Cardiac monitoring of adult cardiac patients in NSW public hospitals
Principles


1.
Cardiac monitoring has no therapeutic value unless the
supervising clinicians can recognise and manage cardiac
abnormalities.
 4.
A daily re-assessment of the clinical indication for continued
monitoring should be performed by the treating medical team for
group A or skilled delegate (e.g. CNC, CNE, NUM) for group B.
2.
The treating medical officer has the final responsibility for
risk assessment of patients requiring cardiac monitoring
and allocation to the appropriate monitoring category.

5.
Patients should remain monitored at all times. If monitoring is interrupted
for any reason, patients must be under direct visual observation by
appropriately skilled staff until monitoring is recommenced.
3.
All cardiac monitors should be connected to a central
monitor. In the absence of local policy, alarm parameters
should be set as per ‘Between the Flags Yellow Zone’.
6.
One nurse who meets competency requirements for the relevant
escort skill sets should be on duty at all times.
CLINICAL INDICATION
ESCORT SKILL SET
Pre-operative cardiac surgery
• All STEMI and NSTEMI must be monitored for a minimum of 24 hours.
• ST segment monitoring may be useful if available.
• At the end of the recommended monitoring period, patients who are clinically
stable should have cardiac monitoring discontinued. NB. This will require a
written medical order.
• Continue cardiac monitoring until successful coronary revascularisation occurs.
Basic and advanced (A – K)
Post-operative cardiac surgery
• Monitor for a minimum of 48 hours.
Basic and advanced (A – K)
• Continue cardiac monitoring during the course of therapy.
• Duration of monitoring must be determined by medical officer based on type of
drug, dose and time since ingestion.
Basic and advanced (A – K)
Confirmed acute coronary
syndrome
GROUP
A
RECOMMENDED MONITORING DURATION
Post cardiac arrest
Life threatening arrhythmias/
Implantable devices
Pharmacotherapy
severe electrolyte
GROUP Acute
imbalance
B
Post PCI, post EPS and post
catheter ablation
Further information

8.
If a patient is being transferred, direct visual
observation must be maintained by a clinician with the
appropriate skill set.

9.
If the facility cannot meet these standards, the patient
should be transferred to a facility able to provide this
standard of care.
REQUIREMENTS
Basic and advanced (A – K)
• Require continuous cardiac monitoring OR direct visual
observation until cardiac monitoring is discontinued.
• Monitor for a minimum of 24 hours and until cause has been identified and treated. Basic and advanced (A – K) • Escort by trained staff as specified with resuscitation
equipment for all internal and inter-facility transfers.
1. Patients who are
• Require a written medical order to discontinue cardiac
considered clinically
• Monitor until reversible cause is identified and treated, cardiac symptoms have
monitoring.
unstable:
been stabilised by medical therapy and/or device is implanted and satisfactorily
Basic and advanced (A – K) • At the end of the recommended monitoring period, Group
tested.
A patients require daily re-assessment of the clinical
NB: Cardiac monitoring is always required during temporary cardiac pacing even 2. Patients who are
indications for continued monitoring and documentation of
if device implant is not planned.
considered clinically stable
these indications in the health care record.
Basic (A – E)
Cardiogenic shock, haemodynamic
• Continue cardiac monitoring during the course of therapy.
or respiratory compromise
• Monitor until second troponin is available. If 2nd troponin is negative and there
Suspected acute coronary
are no acute ECG changes or recurrence of symptoms of suspected myocardial
syndrome
ischaemia, cardiac monitoring can be discontinued.
Arrhythmias
 7.
Each LHD should determine the required competency
assessments to ensure a safe skill mix is available at all
times.
Basic and advanced (A – K)
Basic (A - E)
• Monitor until reversion of rhythm or control of ventricular rate
Basic (A - E)
• Monitor until the acute electrolyte imbalance has been corrected and there are
no related arrhythmias present
Basic (A - E)
• Monitor for a minimum of 4 hours post-procedure (or as per local policy).
• Monitor for up to 24 hours if there are procedural complications, arrhythmias,
chest pain or haemodynamic compromise.
Basic (A - E)
• Require continuous cardiac monitoring OR direct visual
observation until monitoring is discontinued.
• Unless there is a written medical order to continue, cardiac
monitoring should be discontinued by RNs at the end of the
recommended monitoring period if patients are clinically
stable. Discontinuation of cardiac monitoring should be
discussed with the RN in charge or another competent RN (see
competency requirements A – K in the guideline).
• If monitoring continues after the completion of the
recommended period, daily re-assessment and documentation
of the indications for monitoring is required.
• Medical staff should specify the time period for additional
monitoring, or stipulate clinical criteria that necessitate
continued monitoring. If no timeframe or clinical criteria are
listed, the order will apply for 24 hours only.
For information on other conditions when monitoring MAY be required and when cardiac monitoring is NOT required, please refer to the clinical guideline on cardiac monitoring of adult cardiac patients in public hospitals in NSW.
V.1 April 2016