VA Finds Large Gaps in RN Telemetry Training, Retraining

Patient deaths at VA hospitals in Denver and New York City, as well as an overall indictment of nurse competency and processes at Veterans Health Administration facilities in general, are reminders of the critical need for not only training—but retraining—nurses.

Moreover, a report suggests that merely having training requirements on paper isn't enough. Instead, facilities need to have processes in place to make sure that the training actually happens and happens when it's supposed to.

A report issued in late April by the Department of Veterans Affairs Office of Inspector General finds that although all 29 of its facilities included in the evaluation had RN competency assessment and validation policies/processes in place, they varied by location and were not consistently followed.  

For example, the report points to one RN whose last documented telemetry use competency training was 13 years ago, "despite facility annual competency requirements."

In another case, there was no ongoing process to assess and validate RNs cardiac monitoring competencies, and managers knew that their RNs lacked the related skills.

At each of the facilities in the examples above, patients died. Although inspections couldn't prove that nurses' skill deficiencies were directly to blame for the patient deaths, deficiencies were found nonetheless.

In one case, the VA OIG Office of Healthcare Inspections reviewed allegations of poor monitoring of a patient who died on the telemetry unit at the Manhattan Campus of the New York Harbor Healthcare System in New York, NY.

Inspectors found that "medical record documentation by unit staff did not meet industry or facility requirements and that telemetry unit nursing and biomedical engineering staff were not trained to properly use the telemetry monitoring equipment." Neither was there evidence of any refresher training.

The deficiencies were startling. Inspectors discovered that the many of the nurses they interviewed didn't know which alarms would sound if a telemetry lead became disconnected from a patient's chest; whether an ECG strip would automatically print if a lead became disconnected; how to set the parameters on the monitoring system; and or how to retrieve and print a patient's electronically saved telemetry history.

In addition to identifying the critical need for training and refresher courses, the April VA OIG report also cites the Joint Commission requirement that hospitals take action when staff competence does not meet expectations. Although the review found that 58 (17%) of 349 RNs did not demonstrate competency in one or more required skills, it didn't find documentation of actions taken to address the deficiencies for 41% of the 58 RNs.

The April VA OIG report recommends that the Under Secretary for Health:

• Establish specific RN competency assessment and validation requirements to ensure consistency among facilities.
• Work in conjunction with Veterans Integrated Service Networks (VISN) and facility senior managers to ensure that competency validation documentation includes all elements required by Joint Commission standards and local policy.
• Work in conjunction with VISN and facility senior managers to ensure that all RN competency documentation is present in competency folders and is current and validated.
• Work in conjunction with VISN and facility senior managers to ensure that appropriate actions are taken when competency expectations are not met.

The reports should also serve as a reminder to all hospitals that when it comes to training and retraining requirements, on paper doesn't equal in practice.