For her nurse residency program research project, RN Melia Delaney wanted to make a “real difference.”

 About a year ago, a patient had gone into cardiac arrest after pulling out their tracheostomy and, despite strenuous efforts to resuscitate, passed away. The event was unexpected and “traumatizing” for the patient’s family, and for Melia, herself.  

“The idea that this could happen again was terrifying to me,” she said. 

 This particular patient hadn’t had any orders for medical monitoring at the time of her death. Melia wondered if standardized monitoring practices could have made a difference in this situation, and, more broadly, if new protocols could help all her patients. Her final residency research project gave her the opportunity to explore this idea.  

For her project, she conducted an analysis of telemetry orders in her unit. Telemetry is a vital tool for patients who need it, but evidence shows that excessive telemetry monitoring can actually cause harm for certain patient populations. At the same time, patients sometimes wait for monitoring due to a lack of availability of equipment. Melia’s research could show if the people who needed telemetry the most were receiving it, and if others who didn’t need monitoring could be off it, mitigating any potential risks and freeing up necessary equipment. 

Melia analyzed 733 relevant records from her department and determined that 25% of telemetry orders were not medically-indicated based on clinical guidelines.  

From there, she developed a tool to help nurses assess and make recommendations on whether a patient’s telemetry orders should be continued based on clinical and facility guidelines. She distributed two dozen copies of the tool—a simple laminated flowchart—around her unit at nurses’ stations, bulletin boards, and desks. When she analyzed the results months later, she couldn’t believe the results. 

After introducing the new tool, rates of non-indicated telemetry decreased by 50%—representing $1.4 million saved for patients. It also meant telemetry would be available for the patients who needed it most.  

Melia thought back to the patient who had started it all.  

“Obviously, I can’t go back to help that patient,” she said. “But it means a lot to me that, as result of what happened, we did make real changes. We made it harder for something like this to happen again on my unit.” 

Melia never expected her research project to go this far, but she’s proud of the results.  

“I wanted to do something that could use research to make a real difference for my patients,” she said. “It’s a story of what happens when nurses are taken seriously.”