Clinical Practice Supports: Nursing Skills and Procedures

Key Practice Points

• An Authorized Prescriber (AP) order is required to initiate and discontinue cardiac monitoring.
  • The exception is in the emergency department, as per CD-EC-060.

• Skin preparation is necessary for the electrodes to adhere to the skin and therefore produce a clear rhythm/ECG. Wash and dry the skin well and remove any long hair with clippers.
• Accurate lead placement is important to provide diagnostic information. Improperly placed leads can result in false/inaccurate rhythms leading to unnecessary, incorrect or harmful treatment.
• Use two different leads for continuous monitoring.
• During continuous monitoring (bedside/telemetry) replace electrodes every 24h or as needed. If able, place a new electrode on a different spot while maintaining accurate placement.
• Communication between the monitoring unit and the remote telemetry unit is essential, as per CD-CC-015.
• All alarms should be working properly and set for the individual patient's condition. Address critical alarms immediately and then reassess the patient.
• Use rhythm analysis and interpretation in conjunction with physical assessment and patient symptoms, notify the AP of any changes.
• Upon completion of the 12/15 lead ECGs notify the AP for immediate review.
• All components of the eight-step approach to rhythm analysis should be documented for all rhythm strips placed in a patient’s medical record.
• Assess the need for cardiac monitoring daily. Discontinue monitoring if no longer required.