Nurses’ Practices and Lead Selection in Monitoring for Myocardial Ischemia: An Evidence-Based Quality Improvement Project

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Electrocardiogram, Evidence-based nursing, Ischemia, Monitoring, Myocardial, Physiologic, Telemetry



The 5-lead electrocardiogram (ECG) provides key information, including clues that a patient may be experiencing myocardial ischemia, usually demonstrated in the ST segment. Studies have shown that nursing knowledge regarding ischemia monitoring is suboptimal, even though national guidelines for ECG monitoring were published in 2004 by the American Heart Association and endorsed by the American Association of Critical Care Nurses.


The aims of this study were to identify best practice regarding 5-lead ECG myocardial ischemia monitoring, assess current unit-level practice at 1 institution, and to educate nurses on proper monitoring using a nurse-led, evidence-based intervention.


The authors created an educational PowerPoint designed to educate nurses on proper lead selection to monitor the ST segment for patients admitted with known or suspected myocardial ischemia and developed a 3-part online survey to assess current unit practice and to assess knowledge before and after intervention.


A total of 18 registered nurses (RNs) completed the survey. Results indicated that RNs lacked knowledge regarding continuous ECG monitoring for ischemia and had room for improvement in their everyday practice habits. The knowledge preintervention test mean score (out of 9) was 3.11 (SD, 1.68), and the postintervention test mean score was 6.94 (SD, 1.55), which was significant (P = .000). The intervention also significantly improved the monitoring comfort level of RNs, with a preintervention comfort level of 2.53 (SD, 1.07) and a postintervention level of 3.41 (SD, 1.00) (P = .007). The process allowed the authors to reflect on the key steps of implementing evidence-based projects in nursing units.


Continuous, 5-lead ECG monitoring is an active process that requires clinical decision making by the nurse and is not a passive activity. Registered nurses in this sample demonstrated a lack of knowledge regarding ECG monitoring for ischemia that was improved with an online educational intervention and reported intentional daily practice pattern changes postintervention testing. A unit-level intervention driven by nurses may be successful at improving fellow RNs’ knowledge and evidence-based practice.


This article was published in Dimensions of Critical Care Nursing 34, no. 4 (2015): 189-195.