For this week assignment, I will use the issue I have talked about in the “Quality Improvement in Nursing” class I took at Chamberlain University. The reason I am coming back to the same issue is because I fell that outcome of the research could potentially decrease distractions, improve nursing workflow and positively affect patient outcomes.
Our recently opened and state of the art telemetry units were designed with patients and family in mind. Private rooms block outside noise and provide privacy and quiet environment. However, all that technology has increased distractions for nurses who have to deal with almost constant phone ringing. All patients and family call lights (yes, there is separate call light for family members), and alarms from the room are linked to our phones. On average, each nurse has 4-5 patients which adds up to a significant amount of phone calls. Additionally, we receive many phone calls from our central telemetry monitoring station, mainly to inform us that they have lost tracing because transmitter battery died, or tele dots need to be changed to improve reading. With telemetry providing vital information, any time I receive phone call, I have to stop whatever I am doing, check on the patient, and address whatever the issue is with the monitor. All these interruptions in my workflow predispose me for potentially making mistake. Monteiro, Avelar,& Pedreira (2015), indicate that interruptions in nursing activities affect concentration, delivery of care, potentiate occurrence of errors and are putting patients at risk.
Houser (2018) states that “the best research starts with two words: “I wonder”, adding that when “observations about a practice problem become questions, these questions lead to nursing research that provides evidence to solve the problem” (Houser, 2018, p.83). With that being said, I would like to see if incorporating changing tele batteries and tele dots in the routine care can decrease or even eliminate unnecessary phone calls from the telemetry station. We have two telemetry units so it would be easy to use one unit as research subject and second unit as comparison. On the research unit, tele batteries would be changed at the scheduled times every 8 hours, and tele dots would be changed every 24 hours. We use rechargeable tele batteries so new practice would still be cost effective. The comparison unit would continue with current practice of waiting for phone call indicating the need to change the battery or tele dots. The easiest way to keep records would be in the telemetry monitoring room where each phone call can be recorded on the unit specific spread sheet.
I believe that if research finds significant difference in the phone call interruptions between research and comparison unit, new practice can become standard of care not only on the telemetry units, but also on any unit that houses patients requiring portable telemetry monitoring.
My searchable, clinical question in the PICO(T) format would be as following:
On the busy telemetry unit where frequent phone calls affect nursing workflow (Problem), how do scheduled tele monitor battery and tele dots changes (Intervention) compare to nonintervention unit (Comparison), influence number of phone calls nurses receive from the telemetry monitoring station (Outcome) during 30 days trail period (Time frame).
Houser, J. (2018). Nursing research: Reading, using, and creating evidence (4th ed.). Burlington, MA: Jones & Bartlett Learning.
Monteiro, C., Avelar AF., Pedreira, Mda. L. (2015). Interruptions of nurses’ activities and patient safety: an integrative literature review. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4376046/
AAACN Toolkit: Template for Asking PICOT Questions.