ECG Collaborative

Saturday, 16 November 2013

Jennifer L. Zaremba, MSN, RN
Spokane VA Medical Center, Spokane, WA
Karen Carroll, MS, RN
Nursing, VA San Diego Healthcare System, Carlsbad, CA
Kathleen C. Manley, MSN, RN, CCRN, CCNS-CSC
James. A. Haley VA Medical Center, Tampa, FL

Learning Objective 1: The learner will identify that survey data demonstrates differences in actual practice and evidence-based practices, with a lack of standardized guidelines.

Learning Objective 2: The learner will conclude that current practice of lead selection and application of ECG monitoring does not correlate with evidence-based practices and individual patient presentation.

BACKGROUND: Lack of congruity of cardiac monitoring practices with evidence-based guidelines has a direct impact on patient safety. AACN identified that nurses tend to monitor only one lead regardless of diagnosis. Misplacement of leads can lead to errors in identification and diagnosis. Standardized guidelines based on evidence are lacking.  Development and utilization of standardized guidelines would improve the level of care and safety of monitored patients.

METHOD: The ECG Collaborative was a quantitative study that utilized a survey format. The sample included staff members from cardiac monitoring units across the VA healthcare facilities. The audit was developed by the Cardiovascular Field Advisory Committee (FAC) and the Intensive Care Unit (ICU) Workgroup, which is comprised of VHA nurses and educators. The FAC piloted the audit and the ICU Workgroup evaluated the pilot data, edited and refined the tool for national distribution via email. The survey had 777 responses from 100 different VA’s across the country. The data was collected into total response and percentages for each question by Select Survey. The data was analyzed by the ICU Workgroup. 

RESULTS: The data can be distributed into three categories: application, education, and safety. 77% of respondents reported lead II as the default lead, while 11% did not know primary lead selection. Secondary lead choice was VI.  The most prevalent determinant for lead selection was for a better view when changing the default lead. 65% of participants have received formal training. 57% reported a clinical component to ECG training. 80% reported taking a written test and 67% have ECG competencies. Only 34% of respondents based alarm limits on patient diagnosis. 80% have ST segment monitoring capabilities; however, 22% reported they do not use it. Just 69% transport patients with a monitor.