CRNA DNP Project: ECG Lead Placement in the Perioperative Setting: A Quality Improvement Project

Abstract

Proper electrocardiogram (ECG) placement is an important aspect of reliable cardiac monitoring during the perioperative period. Inaccurate and/or inconsistent ECG lead placement has the potential to lead to incorrect, missed, or delayed diagnoses, which may lead to unnecessary interventions and poor patient outcomes. Misplacement of electrodes may result from limited provider knowledge and the lack of continued education reinforcing proper placement. This Doctorate in Nursing Practice project assessed the perceived efficacy of a reference tool 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 and 12-lead placement. This reference tool, along with a PowerPoint presentation, was given to six preoperative nurses to use in their daily practice. Data gathered from the pre- and post-intervention surveys suggests that the reference tool was perceived to be effective in increasing knowledge of accurate ECG lead placement. Participants reported increased perceived confidence levels in accurate placement, decreased incidence of artifact/incorrect morphology in their monitoring, increased likelihood of fixing incorrectly placed ECG leads, and improved quality of the care provided to their surgical patients. ECG lead education projects such as this one should continue to be translated into clinical practice to improve patient outcomes related to ECG lead placement.