Improving ECG Competence and Recognition of Arrhythmias by Nurses on a Pediatric Acute Care Surgical Unit: A Quality Improvement Project
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Authors
Bates, Jourdan
Issue Date
2021-05-14
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Abstract
Background: Nurses are expected to be competent in electrocardiogram (ECG) interpretation; however, studies have shown that nurses often lack competency in ECG interpretation, rhythm recognition and intervention. Though expert opinion calls for standardized rhythm review and ECG component documentation, standardized guidelines in this area do not exist.|Purpose: The purpose of this project was to increase ECG interpretation competence and self-assessed confidence with arrhythmia recognition by nurses on a pediatric acute care surgical unit who care for cardiac surgery and cardiology patients.|Sample/Setting: This project took place on a 45 bed acute care surgical unit within a 407 bed pediatric hospital. Sample participants were nurses that worked regularly on the pediatric acute care surgical unit.|Methods: Quality improvement (QI) project with a pre/posttest survey design evaluated with descriptive statistics following distribution of an ECG educational packet, standardization of cardiac rhythm review and ECG component documentation in the electronic medical record (EMR).|Results: There was an increase in arrhythmia recognition when comparing pre/posttest survey data, and an increase in self assessed confidence with cardiac rhythm identification and analysis. ECG documentation was greater on night shift, with 28% of included patients having proper ECG documentation, as compared with 8% of patients on dayshift. Nurses with less than 2 years of experience were the most consistent in properly documenting ECG components. Standardization of rhythm review during shift hand off was not successful as a result of reported time constraints and lack of prioritization of task during shift hand off. Frequency of rhythm review at the beginning of the nursing shift did show improvement when comparing pre/post practice change data.|Conclusion(s): Focusing on ECG education, rhythm review and ECG component documentation has been successful in keeping the topic of arrhythmias and ECG monitoring relevant among nurses, and has enabled nurses to quickly identify changes in their patients rhythms, escalate those changes and ultimately to improve patient outcomes.
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Creighton University
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Copyright is retained by the Author. A non-exclusive distribution right is granted to Creighton University