Substandard Quality of ECG Monitoring in Current Clinical Practice: Baseline Results of the PULSE Trial

2.50
Hdl Handle:
http://hdl.handle.net/10755/156982
Category:
Abstract
Type:
Presentation
Title:
Substandard Quality of ECG Monitoring in Current Clinical Practice: Baseline Results of the PULSE Trial
Author(s):
Funk, Marjorie; May, Jeanine; Leonie, Rose; Vaughn, Chelsea; Winkler, Catherine; Drew, Barbara; Stephens, Kimberly; Laragy, Margaret; Feder, Sheli; Fennie, Kristopher; Hurley, Elisabeth
Author Details:
Marjorie Funk, RN,MSN,PhD,FAAN,FAHA, Yale University School of Nursing, New Haven, Connecticut, USA, email: marjorie.funk@yale.edu; Jeanine May; Rose Leonie; Chelsea Vaughn; Catherine Winkler; Barbara Drew; Kimberly Stephens; Margaret Laragy; Sheli Feder; Kristopher Fennie; Elisabeth Hurley
Abstract:
POSTER PURPOSE: Although electrocardiographic (ECG) monitoring is the cornerstone of care in hospital cardiac units, no studies have evaluated its quality. The purpose of our study is to examine the quality of ECG monitoring by evaluating electrode placement, leads displayed on the monitor, accuracy of rhythm interpretation, and use of ischemia and QTc interval monitoring when indicated. BACKGROUND/SIGNIFICANCE: ECG monitoring is exclusively within the domain of nursing practice. It is the independent responsibility of nurses to place electrodes in the proper position, determine goals of monitoring for each patient, select the leads to be displayed, select arrhythmia alarm parameters, choose whether to activate ST segment monitoring and determine alarm parameters, and decide whether to monitor the QTc interval. Evidence suggests that monitoring practices are inconsistent and often inadequate. METHOD: The Practical Use of the Latest Standards for Electrocardiography (PULSE) trial is a 5-year multisite randomized clinical trial evaluating the effect of implementing the practice standards for ECG monitoring from the American Heart Association/American Association of Critical-Care Nurses on nurses' knowledge, quality of care, and patients' outcomes. We analyzed baseline data of the PULSE trial, which included 1821 patients on cardiac units in 17 hospitals (15 in the US, 1 in Canada, and 1 in Hong Kong) from July 2008 to July 2009. Research nurses reviewed current medical records and observed patients for electrode placement and leads displayed on the monitor. They compared arrhythmias stored in the monitor's memory with documentation by unit nurses. RESULTS: Patients had a mean age of 65 (SD, 15) years, 58% were male, and 80% were white. Electrodes were frequently incorrectly placed: 15% - 27% of the time for limb electrodes, 76% when 1 chest electrode was used, and 30% - 58% with >1 chest electrode. When the derived EASI system was used, electrode placement was wrong 78% of the time. On most patients, 5 lead wires were used (76%) and lead II was the most frequently displayed (71%). Nurses documented occurrences of arrhythmias correctly only 51% of the time. Of the patients with an indication for ischemia monitoring, 41% were monitored for ST-segment changes. Only 20% of the patients with an indication for QTc monitoring had a QTc value documented by nurses. CONCLUSIONS: Our findings revealed substandard ECG monitoring, including incorrect electrode placement, inaccurate rhythm interpretation, underuse of ischemia monitoring, and failure to monitor for QTc prolongation when indicated. The next phase of the PULSE trial will test whether an online ECG monitoring education program and strategies to implement and sustain changes in practice will enhance nurses' knowledge and the quality of ECG monitoring, ultimately leading to improved outcomes for patients.
Repository Posting Date:
26-Oct-2011
Date of Publication:
26-Oct-2011
Citation:
2010 National Teaching Institute Research Abstracts. American Journal of Critical Care, 19(3), e15-e28. doi:10.4037/ajcc2010866
Conference Date:
2010
Conference Name:
National Teaching Institute and Critical Care Exposition
Conference Host:
American Association of Critical-Care Nurses
Conference Location:
Washington, D.C., USA
Note:
This is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.

