Date of Award
College of Nursing
Dianne Conrad DNP, RN, FNP-BC
Katherine Moran DNP, RN, CDE, FAADE
Amy Kyes RN, MSN, CRNI, APRN, AG-CNS BC
Background: Overuse of cardiac monitoring (CM) in acute care settings contributes to increased healthcare spending and cost of services for patients. Additionally, inappropriate use of CM can contribute to wastefulness of healthcare resources, increases in hospital staff workloads, and can be improved with best evidence-based practice recommendations. A Midwest acute care hospital lacked an evidence-based, systematic method to define care for patients requiring CM.
Objective: The purpose of the project was to pilot an evidence-based CM change initiative, determine feasibility for sustainment, and propose next steps for adoption of the change initiative across non-emergency department, non-intensive care inpatient CM units at a Midwest, acute care hospital.
Method: The project involved piloting an evidence-based practice change that focused on the appropriate use of CM. The practice change consisted of education for ordering providers and nurses on the current American Heart Association's (AHA) and American College of Cardiology's (ACC) CM guidelines (2017), nurse/provider communication, and utilization of a CM clinical tool in daily practice. Data was collected regarding appropriate CM orders, duration of time patients were maintained on CM, and the number of patients maintained on CM until discharge from the hospital over a two-week pre-implementation period and a six-week post-implementation period for comparison. The results of the study were then used to develop evidence-based recommendations for implementing a hospital-wide, CM practice change.
Results: There was a significant decrease in the number of inappropriate CM orders over the duration of the project. Inappropriate CM orders were reduced from 35.0% to 12.1% (p = 0.0019). Additionally, there was a significant decrease in the number of patients maintained on monitoring until the time of discharge, 95.0% to 66.7% (p = 0.0121). The approximate cost savings for delivering CM services to patients over the duration of the project was $11,222.40 and $97,528.00 over a year. Estimated cost of services included patient monitoring, CM equipment, and upkeep of equipment. Approximate cost savings for RN wages over the duration of the project was $2,394.00 and $20,805.00 over a year.
Conclusions: Implementation of an evidence-based practice change significantly decreased the number of inappropriate CM orders as well as the number of patients maintained on CM at the time of discharge from the hospital. Recommendations for sustainability of the practice change include incorporating the use of the AHA/ACC's CM guideline in the electronic ordering system (EOS), use of evidence-based CM guidelines in daily practice, discussion of CM in daily interdisciplinary rounds, continued education for staff on AHA/ACC CM guidelines, and utilization of unit charge nurses to replicate the pilot study findings throughout the organization.
Urbanski, Joseph Paul, "Evidence-Based Cardiac Monitoring: A Practice Change" (2019). Doctoral Projects. 101.