Abstract
Objectives: To evaluate the effect of implementing AHA practice standards for ECG monitoring on nurses’ knowledge (NK), quality of care (QoC), and patient outcomes (PO). We hypothesized that our intervention would increase NK, which would enhance QoC, which would lead to improved PO. Methods: The PULSE Trial was a 6-year multi-site randomized clinical trial with crossover that took place in 65 cardiac units in 17 hospitals. We randomized hospitals to the Experimental (Exp) or Control group after obtaining baseline data at T1. We collected data at 2 additional time points: T2 after the intervention in the Exp group and T3 after the intervention in the Control group. The 2-part intervention consisted of an interactive online ECG monitoring education program and strategies to implement and sustain change in practice, led by nurse champions on each unit. We measured NK by a validated 20-item online test. We assessed QoC over 5 consecutive days by observing monitors and electrode placement, reviewing current medical records, and comparing arrhythmias stored in the monitor with nurses’ documentation. For PO, we used administrative and lab data to identify a subset of medical records for review to determine mortality and in-hospital MI. To account for covariates and intra-hospital and unit correlations, we used linear mixed models for NK, generalized linear mixed models for QoC, and generalized estimating equations for PO. The intervention was significantly associated with better NK and improved markers of QoC. NK was not sustained at T3 in the Exp group, but was significantly better than at T1 (p<.0001). For several QoC variables, at T2 the Exp group was better than at T1 (p<.05), and better than the Control group (p<.05); at T3, the Control group improved (p<.05) and improvement was sustained in the Exp group. The intervention was not associated with change in PO. Conclusions: Online education and strategies to change practice can result in improved NK and QoC related to ECG monitoring.
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