Here is a scenario to think about: Nurses working on a cardiac step-down unit are summoned by an arrhythmia alarm to room 506. The alarm warns nurses of a lethal arrhythmia-asystole. Patient Y, in room 506, is a 78 year old man admitted with syncope and bradycardia, being paced with a temporary transvenous pacemaker until the cardiac catheterization lab is available. Concerned, three nurses, and a respiratory therapist leave their patients, grab the crash cart and sprint down the hall. As they burst into the room, they find Dr. X nonchalantly standing at the Patient Y’s   bedside holding a temporary transvenous pacemaker. The cardiologist had temporarily paused the pacemaker in order to determine his underlying rhythm; he wasn’t the least bit concerned at the reaction it caused on the unit. Out of breath-and frustrated the nurses admonished the physician; “Dr X- would you please tell us next time you are going to play with Mr. Y’s pacemaker”. He shrugged their question off.

In this case it was an “out –of touch” physician. Have you experienced similar scenarios?

This scenario above, points out the importance of communicating with all clinical personnel when ever a treatment might compromise the EKG rhythm. Communicating prior to action will avoid confusion-or possible delay of treatment. Frequent false alarms on a unit will eventually instill a culture of complacency and lack of awareness for the safety of patients. I think those clinicians who are no longer “alarmed by an alarm “, are reckless , and may place their patients and their profession in jeopardy.

What do you do on your unit to communicate treatment strategies with fellow clinicians? Its ‘s easy to understand why we might fail to communicate properly at all times.  Busy healthcare workers get so involved with their  patients they might forget to notify the arrhythmia technician or other nurses when performing treatments that will affect EKG waveforms. Interventions such as administering a bolus of  Adenosine, performing pacemaker threshold testing, or assisting with cardioversion , although controlled and supervised in “your sphere” will appear as a life-threatening events on a cardiac monitor to others.  Simple acts such as untangling a telemetry monitor, calibrating a hemodynamic monitoring system and suctioning a patient can disrupt a signal, cause an alarm and divert the attention of someone needlessly.

Is it professional courtesy to pause and communicate with your colleagues before performing a nursing function that might disrupt and alarm others? Do you think it is too much trouble to pause and communicate simple nursing functions? What should the standard practice be?