2. Andrea Scott, Gary Webster, Laura Zwagerman Ferris State University

3. Mecosta County Medical Center 74 bed acute-care hospital 4 bed Critical Care Unit (CCU) 27 bed Medical Surgical Unit (Medsurg) Telemetry patients(10 beds or 5 rooms) are in Medsurg, but monitored by staff in CCU

4. Risk Associated With Untrained Staff Monitoring Telemetry “Studies have shown that nurses often monitored in a single lead, regardless of the diagnosis, did not properly prepare the skin, misplaced electrodes, and were unable to differentiate wide-complex tachycardias, all of which could lead to false alarms or misdiagnoses.” Nurses working on monitored units need to know how to monitor patients' dysrhythmias effectively.” (Schultz, 2011)

5. Risks Associated with CCU Nurses Monitoring Remote Telemetry Telemetry patients are currently monitored by the CCU nurses who are located in a separate unit CCU nurses evaluate patient rhythms & call Medsurg staff with any changes or concerns CCU nurses can be busy and unable to call Medsurg nurses when the monitor shows a change Medsurg nurses are untrained in proper arrhythmia management

6. Safety increased by Specifically trained staff to monitor and treat telemetry patients Monitor trained nurses will have smaller patient assignments & will be able to respond to monitor/heart rhythm problems faster New unit will be close to CCU in case major problems arise

7. Solution Creation of a new Critical Care Stepdown/Telemetry unit

8. Challenges of a New Unit Challenge: Availability of space Solution: Create new telemetry unit by repurposing 5 current Medsurg rooms each containing 2 patient beds Challenge: Availability of staff Solution: Staff with current CCU nurses & Medsurg nurses who wish to complete monitor training, hire from outside hospital as needed. Current hospital staff can be moved into the needed positions & unfilled positions can be filled by new staff who can be recruited from the area including new FSU graduates

9. Challenges of a New Unit Challenge: Staff training in telemetry monitoring Solution: Train staff who desire to work in new unit in basic & advanced EKG classes and basic medication drips. Increase the current number of available EKG classes to support the increased need for certifications and re- certifications. Challenge: Financial impact on hospital Solution: Start-up cost and increased staff costs are off set by increased patient safety and increased reimbursement rate

10. Mission Statement “To provide high quality, safe, patient centered care to patients requiring advanced cardiac monitoring in a community hospital by nurses with advanced training”

11. Philosophy Respect for all people Commitment to excellence Continuous quality improvement in all areas of service Commitment to the health and well-being of people in our service area Successful adaptation to technological, medical, and social changes

12. Goals and objectives Goal: provide advanced cardiac monitoring and direct patient care by nurses educated and trained in advanced cardiac monitoring Objective: To institute a new independent stepdown/telemetry unit at Mecosta County Medical Center located near the Critical Care Unit and the Medical Surgical Unit providing ten telemetry beds for cardiac patients Objective: To have 14 advanced cardiac monitoring educated nurses by June 1, 2013 Objective: To provide on-campus educational support for all nursing staff members who work in the stepdown/telemetry unit in the forms of basic EKG classes and advanced EKG classes, with evaluations to ensure competency before these nurses are allowed to care for patients

13. Location within the hospital’s organizational chart The new telemetry unit will be managed by the current manager of the Critical Care Unit The new unit will be part of Clinical Services The manager reports to the Chief Clinical Officer (CCO) The CCO reports to the Chief Executive Officer (CEO)

14. Job Postings Job Title: Staff RN - Telemetry Location: Mecosta County Medical Center Regular full-time 12 hour shifts Schedule: 7 pm to 730 am or 7 am to 730 pm 72 hours per pay period

15. Job Postings Job Title: Health care tech/Unit secretary Location: Mecosta County Medical Center Regular full-time 12-hour shifts Schedule: 7 pm to 730 am or 7 am to 730 pm 72 hours per pay period

16. Budget Nurses - 14 full time nurses Health care techs/unit secretaries – 11 full time techs TotalBudget Nurses$838,656 Techs$308,880 Benefits$375,000 Supplies$75,000 Total first year budget$1,597,536

17. Hours of OperationReimbursement This unit will be open 24 hours a day, 7 days a week and maintain staffing adequate for the census level Reimbursement will come from private pay, insurance, and state and federal funds

18. Conclusion The citizens of Mecosta County and it’s surrounding areas deserve to have the most advanced medical care and cardiac monitoring available to them without having to travel far The new stepdown/telemetry unit will provide this care and monitoring locally while maintaining the hospital’s motto of “advanced care with a personal touch” (mcmcbr.com)

19. References About MCMC (n. d.) In Mecosta County Medical Center. Retrieved from http://www.mcmcbr.com/http://www.mcmcbr.com/ Schultz, S.J (2011). Evidence-based strategies for teaching dysrhythmia monitoring practices to staff nurses. The Journal of Continuing Education in Nursing, 42(7), 308-314 Retrieved from https://fsulearn.ferris.edu/courses/1/80448.20120 8/groups/_785_1//_85952_1/Evidence- Based%20%20Strategies%20for%20Teaching.pdf https://fsulearn.ferris.edu/courses/1/80448.20120