Abstract 1335: Deficiencies in Nurses’ ECG Monitoring Knowledge: Preliminary Results of the Practical Use of the Latest Standards for Electrocardiography (PULSE) Trial
Despite major advances in electrocardiographic (ECG) monitoring technology, monitoring practices are inconsistent and often inadequate. It is unclear whether this is partly due to knowledge deficits of nurses.
Purpose: To evaluate nurses’ knowledge related to ECG monitoring and determine if any characteristics of the nurses predict ECG monitoring knowledge.
Methods: This descriptive study is the initial phase of a multi-site randomized clinical trial evaluating the effect of implementing practice standards for ECG monitoring on nurses’ knowledge, quality of care, and patient outcomes (PULSE Trial). We examined baseline knowledge of nurses working in units with cardiac patients in 15 hospitals in the US and 1 in Hong Kong. Nurses completed an online demographic form and 20-item knowledge test that covered essentials of ECG monitoring and arrhythmia, ischemia, and QT interval monitoring. The test was developed by the investigators, pilot tested on 124 nurses, and revised based on an item analysis. Scores can range from 0 to 100, with higher scores indicating greater knowledge.
Results: The sample of 1,050 nurses was 89% female, 68% white, with a mean age of 38.8±11.1 years. Almost 2/3 (63%) had a bachelor’s degree. Participants worked on a cardiac unit for 9.5±9.2 years and 25% practiced in a coronary care unit. Test scores ranged from 6 to 90, with a mean of 48.8±11.8. Of the 4 subsections, essentials of ECG monitoring had the highest mean score (52.3±16.0) and ischemia monitoring had the lowest (36.3±22.6). Mixed modeling treating hospital as a random effect revealed that the following predicted higher scores: male gender (p<.001), working in a coronary care unit (p<.001), education at a bachelor’s level or higher (p=.018), longer time working on a cardiac unit (p<.001), and having had a critical care course (p=.030). Having had a telemetry course predicted lower scores (p=.018).
Conclusions: Test scores, especially related to ischemia monitoring, indicated that nurses’ knowledge about ECG monitoring can be improved. Education should particularly target nurses working in telemetry units. The online ECG monitoring education program in the next phase of the PULSE Trial may improve knowledge and, ultimately, the quality of ECG monitoring and patient outcomes.