Development of evidence-based remote telemetry policy guidelines for a multifacility hospital system.

Over 10 years ago, the standards for cardiac monitoring were set forth by the Councils on Cardiovascular Nursing, Clinical Cardiology, and Cardiovascular Disease in the Young. The standards were endorsed by the International Society of Computerized Electrocardiology and the American Association of Critical-Care Nurses. The American Heart Association printed the standards as an American Heart Association Scientific Statement. The standards provided direction related to remote telemetry monitoring to acute care hospitals. Since the standards were published, remote monitoring of cardiac patients has increased dramatically prompting research and literature related to appropriate utilization. Appropriate and safe telemetry monitoring requires clearly written evidence-based facility policies. This article describes the process whereby a team of Veterans Hospital Administration nurses from across the country reviewed 70 remote telemetry policies representing 75 Veterans Hospital Administration hospitals for clarity, consistency, and congruency to existing levels of evidence found in the literature. This article describes the processes, successes, and challenges of compiling an evidence-based remote telemetry policy guideline.

Rapid warfarin reversal with factor VIIa in an elderly trauma patient with retroperitoneal hematoma.

While mortality from trauma increases, there has been a decline in mortality from cardiovascular and cerebrovascular diseases which parallels advances in antithrombotic and anticoagulation therapy. Warfarin (coumadin) is the most common oral anticoagulant used for chronic anticoagulant therapy and most patients requiring such therapy are elderly (greater than 65 years old). The most common complication of warfarin use is adverse bleeding. It is becoming increasingly evident the population at highest risk for sustaining a complication related to anticoagulation is that group presenting with traumatic brain injury. Recent studies show that patients with other injury patterns do not appear to have significant differences post trauma, although the data about such outcomes is sparse. Significant bleeding from retroperitoneal hematomas is more often associated with major pelvic fractures from high energy blunt force mechanisms, and the blood loss may be tamponaded by the retroperitoneal structures if natural clotting mechanisms are intact. Recombinant Factor VIIa (FVIIa) can be used to reverse coagulopathy in patients on coumadin who sustain a traumatic injury.