.I am surprised that with the ECG interpretation class, they are also not teaching general diagnosis and how it affect rhythms. I am not sure how one would establish what is going on to begin with, in order to discuss changes.

To have us write the patient Dx seems unnecessary, irrelevant and clearly outside our scope as a tele tech. Consider the fact that in most cases the tele tech position requires zero education beyond a basic ecg interpretation course.

At my old job, we had a world class tele tech with which many of the cardios would discuss strips. She never knew diagnoses. She watched 80 monitors and never missed a thing.All the the points above are indicative of a really good tele tech (interpreting pt activity from monitor tracings, asking for parameters for SpO2 monitoring, etc.), but none of them require knowing the diagnosis. Going from NSR to afib post cardioversion is reportable even without knowing the patient was converted. Hell, I just want the tele techs where I work to pay attention. One in particular is known to change alarm parameters to something ridiculously high after the first report to the nurse without asking permission from the nurse. The first time he did that with one of my patients, I changed it back and asked him why he changed it. He said, "because it kept alarming." Without really giving a crap how I sounded, I said, "yes, that is why the alarms are on in the first place. Don't you ever change alarm parameters without discussing it with me first." If he had been the world class tech from my old place, I would have trusted him more to think through everything, and I wouldn't have had an issue with changing alarms without permission. But, he's an idiot....so, no.

Quote from dudette10but none of them require knowing the diagnosis.

Okay - lets keep our terms of service in mind and debate the topic, not the poster.

I voted yes.The following link will take you to the AHA Practice Standards for Cardiac Monitoring in the Hospital.CirculationI am accustomed to working with tele techs who have expertise with cardiac diagnoses, the causes of dysrhythmias, medications and cardiac side effects as well as full access to the EMR. They can be counted on to record and report changes to the Nurse in charge of the patient.

GrannyRRT, you misinterpreted "none of them require knowing the diagnosis." What I meant was, your examples that I put in parentheses do not require a diagnosis. In fact, they are unrelated to a diagnosis and more related to treatment of any number of diagnoses. That doesn't mean that nurses never speak to tele techs to give them info on a patient. If I start a person on diltiazem, OF COURSE I'm gonna tell the tech and ask him/her to inform me if the HR goes sustains even higher, or hits a normal rate, or changes rhythm.

Quote from GrannyRRTIt sounds like you did not realize you were getting hired to be part of a PATIENT CARE TEAM. You don't need a college degree to understand a few things beyond the squiggly lines on the monitor and how they pertain to the total care of the patient.

Thanks for the link icuRNmaggie, I certainly hope my hospital follows similar high cardiac monitoring standards. I don't see how it supports your vote, though. We have techs, myself included who have a solid understanding of cardiac diseases and the associated arrhythmias, medications and side effects. As a monitor tech I still fail to see how access to the pt's Dx would influence how I perform my duties. If I just used pt diagnosis in any way to shape my actions, I've just become a nurse and am outside of my scope. I just observe and report. It's up to the RN to decide whether what I report is important and needs addressing.

I'm not sure what everyone else's experience is, or what standard every hospital has for their tele techs... But where I've worked, they are basically a CNA with some extra training in reading rhythms, so I'm basing my comment off of what I know. Are they a valued part of the team, absolutely. Is their role important, absolutely. If I set an unusual parameter, can the tech know the RN's reasoning, absolutely--not at all appropriate to tell a valued member of the team "Just do as you're told." That said, in my experience, they knowing what drugs the pt is on or that the pt has crush injuries is irrelevant because they have not studied patho. I would want them to report peaked T-waves because it's a change in rhythm, but I can't expect them to put the pieces together that pt has crush injuries so is at risk for elevated K+ which can cause peaked T-waves. Because they haven't studied patho.

Quote from mycoholic1My argument is based on the experience I've gained over the last 7 years as a tele tech "watching squiggly lines" and rarely, if ever have had the need cross-reference a pts rhythm with their Dx. I understand the squiggly lines well and have taught 12-lead. I know what is normal and what isn't. I know when to call the RN and maybe even more importantly, when not to. My job is to simply observe and report in a swift manner as to avoid any potential delay of treatment. Not to speculate about what a patient may or may not be doing. The Dx really doesn't help me in any way. But, lets dive down that rabbit hole for kicks and grins.

Whether or not a tele tech knows a patient's diagnosis is irrelevant, because they are only expected to alert nurses when a rhythm is outside its parameters. Unless a tele tech has had other types of education, I don't see how knowing a diagnosis would be of any use to them or to nurses. I'm not a huge fan of having tele techs to begin with. I've worked in environments with and without them, and I've seen many times when a nurse noticed a subtle, but important, change that wouldn't have been reported by a tech...QT intervals becoming gradually more prolonged, sudden increases or decreases in heart rate, a notched p-wave...not to mention that the tele techs hardly ever looked at anything other than lead II.