Precordial Electrode Placement Accuracy by Nurses in a Large Midwestern Tertiary Care Hospital

Wirt, Elizabeth M; Milbrath, Christine D.; Farnsworth, Monica

doi:10.3928/00220124-20140625-09

Cited by 5 publications

(17 citation statements)

References 10 publications

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“…Others who evaluated the 5-electrode Mason-Likar system for continuous monitoring, reported similar results, including a low rate of correct V lead placement. 4,27 The interventions in these studies were similar to ours and included education and auditing of electrode placement with real-time feedback by unit champions 4 and tip cards and posters. 27 …”

Section: Discussionmentioning

confidence: 99%

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

Funk

Fennie

Stephens

et al. 2017

Circ: Cardiovascular Quality and Outcomes

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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.

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Section: Discussionmentioning

confidence: 99%

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

Funk

Fennie

Stephens

et al. 2017

Circ: Cardiovascular Quality and Outcomes

View full text Add to dashboard Cite

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“…In addition to knowledge and skills, attitude is also important in nurses' competency in ECG interpretation. Several studies in this review reported nurses' negative attitudes around ECG interpretation, affecting their competency in this important nursing role (Drew et al, 1991;Nickasch, 2016;Wirt et al, 2014). Positive attitudes can motivate nurses' self-directed learning and promote their application of knowledge and skills into practice (Zhou et al, 2012); hence, negative attitudes need to be addressed.…”

Section: Discussionmentioning

confidence: 93%

“…Other causes for the negative attitudes were lack of knowledge and confidence in ECG interpretation. All these suggest that there is an urgent need to develop standardized education programs that improve nurses’ knowledge, skills and attitudes towards ECG interpretation, thereby meeting critical safety points (Fålun et al, 2020; Nickasch, 2016; Wirt et al, 2014).…”

Section: Discussionmentioning

confidence: 99%

“…This review did not find any association between nurses’ ECG knowledge and their skills. However, nurses’ ECG knowledge is not always linked to skills in ECG interpretation or capacity to apply knowledge (Ruhwanya et al, 2018; Wirt et al, 2014; Zimmerman et al, 2012). A cross‐sectional study revealed that more than half of nurses (60%) in critical care settings scored high when their knowledge of life‐threatening arrhythmia identification was tested; however, 84% of the nurses scored low in their ability to intervene when faced with rhythm abnormalities (Ruhwanya et al, 2018).…”

Section: Discussionmentioning

confidence: 99%

“…For instance, researchers measured nurses’ knowledge and/or attitudes in pressure injury prevention (Jiang et al, 2020), pressure ulcer care (Kaddourah et al, 2016) and peripheral intravenous cannulation (Hassanein et al, 2021), without assessing actual skills. Assessing skills usually requires an on‐the‐spot evaluation that needs extra resources (Funk et al, 2017; Wirt et al, 2014), which may explain why skills are not commonly included in competency assessment. Despite this, skills should be included in nurses’ competency assessments, directly related to patient safety (Funk et al, 2017; Hassanein et al, 2021).…”

Section: Discussionmentioning

confidence: 99%

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Nurses’ competency in electrocardiogram interpretation in acute care settings: A systematic review

Chen

Kunst

Nasrawi

et al. 2022

Journal of Advanced Nursing

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Aims Identify and synthesize evidence of nurses’ competency in electrocardiogram interpretation in acute care settings. Design Systematic mixed studies review. Data sources Cumulative Index to Nursing and Allied Health Literature, Medline, Scopus and Cochrane were searched in April 2021. Review methods Data were selected using the updated Preferred Reporting Items for Systematic Reviews and Meta‑Analysis framework. A data‐based convergent synthesis design using qualitative content analysis was adopted. Quality appraisal was undertaken using validated tools appropriate to study designs of the included papers. Results Forty‐three papers were included in this review. Skills and attitudes were not commonly assessed, as most studies referred to ‘competency’ in the context of nurses’ knowledge in electrocardiogram interpretation. Nurses’ knowledge levels in this important nursing role varied notably, which could be partly due to a range of assessment tools being used. Several factors were found to influence nurses’ competency in electrocardiogram interpretation across the included studies from individual, professional and organizational perspectives. Conclusion The definition of ‘competency’ was inconsistent, and nurses’ competency in electrocardiogram interpretation varied from low to high. Nurses identified a lack of regular training and insufficient exposure in electrocardiogram interpretation. Hence, regular, standard training and education are recommended. Also, more research is needed to develop a standardized and comprehensive electrocardiogram interpretation tool, thereby allowing educators to safely assess nurses’ competency. Impact This review addressed questions related to nurses’ competency in electrocardiogram interpretation. The findings highlight varying competency levels and assessment methods. Nurses reported a lack of knowledge and confidence in interpreting electrocardiograms. There is an urgent need to explore opportunities to promote and maintain nurses’ competency in electrocardiogram interpretation.

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Examining the causes and effects of electrode misplacement during electrocardiography: a literature review

Pearce

2019

British Journal of Cardiac Nursing

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Background/Aims Electrode misplacement appears to be a common finding during 12-lead electrocardiography and there are numerous potential causes and effects. This article aims to identify the frequency of electrode misplacement during electrocardiography, examine the effect this may have on patient safety and review the causes of misplacement. Methods A systematic literature review of current primary research was conducted across three electronic healthcare databases using the EBSCOhost platform. Findings Electrode misplacement is a very common finding, particularly in acute healthcare areas. There are many causes, some intentional but most are unintentional in nature. Electrode misplacement affects the electrocardiograph morphology substantially, having the potential to alter the diagnosis that could lead to unnecessary patient harm. Conclusion: It is of great importance for electrocardiograms to be recorded accurately and correctly to preserve patient safety. This could be achieved through structured training facilitated by nurse specialists.

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Precordial Electrode Placement Accuracy by Nurses in a Large Midwestern Tertiary Care Hospital

Cited by 5 publications

References 10 publications

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

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

Nurses’ competency in electrocardiogram interpretation in acute care settings: A systematic review

Examining the causes and effects of electrode misplacement during electrocardiography: a literature review

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