Abstract 14151: Improved Electrocardiographic Monitoring Practices in the Practical Use of the Latest Standards of Electrocardiography (PULSE) Trial
Introduction: Although ECG monitoring is ubiquitous in hospitals, evidence suggests that monitoring practices are inconsistent and often inadequate.
Hypothesis: An intervention consisting of an online ECG monitoring education program and strategies to implement and sustain change will result in improved practices related to ECG monitoring.
Methods: The PULSE Trial is a 5-year, 3-phase, multi-site randomized clinical trial to evaluate the effect of the implementation of AHA practice standards for ECG monitoring on nurses’ knowledge, quality of care, and patient outcomes. We are reporting quality of care results from baseline and after the intervention in experimental group hospitals. Over 5 consecutive days at each time point, 3 research nurses observed monitors and electrode placement, reviewed current medical records, and compared arrhythmias stored in the monitor’s memory with documentation by unit nurses. The sample contained 2,872 patients on cardiac units in 14 hospitals in the US, Canada, and China. We used stratified analyses and repeated measures mixed modeling treating hospital and unit as random effects.
Results: The sample was 57% male and 83% white, with a mean age of 66±16 years; 66% had a cardiac diagnosis. Accuracy of precordial V electrode placement improved more in the experimental group (19% to 61% correct) vs. the control group (30% to 41% correct) (p<.0001). In analyses stratified by time, after the intervention accuracy of limb electrode placement was significantly better in the experimental vs. control group (p<.01). Accuracy of documented arrhythmia interpretation improved more in the experimental group (76% to 98% correct) vs. the control group where it declined (96% to 82% correct) (p=.0004). Monitoring problems, such as electrodes not secure, patient off monitor inappropriately, alarms silenced inappropriately, and lead wire reversal, occurred infrequently (<1%-7% of patients), and the intervention had no measurable effect.
Conclusions: Education and strategies to improve practice can result in enhanced quality of care related to ECG monitoring. Whether the changes we observed will be sustained over time or result in improvements in patient outcomes will be determined in the next phase of the PULSE Trial.
- © 2013 by American Heart Association, Inc.