PHILIPPINE HEART CENTER

East Avenue, Quezon City

Name:___________________________________________________ Unit:_________________
Immediate Supervisor:______________________________________ Date:_________________

Telemetry Monitoring

Legend: CD – Correctly Done ; ID – Incorrectly Done

Date: Date: Date:
CRITICAL CARE COMPETENCIES
CD ID CD ID CD ID
PREPARATORY PHASE:
1. Identifies the purpose
a. Patient criteria telemetry monitoring
2. Performs hand hygiene properly
3. Prepares the needed equipment for Telemetry
Monitoring
a. Central Telemetry Monitor Unit
b. Telemetry Module with NIBP
c. Electrocardiogram chest leads
d. Electrodes
e. Pulse Oximeter
f. Rechargeable Battery
4. Checks equipment functionability
a. Turning on the central monitor
b. Turning on te telemetry module
c. Checks for intactness of ECG lead wire and
pulse oximeter
d. Checks for the battery power
5. Enters the following data to the central monitor
a. Patient's Name
b. Sex
c. Age
d. Height
e. Weight
f. Hospital Number
g. Room Number
h. Date of Birth
i. Telemetry module number
B. PERFORMANCE PHASE:
6. Performs proper hand hygiene
7. Informs patient / relative about the telemetry
procedure.
8. Attaches Telemetry module to the patient's arm.
9. Attaches ECG lead wire and Pulse Oximeter to
Telemetry Module
10. Prepares skin for electrode placement
a. Cleanses skin with alcohol and allows drying
b. Clips chest hair as needed
11. Demonstrates proper chest leads placement
( RA – Red, LA – Yellow, LL – Green)
12. Properly attaches the oximeter probe on patient's
finger (checks for warmth and nail color)

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 Date: Date: Date:
CRITICAL CARE COMPETENCIES
CD ID CD ID CD ID
13. Turns on telemetry module (Sets the frequency of
NIBP Monitoring accordingly)
14. Selects appropriate leads and sensitivity on the
central monitor unit.
15. Sets alarm limit at the central telemetry monitor
unit.
16. Prints out a baseline 6 second ECG strip
17. Interprets ECG Rhythm strip
a. Differentiates normal from abnormal ECG
rhythm and potential causes.
b. Discusses the possible interventions related to
the ECG rhythm abnormalities
18. Renders appropriate nursing action to an abnormal
parameters
FOLLOW UP PHASE
19. Performs Hand Hygiene
20. Updates healthcare team on the patient status.
21. Updates significant others on the patient status.
22. Performs proper documentation.
23. Checks the previous ECG readings at the central
monitor unit.
24. Charges use of equipment every shift
DISCONTINUANCE PHASE
25. Checks physician's order
26. Performs proper hand hygiene
27. Informs patient/significant others of the procedures
28. Detaches the following from the patient (chest leads,
finger probe & telemetry module)
29. Checks for completeness of equipment
30. Performs proper after care of the equipment

1. Clinical Evaluator : ______________________________ Date:_______________

Signature Over Printed Name
Remarks:
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________

1. Clinical Evaluator : ______________________________ Date:_______________

Signature Over Printed Name
Remarks:
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________

1. Clinical Evaluator : ______________________________ Date:_______________

Signature Over Printed Name
Remarks:
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________

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