Newswise — To many, the waves from an electrocardiogram (ECG) are indecipherable, but to critical care professionals, the results offer clear insight into a patient’s heart rhythms and are an essential tool for effective clinical decision-making.
Cardiac monitoring remains a key element in caring for hospitalized patients who are critically ill, and it takes high levels of knowledge and skill to ensure accurate results from ECGs.
As part of its ongoing efforts to standardize clinical practice and improve patient outcomes, the American Association of Critical-Care Nurses (AACN) recently updated its AACN Practice Alerts related to cardiac monitoring.
For nurses at the bedside, “Accurate Dysrhythmia Monitoring in Adults” summarizes current expected nursing practice, beginning with the initial placement and selection of chest leads.
The nine-page document continues with step-by-step guidance on identifying dysrhythmia, interpreting results and assessing QT intervals, including:• Two leads should be displayed whenever available to aid in accurate rhythm interpretation. • Electrodes should be changed daily. • Electrode placement is integral for accurate results. When an electrode is misplaced by as little as one intercostal space, QRS morphology may change and contribute to misdiagnosis. • Both the onset and termination of the dysrhythmia should be documented. • A short PR interval on a resting ECG may be associated with the presence of an accessory pathway. • The QTc interval should be measured once per shift in patients who meet the criteria for QT-interval monitoring. More frequent assessment may be indicated on the basis of additional ECG and clinical risk factors.
The AACN Practice Alert also includes recommendations for healthcare managers and hospital administrators related to dysrhythmia monitoring, with supporting evidence and citations for more than 100 references.
AACN has published a separate practice alert, “Ensuring Accurate ST-Segment Monitoring,” for nurses caring for hospitalized patients with acute coronary syndrome, coronary disease or cardiac risk factors. ST-segment monitoring can help detect ischemia and provide additional information that can potentially influence treatment decisions.
The AACN Practice Alerts are available at no cost electronically on the AACN website, www.aacn.org/practicealerts.
They join the growing library of clinical resources from AACN with the latest evidence-based resources and research. Each AACN Practice Alert outlines the scope of the problem, summarizes the expected nursing practice and provides supporting evidence and research.
Supported by authoritative evidence, each AACN Practice Alert seeks to ensure excellence in practice along with promotion of a safe and humane work environment. Topics address both nursing and interprofessional activities of importance for patients in acute and critical care environments. Some alerts include additional resources for staff education and performance-improvement activities.
Previously released alerts address verification of feeding-tube placement, pulmonary artery pressure monitoring, family presence during CPR and invasive procedures, and prevention of aspiration.
About the American Association of Critical-Care Nurses: Founded in 1969 and based in Aliso Viejo, California, the American Association of Critical-Care Nurses (AACN) is the largest specialty nursing organization in the world. AACN joins together the interests of more than half a million acute and critical care nurses and has more than 225 chapters worldwide. The organization’s vision is to create a healthcare system driven by the needs of patients and their families in which acute and critical care nurses make their optimal contribution. http://www.aacn.org; http://www.facebook.com/aacnface; http://www.twitter.com/aacnme
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