Implementation of Practice Standards for ECG Monitoring

Despite advances in hospital electrocardiographic (ECG) monitoring technology, monitoring
practices are inconsistent and often inadequate. The investigators recently published
practice standards for ECG monitoring. The primary purpose of this 5-year multisite
randomized clinical trial is to test the effect of implementing these standards on nurses'
knowledge and skills, quality of care, and patient outcomes. The investigators expect that
increased knowledge and skills of nurses will lead to enhanced quality of care, which will
result in improved outcomes for patients. Units serving cardiac patients in 17 hospitals
will participate. Hospitals will be randomized to the experimental or control group after
baseline measures of knowledge and skills, quality of care, and patient outcomes are
obtained. The intervention will include ECG monitoring education and strategies to implement
and sustain change. The online education will include 4 modules: essentials of ECG
monitoring, arrhythmia monitoring, ischemia monitoring, and QT interval monitoring. The
strategies to implement and sustain change in the clinical area include reinforcement of
education, incentives, and the designation of "champions" on each unit who will actively
promote the implementation of the practice standards.

Inclusion Criteria:

- Nurses (and monitor technicians): All nurses (and monitor technicians) working on
participating units serving patients with cardiac disease

- Patients: All patients cared for on participating units

Exclusion Criteria:

- Nurses (and monitor technicians): No nurses (or monitor technicians) will be excluded

- Patients: No patients on the participating units will be excluded, even if their
primary diagnosis is not cardiac