Telemetry Discontinuation Readiness Review App

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Suggested Telemetry Discontinuation

How it Works

After configuration, SafeNSound will use the documented information to evaluate the patient's indication for cardiac monitoring (per AHA recommendation), the length of time on monitor, heart rate, blood pressure, and rhythm interpretation.  If the patient has met all the policy rules for telemetry discontinuation, a green checkmark will appear on the Clinical Insights - Daily Rounding Report, indicating that the patient has met all previously established criteria to suggest reviewing the patient's record for possible discontinuation of monitoring. 

Implementation

Implementation is a a several step process that involves not only a technical configuration but also clinical workflow changes.  Change management will be of the utmost importance. We recommend implementing this feature is 3 phases and after your initial go-live with SafeNSound. 

Phase 1 - Decision Making and System Configuration (2-6 weeks)

In phase 1, customers will make decisions around heart rate and blood pressure limits, allowed rhythm interpretations, and ICD-10 diagnosis codes.  The Spacelabs technical team will work with customers to configure the system as per customer decisions, including the interface of the patient diagnoses.

Phase 2 - Data Validation, Benchmarking, and Education (2 months)

In the second phase, we partner with the customer to validate the data that we are receiving for customers and that it matches expectations.  During this phase, workflow changes should be solidified and team education regarding the process changes should occur.  Also during this phase, baseline data should be collected/documented around utilization and length of monitoring (LOM). 

Phase 3 - Go-Live (1-2 weeks)

This phase should involve customer-led support for the process change.  Spacelabs will develop a plan, in conjunction with the customer to ensure adequate access to technical resources for any questions or issues.

 

Patient Diagnosis Entry: Ensure the patient's diagnosis is accurately entered into the patient record. This information is vital in determining the duration of telemetry monitoring required. Diagnosis information can be manually entered on the patient details window.

You can take advantage of your existing physician workflows for diagnosis entry.  We recommend part of the workflow analysis process is to ensure that diagnoses are entered in a timely fashion.  We recommend partnering a physician champion with the Spacelabs team. 

The diagnosis determines how long the patient is Intended to be monitored, such as 24 hours (Class III), 48 hours (Class II), or continuous (Class I), in line with the American Heart Association guidelines for cardiac monitoring. However, these categories are only clinical suggestions and must be designated based on the facility’s preferences and policies. 

Clinical Insights: Discharge policy column In Daily Rounding shows a green check mark if the patient has met all rules for discontinuation.

 

To Enable Telemetry Discontinuation

Telemetry Discontinuation Readiness Review is accessible in the App Store under Workflow. To enable it, select the toggle on the top right.

                              TD_App.png

 

To Edit Telemetry Discontinuation Criteria

  1. Click on the Telemetry Discontinuation App and edit details.
  2. When finished select save.
  3. To edit Class I, II, III refer to the charts in the subsections below.

TD_Edit.png

To Edit Diagnostic Codes

Click on Administrator --> Settings  --> Diagnostic Codes

Codes can be added using the plus button

Codes can be removed using the X

 

Recommended Defaults

Detail Tab

Only Allowed Rhythm Interpretation Sinus Rhythm, Atrial Fibrillation
24 hours Heart Rate < Than 120
24 hours Systolic BP > Than 90

 

 

Class Tabs - Sample Policy with ICD-10 codes

Class I

A class I diagnosis requires a physician order for discontinuation of monitoring. The diagnoses specified place the patient in the following category.

Diagnosis ICD-10
Acute Coronary Syndrome I24.9
Myocardial Infarction I21.9
Coronary Artery Disease I25.1
Vasospastic Angina I20.1
Cardiac Syncope R55
Stress Cardiomyopathy I51.81
ST Elevation/STEMI I21.01

Post Open Heart Surgery

Z48.812

Left Ventricular Failure

I50.1

Post Trans-Catheter Intervention

Z95.2

Post Resuscitation from Cardiac Arrest

I46.9

Acute Dysrhythmia

I45.9

Symptomatic Bradycardia

R00.1

2nd Degree Block, Type 1 & 2

I44.1

3rd Degree Block

I44.2

Wolff-Parkinson-White Syndrome

I45.6

Acute Decompensated Heart Failure

I50.9

ICD Shocks, Requiring Hospital Admission

Z45.02

Temporary Pacemaker

Z45.018

Permanent Pacemaker Implantation

Z95.0

Stroke

I63.9

Severe Electrolyte Imbalance

E87.8

Drug Overdose

T50.901A

 

Class II

If no event occurs, a Class II diagnosis usually discontinues monitoring after 48 hours. The diagnoses specified places the patient in the following category:

Diagnosis ICD-10
Symptomatic Atrial Fibrillation I48.91
Ventricular Tachycardia I47.2
Infective Endocarditis I33.0
Severe Sepsis R65.21
Cardiac Ablation Z86.79
Hemodialysis Z99.0
Pulmonary Embolism I26

 

Class III

If no event occurs, a Class III diagnosis usually discontinues monitoring after 24 hours. The diagnoses specified place the patient in the following category:

Diagnosis ICD-10
Acute Coronary Syndrome I24.9

Coronary Angioplasty

Z98.61
Low-risk and Non-Cardiac Chest Pain R07.89
Asymptomatic Bradycardia R00.1
GI Bleed K92.2
Alcohol Withdrawal F10.239
COPD J44.9

 

Sample Physician Notification Policy

  • RN will notify the Physician based on the following parameters/standards unless otherwise ordered.
    • Sinus Node Dysfunction:
    • Symptomatic bradycardia
    • Asymptomatic bradycardia < 50bpm
  • Heart block (with or without symptoms)
    • Third-degree AV-block
    • Second—degree AV block (Type I or Type II)
    • Any block including First-degree AV-block. in patients with history of muscular dystrophy
  • Pauses:
    • If underlying rhythm is sinus: 3 seconds
    • If underlying rhythm is AFIb I Aflutter. 5 seconds
  • Abnormal intervals:
    • New bundle-branch block
    • QT > 500ms (when ordered to measure per physician)
  • Premature Ventricular Beats/Non- sustained ventricular tachycardia
    • Symptomatic
    • Ventricular Run > 10 seconds or > 20 ventricular beats per minute
  • Supraventricular tachycardia (SVT and/m a-fib)
    • Symptomatic
    • Any new a-fib / a-flutter
    • Non a-fib SVT > 30 seconds with or without symptoms

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