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Telemetry– Related Events

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Telemetry– Related Events A Brief Analysis of Telemetry– Related Events Elizabeth Kukielka, PharmD, MA, RPh, Kelly R. Gipson, BSN, RN & Rebecca Jones, MBA, RN DOI: 10.33940/biomed/2019.12.4 Abstract monitoring submitted to PA-PSRS. User errors accounted for nearly half (47.1%, Successful telemetry monitoring relies on 263 of 558) of events in the analysis. The timely clinician response to potentially life- most common event subtypes included: threatening cardiac rhythm abnormalities. errors involving batteries in telemetry Breakdowns in the processes and procedures monitoring equipment (14.0%); errors associated with telemetry monitoring, as in which patients were not connected to well as improperly functioning telemetry telemetry monitoring equipment as ordered monitoring equipment, may lead to events (12.9%); errors involving broken, damaged, that compromise patient safety. An analysis or malfunctioning telemetry monitoring of reports submitted to the Pennsylvania equipment (10.9%); and errors in which Patient Safety Reporting System (PA-PSRS) patients were connected to the wrong from January 2014 through December 2018 telemetry monitoring equipment (9.0%). identified 558 events specifically involving interruptions or failures associated with Keywords: telemetry, cardiac monitoring, telemetry monitoring equipment or with the patient safety, alarm management, healthcare providers responsible for setting cardiac arrhythmias, communication, up and maintaining proper functioning of equipment malfunction, monitor technician that equipment. The analysis highlighted Corresponding author a steady increase in the quantity of Patient Safety Authority event reports associated with telemetry Disclosure: The authors declare that they have no relevant or material financial interests. 36 I PatientSafetyJ.com I December 2019 Figure 2: Telemetry Monitoring Events by Harm Score, N=558 A – Circumstances that could cause adverse events (e.g., 300 289 look-alike medications, confusing equipment, etc.) Introduction Methods B1 – An event occurred but it did not reach the individual (“near miss” or “close call”) because of chance alone B2 – An event occurred but it did not reach the individual ontinuous cardiac monitoring of a patient We queried PA-PSRS for events submitted from 250 (“near miss” or “close call”) because of active recovery outside the setting of the intensive care January 1, 2014 through December 31, 2018. We efforts by caregivers unit (ICU) is usually achieved via portable identified events for analysis if one of the free text C – An event occurred that reached the individual but telemetry monitoring equipment (hereafter fields contained either “telemetry” or “tele” (excluding 200 did not cause harm and did not require increased C monitoring (an error of omission such as a missed referred to in some instances as “equipment”) “telephone” and “telemed”) and one of the following: medication dose does reach the individual) connected to a patient that transmits vital data, such “off”, “alarm”, “batter”, “disconnect”, “expire”, or D – An event occurred that required monitoring to 150 confirm that it resulted in no harm and/or required as heart rate and rhythm, to a telemetry monitoring “transmi”. An analyst manually reviewed all event 118 intervention to prevent harm station that may be located on the nursing unit or reports to identify events that involved interruptions E – An event occurred that contributed to/resulted in 92 temporary harm and required treatment or intervention to a remote centralized telemetry monitoring unit or failures associated with equipment or with the 100 F – An event occurred that contributed to/resulted located away from the nursing unit.1 Successful healthcare providers responsible for setting up and in temporary harm and required initial or prolonged telemetry monitoring relies on timely clinician maintaining proper functioning of that equipment. hospitalization G – An event occurred that contributed to/resulted in response to potentially life-threatening cardiac Events related to telemetry monitoring were 50 25 permanent harm rhythm abnormalities identified through the use categorized according to whether they resulted from 18 13 H – An event occurred that resulted in a near-death event (e.g., required ICU care or other intervention necessary of this healthcare technology. Breakdowns in the user errors, communication breakdowns between 1 0 0 2 0 to sustain life processes and procedures associated with telemetry healthcare providers, device malfunctions, or alarm A B1 B2 C D E F G H I I – An event occurred that contributed to/resulted in death monitoring, as well as improperly functioning issues, and were then further subcategorized within equipment, may lead to events