A quality improvement project to improve electrocardiogram competency and confidence in medical-surgical clinical staff

Electrocardiogram (ECG) monitoring is used for early detection and recognition of cardiac arrhythmias. There has been an increase in hospitalized patients requiring ECG monitoring which is now a responsibility for medical-surgical nursing staff. Medical-surgical clinical staff (MSCS) must be competent to interpret and recognize ECG arrhythmias. The lack of ECG knowledge from the MSCS has resulted in multiple in-hospital cardiac arrests. The purpose of this DNP project was to determine if just-in-time training could improve ECG competence and confidence for MSCS and reduce adverse patient safety events. Just-in-time training is a teaching methodology that supports workplace training. The project design was a pre- and post-test design measuring the degree of change over time. A convenience sampling method was used. There were forty-three participants. A 3-month just-in-time ECG education program was implemented which included ECG just-in-time education and in-services. Overall results did not reveal increases in ECG competence or ECG confidence, however results show improved competency and confidence for many staff members and there was a 60% decrease in patient safety events. Participants with a bachelor’s or master’s degree and 18-34 years of age self-reported improved ECG confidence. Registered nurses, medical technicians, and continuous telemetry monitor technicians all had a significant increase in ECG competence. Based on the findings, MSCS need additional ECG education and training. It is recommended that MSCS participate in regular formal ECG education and use of just-in-time training to reinforce learning.