Full metadata record

DC FieldValue Language
dc.type.categoryAbstracten_GB
dc.typePresentationen_GB
dc.titleSubstandard Quality of ECG Monitoring in Current Clinical Practice: Baseline Results of the PULSE Trialen_GB
dc.contributor.authorFunk, Marjorieen_GB
dc.contributor.authorMay, Jeanineen_GB
dc.contributor.authorLeonie, Roseen_GB
dc.contributor.authorVaughn, Chelseaen_GB
dc.contributor.authorWinkler, Catherineen_GB
dc.contributor.authorDrew, Barbaraen_GB
dc.contributor.authorStephens, Kimberlyen_GB
dc.contributor.authorLaragy, Margareten_GB
dc.contributor.authorFeder, Shelien_GB
dc.contributor.authorFennie, Kristopheren_GB
dc.contributor.authorHurley, Elisabethen_GB
dc.author.detailsMarjorie Funk, RN,MSN,PhD,FAAN,FAHA, Yale University School of Nursing, New Haven, Connecticut, USA, email: marjorie.funk@yale.edu; Jeanine May; Rose Leonie; Chelsea Vaughn; Catherine Winkler; Barbara Drew; Kimberly Stephens; Margaret Laragy; Sheli Feder; Kristopher Fennie; Elisabeth Hurleyen_GB
dc.identifier.urihttp://hdl.handle.net/10755/156982-
dc.description.abstractPOSTER PURPOSE: Although electrocardiographic (ECG) monitoring is the cornerstone of care in hospital cardiac units, no studies have evaluated its quality. The purpose of our study is to examine the quality of ECG monitoring by evaluating electrode placement, leads displayed on the monitor, accuracy of rhythm interpretation, and use of ischemia and QTc interval monitoring when indicated. BACKGROUND/SIGNIFICANCE: ECG monitoring is exclusively within the domain of nursing practice. It is the independent responsibility of nurses to place electrodes in the proper position, determine goals of monitoring for each patient, select the leads to be displayed, select arrhythmia alarm parameters, choose whether to activate ST segment monitoring and determine alarm parameters, and decide whether to monitor the QTc interval. Evidence suggests that monitoring practices are inconsistent and often inadequate. METHOD: The Practical Use of the Latest Standards for Electrocardiography (PULSE) trial is a 5-year multisite randomized clinical trial evaluating the effect of implementing the practice standards for ECG monitoring from the American Heart Association/American Association of Critical-Care Nurses on nurses' knowledge, quality of care, and patients' outcomes. We analyzed baseline data of the PULSE trial, which included 1821 patients on cardiac units in 17 hospitals (15 in the US, 1 in Canada, and 1 in Hong Kong) from July 2008 to July 2009. Research nurses reviewed current medical records and observed patients for electrode placement and leads displayed on the monitor. They compared arrhythmias stored in the monitor's memory with documentation by unit nurses. RESULTS: Patients had a mean age of 65 (SD, 15) years, 58% were male, and 80% were white. Electrodes were frequently incorrectly placed: 15% - 27% of the time for limb electrodes, 76% when 1 chest electrode was used, and 30% - 58% with >1 chest electrode. When the derived EASI system was used, electrode placement was wrong 78% of the time. On most patients, 5 lead wires were used (76%) and lead II was the most frequently displayed (71%). Nurses documented occurrences of arrhythmias correctly only 51% of the time. Of the patients with an indication for ischemia monitoring, 41% were monitored for ST-segment changes. Only 20% of the patients with an indication for QTc monitoring had a QTc value documented by nurses. CONCLUSIONS: Our findings revealed substandard ECG monitoring, including incorrect electrode placement, inaccurate rhythm interpretation, underuse of ischemia monitoring, and failure to monitor for QTc prolongation when indicated. The next phase of the PULSE trial will test whether an online ECG monitoring education program and strategies to implement and sustain changes in practice will enhance nurses' knowledge and the quality of ECG monitoring, ultimately leading to improved outcomes for patients.en_GB
dc.date.available2011-10-26T19:18:59Z-
dc.date.issued2011-10-26en_GB
dc.date.accessioned2011-10-26T19:18:59Z-
dc.identifier.citation2010 National Teaching Institute Research Abstracts. American Journal of Critical Care, 19(3), e15-e28. doi:10.4037/ajcc2010866en_GB
dc.conference.date2010en_GB
dc.conference.nameNational Teaching Institute and Critical Care Expositionen_GB
dc.conference.hostAmerican Association of Critical-Care Nursesen_GB
dc.conference.locationWashington, D.C., USAen_GB
dc.identifier.citation2010 National Teaching Institute Research Abstracts. American Journal of Critical Care, 19(3), e15-e28. doi:10.4037/ajcc2010866en_GB
dc.description.noteThis is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.-
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