NR 721 Week 3 Drift Analysis Example

Drift Analysis: Which Way the Telemetry Discontinuation Protocol Has Moved Since August 2026, How Far, and the Step That Gave Way First

Student Name

College of Nursing, Chamberlain University

NR 721: Topics in Healthcare Systems Leadership II

Instructor Name

Month Day, Year

Drift Analysis: Which Way the Telemetry Discontinuation Protocol Has Moved Since August 2026, How Far, and the Step That Gave Way First

What Was Examined

Drift was examined in two ways, both small and both stated plainly. The manager watched 12 telemetry reminders being answered on the 36-bed medical unit between 8 and 21 September 2027, seven at 07:00 and five later in the morning, and opened the records of all 40 telemetry removals made in September. The record also supplied a count of every reminder that fired that month and how it was answered, which could be set against the same month a year earlier, September 2026, the second month of the protocol. No survey was used; the question was what the practice actually does on the unit, not what staff think of it.

Direction Before Distance

The practice has moved in three directions, and the direction matters more than any single percentage. First, from assessment toward default: in September 2026, 14% of reminders were answered "continue, provider preference"; in September 2027 it was 109 of 268, 40.7%. Second, from the day nurse toward the night nurse: the reminder fires at 07:00, during handoff, and in the 12 observed cases the departing night nurse answered it seven times, usually without having assessed the patient that morning. Third, from the charging station toward the patient's room: boxes are now often left in the room after removal, and the asset log shows a transmitter scanned back onto a charging station within an hour of removal in 23 of the 40 September removals.

Distance, Counted

In the 12 observed reminders, 7 matched the installed version: the criteria were checked against the order and the patient, and the box was removed or a reason recorded. In the 40 September removal records, the criteria were documented in 31, the box was removed a median of 11 hours after the reminder, against the two hours the installed protocol expected, and the provider was messaged after 14. The core decision, whether to remove, is still made by assessment a little over half the time; the steps around it have drifted further.

Where the Drift Is Greatest

The September counts can be split by when the reminder fired, and the split shows where the protocol is held and where it is not. On weekdays, 69 of 192 reminders, 35.9%, were answered with the stock default; on weekends, 40 of 76, 52.6%. The difference tracks a person rather than a day. On the 13 days in September when the telemetry champion was the day charge nurse, 34 of 117 reminders, 29.1%, got the default; on the other days, 75 of 151, 49.7%. The champion does nothing dramatic on those days: the report of patients past 48 hours is run at 08:00 every morning, and the champion asks at the 09:00 huddle why each is still monitored. That single, unremarkable question appears to hold about a third of the protocol in place, which means the practice depends on one role's presence far more than the installed design assumed.

The Step That Gave Way First

The first step to give way was the time of the reminder. In August 2026 the reminder was set for 07:00 because that was when the overnight telemetry report printed, and the design assumed the day nurse would act on it after report. On this unit, report runs from 07:00 to about 07:40, and the day nurse's first hour is the morning medication pass. The reminder therefore arrives when the night nurse is leaving and the day nurse is not yet free. The night nurse can answer it quickly with the default, and the day nurse, finding it answered, moves on. The paper "keep on tele" list grew around this moment, giving the default a reason that looks legitimate.

Physical Reasons First

Before attributing drift to attitudes, the analysis looked for physical causes, and found three. The reminder time, described above, is a property of the build, not of any nurse. The six charging stations sit in the clean supply room beyond the last patient room, about 40 meters from the farthest beds, so returning a box means a walk that a nurse halfway through giving medicines puts off until later in the morning. And the laminated criteria cards are clipped to those same charging stations, so the criteria are farthest from the bedside exactly when they are needed. None of these was visible in the compliance figure, and each would produce drift even in a careful, well-intentioned unit (Debono et al., 2013).

Consider That They Improved It

Not all of the drift is decay. Nurses added a call to the monitor technician before each removal, which ended a stream of leads-off alarms from boxes lying on bedside tables. And on the days observed, several day nurses had begun answering later reminders at about 10:00, after the medication pass, when they had seen the patient; those reminders were the ones most often answered with an assessment and a removal. In effect, some staff have already moved the reminder to the time it should have been, without being asked. A revised protocol should adopt both changes rather than correct them.

What the Analysis Cannot Show

The observations are few, two weeks of reminders on one unit, and the observer's presence may have improved the answers given. The record counts cannot show whether a "provider preference" answer reflects a real request from a hospitalist or a habit, though the paper list suggests both occur. And the analysis does not show harm; telemetry continued longer than necessary for some patients, which the national standards treat as overuse rather than as a safety event (Sandau et al., 2017). Drift of this kind, toward the old practice and around a badly timed step, is common in practices that remove something rather than add it (Norton & Chambers, 2020).

What Follows

The analysis points to three changes for the next stage: move the reminder to 10:00, move the criteria cards to the bedside telemetry pouch and add a box return point at the nurses' station. Whether to make them, or to stop the protocol, is for the continue-or-stop decision later in the review, which will also have to decide what replaces the champion's daily question on the days the champion is not working.

References

Debono, D. S., Greenfield, D., Travaglia, J. F., Long, J. C., Black, D., Johnson, J., & Braithwaite, J. (2013). Nurses' workarounds in acute healthcare settings: A scoping review. BMC Health Services Research, 13, Article 175. https://doi.org/10.1186/1472-6963-13-175

Norton, W. E., & Chambers, D. A. (2020). Unpacking the complexities of de-implementing inappropriate health interventions. Implementation Science, 15, Article 2. https://doi.org/10.1186/s13012-019-0960-9

Sandau, K. E., Funk, M., Auerbach, A., Barsness, G. W., Blum, K., Cvach, M., Lampert, R., May, J. L., McDaniel, G. M., Perez, M. V., Sendelbach, S., Sommargren, C. E., & Wang, P. J. (2017). Update to practice standards for electrocardiographic monitoring in hospital settings: A scientific statement from the American Heart Association. Circulation, 136(19), e273-e344. https://doi.org/10.1161/CIR.0000000000000527