Inspiring Change: Leading quality change, one beat at a time
Aislynn Moyer MSN/Ed, RN-BC
Amy McCowan MEd, BSN, RN
James Fenush MS, RN

October 2011 
Volume 41  Number 10
Pages 21 - 23
  PDF Version Available!

CARDIAC MONITORING involves many quality and patient safety issues, including implementing processes for regularly assessing cardiac rhythms, troubleshooting alarms, preventing alarm fatigue (nurses' desensitization to monitor alarms), and ensuring that appropriate patients are placed on cardiac monitors. Our project began when a patient's monitor didn't alarm properly on an inpatient medical-surgical unit. To examine this quality and patient safety issue, a team was created that included multiple disciplines. It was led by an executive oversight committee composed of the three authors of this article.The project's objective was to evaluate current practices and policies surrounding cardiac monitoring to ensure safe, high-quality patient outcomes. We used the Triad model of evidence-based practice to integrate nurses' clinical expertise with the best external research evidence.1 (See What's the Triad model?)The evidence strongly suggested that current practices weren't evidence-based and could be improved. We created an interdisciplinary team to align current cardiac monitoring practices with the evidence to ensure safe, quality patient care by using an action-oriented timeline. This article describes our project and the many initiatives we completed to promote a culture of quality and safety.In the past, cardiac monitoring was reserved for patients in ICUs, where they were under close observation. Over the last decade, as patient acuity in medical-surgical units has increased, cardiac monitoring has moved into other busy clinical areas. Assessing cardiac rhythms in detail, responding to alarms, and notifying clinicians while also caring for four or five other acutely ill patients is often challenging.Many clinicians now rely on computerized systems to alert them of cardiac dysrhythmias. Although these systems have proven reliable, alarm fatigue and timely response to electronic notification continue to be problems.The policy of our organization, the Penn State Milton

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