Top Things to Know: Update to Practice Standards for Electrocardiographic Monitoring in Hospital Settings
Published: October 03, 2017
- This update to the original 2004 Practice Standards for Electrocardiographic Monitoring in Hospital Settings addresses new issues that have emerged and provides a comprehensive review of evidence and recommendations for continuous ECG monitoring of hospitalized patients.
- The goals of electrocardiographic (ECG) monitoring have expanded from simple heart rate and basic rhythm determination to the diagnosis of complex arrhythmias, the detection of acute and often silent myocardial ischemia, and the identification of drug-induced prolonged QT interval.
- Topics addressed in this statement include:
- Overview of Arrhythmia, Ischemia, and QTc Monitoring
- Recommendations for Indication and Duration of ECG Monitoring presented by patient population
- Organizational Aspects: Alarm Management, Education of Staff, and Documentation;
- Implementation of Practice Standards into practice
- Call for Research
- No recommendations for other forms of ECG monitoring, including the static 12-lead ECG, exercise testing, or ambulatory ECG (Holter) monitoring are included in this scientific statement.
- Four rationales for arrhythmia monitoring were noted:
- Immediate recognition of sudden cardiac arrest to improve time to defibrillation
- Recognize deteriorating conditions
- Facilitate management of arrhythmias
- Facilitate diagnosis of arrhythmias or cause of symptoms (e.g., syncope and palpitations) and subsequently guide appropriate management
- It is important that careful consideration be given to the type of data that may help to assess for relevant changes and for inter-professional collaboration in the design of any ECG implementation protocols.
Citation
Sandau KE, Funk M, Auerbach A, Barsness GW, Blum K, Cvach M, et al; on behalf of the American Heart Association Council on Cardiovascular and Stroke Nursing; Council on Clinical Cardiology; and Council on Cardiovascular Disease in the Young. Update to practice standards for electrocardiographic monitoring in hospital settings: a scientific statement from the American Heart Association [published online ahead of print October 3, 2017]. Circulation. doi: 10.1161/CIR.0000000000000527.