Improving Bedside Nurse Accuracy in Rhythm Interpretation Using Different Teaching Strategies

High quality cardiac care at an academic medical center demands a nursing staff with sound knowledge of ECG rhythm interpretation. However, the competency of our nurses was in doubt when using a dynamic rhythm competency. At our institution there was debate on the adequacy of the current methods of teaching and evaluation of rhythm interpretation. Despite the increasing use of remediation within the nursing education department we identified lower rates of success on our annual ECG rhythm interpretation exam. This quality improvement project tested whether clinical nurses could learn and retain the theory and skill of rhythm interpretation more effectively when given a standardized face to face training session with periodic snack learning. Monthly real time audits and test scores on a static and dynamic exam confirmed that accuracy of rhythm interpretation improved significantly among all nurses .

The AHA recommendation supports the notion that bedside nurses must be competent in identifying common and lethal arrhythmias and intervene appropriately through initiation of resuscitation or notification of the healthcare provider. Still, there is little existing evidence to support innovative teaching strategies to ensure competency and retention of knowledge as it relates to rhythm interpretation and management . Standards are not consistent for annual competency for rhythm interpretation and it is not well understood how well nurses retain the information from year to year or from time to time (Kanyok & Brooks, 2016). Brooks and Kanyok (2016) concluded that bedside nurses need on-going support and coaching testing to sustain the arrhythmia interpretation knowledge. Funk et al (2016) found that nurses who received online education and specific strategies on the unit by nurse champions retained knowledge but by the third time new knowledge on rhythm interpretation was not sustained. Ehrhardt & Grumley (2013) recommended multiple approaches to reinforcing knowledge and supporting rhythm retention including active learning and case studies.

In 2017 over 900 nurses sat for a dynamic interpretation with a 63% pass rate on first attempt. Although all nurses were eventually deemed competent the 2018 program evaluation suggested an education plan built for success. In 2018 the methodology changed to : face to face class, study guide and snack education bites delivered the 3 month period prior to competency evaluation. To evaluate competency a test consisting of dynamic rhythms and a static exam using the policy and procedure as a blueprint was administered . Over 900+ nurses sat for the exam for 2018 97% were successful upon first attempt.

This project measured nurse competency in rhythm interpretation and management over a 2-year period. Results have refocused the importance of reinforcement of knowledge using snack like learning between mandatory competency evaluation. t is important for hospital educators to recognize spaced snack education over time helps the bedside nurse retain knowledge.