Case Study: Cross-Monitoring for Smooth Recovery
Mrs. Ashburn is a patient on the cardiac care unit of the hospital recovering from triple bypass heart surgery. Her past medical history includes rheumatoid arthritis affecting both knees and ankles that requires the use of a wheeled walker for ambulation. Her cardiologist has consulted physical therapy to begin her cardiac rehabilitation walking program. At day 2 after surgery she is still wearing a heart monitor, which sends a signal to the electrocardiography (ECG) technician station. Nurses oversee her pain medication, her vital signs, and care of her incisions. The respiratory therapist instructed Mrs. Ashburn on use of the spirometer to encourage deep breathing and reduce the risk of developing pneumonia. Each healthcare team member has an important role in promoting successful recovery from surgery. The physical therapist checks in with the nurse caring for Mrs. Ashburn to see how she has been doing for the past 24 hours. The physical therapist also checks in with the ECG-monitor technicians to discuss the current readings from Mrs. Ashburn’s heart monitor and to alert them that she will be taking the patient for a walk in the hallway. The physical therapist checks her heart rate, blood pressure, and oxygen saturation before walking with her in the hallway. Midway through the walk in the hallway with the physical therapist, the ECG technician notes an abnormal heart rhythm and calls the nurse to communicate this information. The nurse brings a wheelchair to the hallway and suggests they take a rest break. The physical therapist and nurse closely monitor her heart rate, blood pressure, and oxygen saturation. Mrs. Ashburn says that she feels a little tired but otherwise alright. After a few minutes of rest, the ECG technician notifies them that her heart rhythm has returned to normal. The nurse and PT walk Mrs. Ashburn back to her room.
Discussion Questions
- Why was it important to have an interprofessional team cross-monitoring and communicating about the patient’s status during activity? What could have happened if patient care decisions were made “in a silo”?
- Imagine that the nurse had handled the situation differently, placing blame for the episode of abnormal heart rhythm rather than addressing it with the team. What would have been the impact on the patient? What would have been the impact on the physical therapist?
- Identify at least three examples in this case study in which team members effectively engaged others in the plan of care. Can you suggest additional strategies that they could use?
