Monitor-Watcher Use, Nurses’ Knowledge of Electrocardiographic Monitoring, and Arrhythmia Detection

Abstract

Background Electrocardiographic telemetry monitors are ubiquitous in hospitals. Dedicated monitor watchers, either on the unit or in a centralized location, are often responsible for observing telemetry monitors and responding to their alarms. The impact of use of monitor watchers is not known. Objectives To evaluate the association of monitor-watcher use with (1) nurses’ knowledge of electrocardiographic (ECG) monitoring and (2) accuracy of arrhythmia detection. Methods Baseline data from 37 non–intensive care unit cardiac patient care areas in 17 hospitals in the Practical Use of the Latest Standards for Electrocardiography trial were analyzed. Nurses’ knowledge (n = 1136 nurses) was measured using a validated, 20-item online test. Accuracy of arrhythmia detection (n = 1189 patients) was assessed for 5 consecutive days by comparing arrhythmias stored in the monitor with nurses’ documentation. Multiple regression was used to evaluate the association of use of monitor watchers with scores on the ECG-monitoring knowledge test. The association of monitor-watcher use with accuracy of arrhythmia detection was examined by χ2 analysis. Results Of the 37 units, 13 (35%) had monitor watchers. Use of monitor watchers was not independently associated with ECG-monitoring knowledge (P = .08). The presence of monitor watchers also was not significantly associated with the accuracy of arrhythmia detection (P = .94). Conclusion Although the use of monitor watchers was not associated with diminished nurses’ knowledge of ECG monitoring, it also was not associated with more accurate arrhythmia detection. If implementing a monitor-watcher program, critical safety points, such as ensuring closed-loop communication, must be considered.

Ritmo Idioventricular: caso clínico

“…Las enfermeras deben estar capacitadas para intervenir rápida y adecuadamente cuando se produzcan arritmias cardíacas, estas profesionales observan periódicamente los monitores y escuchan las alarmas al mismo tiempo que brindan atención al paciente, en este sentido un estudio reveló que, aunque el uso de monitores no disminuyó el conocimiento de las enfermeras sobre la monitorización electrocardiográfica, tampoco aumentó la precisión de la detección de arritmias. Las investigaciones futuras deben abordar el uso de monitores para pacientes no cardíacos, la rentabilidad de los monitores y la asociación entre el uso de monitores y los resultados adversos de los pacientes y los eventos clínicamente importantes perdidos, siendo crucial determinar la cantidad de vigilancia humana de la tecnología necesaria para mantener la seguridad del paciente (Funk et al, 2021).…”