SHM Converge Scientific Abstract ePoster Gallery-Decreasing Inappropriate Telemetry Usage via Nursing-Driven Checklist and Emr Order Set

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This quality improvement study tested whether inappropriate telemetry use on an inpatient medical ward could be reduced using a nurse-driven checklist and an EMR-based telemetry order set modification with just-in-time education. Telemetry overuse is a known problem because it increases cost, unnecessary workups, and alarm fatigue, and the study aimed to align practice with 2017 AHA/ACC telemetry standards.<br /><br />The project used a rapid PDSA cycle at Rocky Mountain Regional Medical Center in Aurora, Colorado, comparing three cohorts: a control period with no intervention (March 2019), a period using an RN-driven checklist (July 2019), and a later period using the checklist plus EMR modification (July–August 2020). Telemetry records were reviewed for indication, duration, and appropriateness based on AHA classifications. Statistical comparisons used Pearson chi-square analysis.<br /><br />Results showed that inappropriate telemetry orders fell from 37% in the control group to 26% with the RN checklist alone, and further to 17% when the EMR modification was added. The intervention also appeared to improve overall appropriateness, though effects on telemetry duration were less clear and may have been underpowered.<br /><br />The authors concluded that an RN-driven checklist combined with EMR order set changes can meaningfully reduce inappropriate telemetry use in a feasible and low-cost way. They noted limitations including differences in time periods between cohorts, the COVID-19 pandemic’s impact, possible underpowering for duration outcomes, and uncertain generalizability. They recommend future research on cost savings, patient experience, nursing alarm fatigue, and length of stay.

Asset Subtitle

Michelle Knees

Meta Tag

Author List Andrew Berry, Joseph Simonetti, Katarzyna Mastalerz, Michelle Knees

Category Research

Concept Continuous ECG Monitoring

Concept Reduced Inappropriate Telemetry Use

Concept Inappropriate Use

Concept AHA/ACC Practice Standards

Concept Alarm Fatigue

Distinguished Non-Finalist

Presenter Organization University of Colorado Anschutz School of Medicine

Presenting Author Michelle Knees

Track Quality Improvement

Keywords

telemetry overuse

quality improvement

nurse-driven checklist

EMR order set modification

just-in-time education

AHA ACC standards

inappropriate telemetry

PDSA cycle

alarm fatigue

inpatient medical ward

Continuous ECG Monitoring

Reduced Inappropriate Telemetry Use

Inappropriate Use

AHA/ACC Practice Standards

Alarm Fatigue