that compromise each of these categories. patient safety. Figure 3: Telemetry Monitoring Events by Category and Subcategory, N=558 Results Following review of several event reports submitted to the Pennsylvania Patient Safety Reporting System* The query returned 1,494 event reports submitted (PA-PSRS) involving telemetry monitoring that resulted to PA-PSRS during the five-year study period. An in serious harm, we decided to investigate the full analyst manually reviewed all events and determined spectrum of events in PA-PSRS involving interruptions that 812 events specifically involved interruptions or failures related to telemetry monitoring. In addition or failures related to telemetry monitoring. The to our analysis, we also share relevant examples of remaining 682 events were excluded from the telemetry monitoring events to promote awareness of analysis because they did not involve interruptions areas in which actionable changes within healthcare or failures related to telemetry monitoring; many of facilities are possible, as well as a summary of lessons these events simply mentioned that the patient was learned from these events. on telemetry monitoring. Of the 812 events involving interruptions or failures related to telemetry monitoring, 558 events were included in the analysis because they were related Figure 1: Number of Telemetry Monitoring Events Submitted to issues with the equipment or by200 Year, N=558 with the healthcare providers 180 responsible for setting up and 160 maintaining proper functioning 140 of that equipment (e.g., a patient 120 who became disconnected from 100 equipment during transfer from one unit to another); 254 events 80 were excluded from the analysis 60 because they were considered 40 to be outside the control of the 20 hospital staff and unrelated to 0 the function of equipment (e.g., a 2014 2015 2016 2017 2018 patient who became disconnected from telemetry following a fall). 38 I PatientSafetyJ.com I December 2019 Patient Safety I December 2019 I 39 Table: Telemetry Event Subcategories Figure 1 shows the number of events submitted each based on actual reports submitted to PA-PSRS, but S ubcategory Definition year from 2014 through 2018. The majority (97.1%, none of these examples represents an individual Patient not connected Patient had verbal or w ritten ord ers for to telemetry event report, and event details were modified to continuous telemetry monitori ng, but 542 of 558) of telemetry monitoring events were monitoring equipment monitoring was delayed or not initiated † as ordered categorized as incidents ; the remaining 16 events ensure confidentiality. ‡ Patient had orders for continuous telemetry were categorized as serious events . Harm scores Patient transferred or Equipment Malfunctions Harm associated“ with monitoring, but patient was transferred transported without were identified by healthcare facilities at the time of from one unit to another unit without telemetry monitoring their reporting. Figure 2 summarizes the frequency Telemetry Monitoring Equipment Broken, proper monitoring d uring transit telemetry monitoring is rare of each harm score and includes definitions of each Damaged, or Malfunctioning Patient had orders for continuous telemetry but potentially catastraphic, Patient off unit harm score. Most serious events (harm scores E–I) monitoring but was not properly monitored The telemetry monitoring technician called to without telemetry while off the unit (such as while receiving resulted in death (13 of 16). monitoring notify the nurse on the medical/surgical unit that with death being the most dialysis or imaging) GP’s cardiac tracing had not been displayed on the Telemetry monitoring events were categorized frequent outcome among technician’s central monitor for about 10 minutes, Patient had orders for continuous telemetry according to whether events resulted from user errors, monitoring but was permitted to be off the and that he was now displaying in atrial fibrillation serious events. Patient not unit without telemetry monitoring for a communication breakdowns between healthcare reconnected to with a rapid ventricular rate. The nurse attempted to procedure or test; however, upon return to telemetry monitoring providers, device malfunctions, or alarm issues. User the unit, the patient was not reconnected to rectify the situation by changing the leads connected equipment upon errors accounted for nearly half (47.1%, 263 of 558) the telemetry monitoring equipment in a return to unit to the patient as well as the batteries in the telemetry timely fashion and was therefo re of the events. Events were further subcategorized transmitter, but GP yet again did not display on the unmonitored for some period of time based on common details among reports, and these technician’s central monitor. A biomedical
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