Association of Implementation of Practice Standards for Electrocardiographic Monitoring With Nurses’ Knowledge, Quality of Care, and Patient Outcomes

Abstract

Background Although continuous electrocardiographic (ECG) monitoring is ubiquitous in hospitals, monitoring practices are inconsistent. We evaluated implementation of American Heart Association practice standards for ECG monitoring on nurses’ knowledge, quality of care, and patient outcomes. Methods and Results The PULSE Trial was a 6-year multi-site randomized clinical trial with crossover that took place in 65 cardiac units in 17 hospitals. We measured outcomes at baseline, Time 2 after Group 1 hospitals received the intervention, and Time 3 after Group 2 hospitals received the intervention. Measurement periods were 15 months apart. The 2-part intervention consisted of an online ECG monitoring education program and strategies to implement and sustain change in practice. Nurses’ knowledge (N=3,013 nurses) was measured by a validated 20-item online test, quality of care related to ECG monitoring (N=4,587 patients) by on-site observation, and patient outcomes (mortality, in-hospital myocardial infarction, and not surviving a cardiac arrest) (N=95,884 hospital admissions) by review of administrative, laboratory, and medical record data. Nurses’ knowledge improved significantly immediately following the intervention in both groups, but was not sustained 15 months later. For most measures of quality of care (accurate electrode placement, accurate rhythm interpretation, appropriate monitoring, and ST-segment monitoring when indicated), the intervention was associated with significant improvement, which was sustained 15 months later. Of the 3 patient outcomes, only in-hospital myocardial infarction declined significantly after the intervention, and was sustained. Conclusions Online ECG monitoring education and strategies to change practice can lead to improved nurses’ knowledge, quality of care, and patient outcomes.

Nurses’ use of monitors in patient surveillance: an ethnographic study on a coronary care unit

“…27 Continuing education and training in monitor use can both enhance the knowledge and competence of nurses in patient surveillance and improve patient outcoms. 28 This can be achieved by implementing a core curriculum for the continuing professional education for qualified cardiac nurses, including learning activities in the role of technology in patient safety, heart rhythm, conduction disorders and EKG skills. 29…”

“…1 Implementing protocols for appropriate monitor use, educating nurses in monitoring practice standards and involving them in the monitor discontinuation decision process can potentially eliminate monitor overuse and reduce excessive nuisance alarms. 28 The nurses observed in this study were mobile in their work and nursing tasks took them all over the unit, and even outside of it, to care for their patients. Considered alongside the layout of the unit, this made it difficult for them to hear and respond to the alarms effectively, which has been shown to affect alarm safety.…”

Highlights From the 2017 Cardiovascular and Stroke Nursing Clinical Symposium

“…The PULSE trial, a 6- year multisite randomized controlled trial, examined the effects of implementing the 2004 AHA standards for ECG monitoring on nurses' knowledge, quality of care, and patient outcomes. 4 The study revealed that improving nurses' knowledge about appropriate ECG monitoring leads to better patient outcomes. Dr Funk reminded the audience that an Update to the Practice Standards for Electrocardiographic Monitoring in Hospital Settings was published recently in Circulation.…”

“…Dr Marjorie Funk presented the findings from the PULSE (Practical Use of the Latest Standards for Electrocardiography) trial. The PULSE trial, a 6‐year multisite randomized controlled trial, examined the effects of implementing the 2004 AHA standards for ECG monitoring on nurses’ knowledge, quality of care, and patient outcomes 4. The study revealed that improving nurses’ knowledge about appropriate ECG monitoring leads to better patient outcomes.…”

Comparative study of virtual and traditional teaching methods on the interpretation of cardiac dysrhythmia in nursing students

“…Nurses should have enough knowledge to carry out these responsibilities so that they can maximize the quality of care and patient outcomes. [6] Nurses should be able to quickly and correctly detect and interpret ECG abnormalities and intervene in a timely manner. [7]…”