Course Information

Educational Need

The first “electrokardiogram (EKG)” was invented in 1902 and since that time, usage of “electrocardiograms (ECG)” has become standard practice for the monitoring of cardiac rhythms in hospitalized patients. For patients in intensive care units and progressive care units, using a continuous 12-lead ECG to evaluate changes in the ST-segment of the waveform allows for the ongoing assessment of ischemia, injury, and infarction. However, research has shown that nurses do not monitor patients for ST-segment changes as recommended by the American Heart Association Practice Standards for ECG Monitoring in Hospital Settings. In fact, a recent multi-site randomized clinical trial found that only 35% of hospitalized patients with an indication for ischemia were actually monitored. The authors of the study suggest that underutilization of ST-segment monitoring for the identification of ischemia may be due in part to a lack of knowledge on the part of nurses.

An educational need has been identified for a continuing education activity on ECG ST-segment monitoring for the identification of ischemia, injury, or infarction. Specifically, this activity will review the scope and impact of these conditions, discuss ST-segment monitoring, and described recommended practices with regard to the utilization of continuous 12-lead ECG to evaluate changes in the ST-segment of the waveform. This one-hour online continuing education activity is recommended for nurses and telemetry technicians.

Overview

For patients in intensive care units and progressive care units, using a continuous 12-lead ECG to evaluate changes in the ST-segment of the waveform allows for the ongoing assessment of ischemia, injury, and infarction. However, research has shown that nurses do not monitor patients for ST-segment changes as recommended by the American Heart Association Practice Standards for ECG Monitoring in Hospital Settings. This continuing education activity will provide nurses and telemetry technicians with the information they need to utilize continuous ST-segment monitoring for the identification of ischemia, injury, or infarction. Specifically, this activity will discuss ST-segment monitoring and describe recommended practices with regard to the utilization of continuous 12-lead ECG to evaluate changes in the ST-segment of the ECG waveform.

Learning Outcome / Objectives

After completing this continuing education activity, nurses and telemetry technicians will be able to monitor patients for ST-segment changes and use this information to identify myocardial ischemia, injury, or infarction. Specifically, they will be able to measure the ST-segment, identify ST-segment deviations, and predict the occurrence of ischemia, injury, and infarction based on ST-segment evaluation.

Outline

• Scope and Impact of Ischemia, Injury, and Infarction
• ST Segment Monitoring
  • The ST segment
  • Evidence supporting ST segment monitoring
  • Underutilization of ST Monitoring
  • Indications for monitoring (AHA Practice Standards)
• Expected Practice
  • 12-Lead ECG
  • Lead placement
  • Measuring the ST segment
  • Evaluating the ST segment
  • ECG findings
  • Causes of abnormal parameters
• Improving Quality
  • Identifying fluctuations resulting from body position changes
  • Appropriately preparing the skin
  • Consistently placing the leads
  • Appropriately setting alarm parameters
  • Understanding the specific goals of monitoring
  • Ensuring accurate analysis