ECG Lead Placement: A DNP Project

Abstract

An electrocardiogram (ECG) is a recording of the magnitude and direction of the electrical current generated during depolarization and repolarization of the heart, gathered by external electrodes placed in specific positions on the body surface. Inaccurate and/or inconsistent ECG lead placement in the perioperative setting has the potential to result in incorrect, missed, or delayed patient diagnoses and inappropriate management. The purpose of this Doctor of Nursing Practice Quality Improvement (QI) project was to assess the perceived efficacy of a standardized educational aid designed to streamline ECG lead placement and increase consistency across all disciplines in the perioperative setting. The ECG lead placement education included standard 6-lead placement and alternative placement required for varying surgical procedures and positions. This QI project utilized a pre- and post-survey design to complete a single PDSA cycle among a group of RNs who provide care to patients during the perioperative period. Invitations to participate were sent to 42 RNs via their employee email. Of these, six participated in the pre-intervention survey and four in the post-intervention survey. Results of the pre-intervention survey indicated that most of the participants did not routinely use a standardized method for ECG lead placement. After utilization of the ECG lead placement tool, participant responses showed a generalized increase in confidence levels amongst all positions. Recommendations for future projects of this caliber include following similar strategies while also identifying alternative approaches to improve participation and increase access to the ECG lead placement tool.