title: Improvement of in-hospital telemetry monitoring in coronary care units: an intervention study for achieving optimal electrode placement and attachment, hygiene and delivery of critical information to patients.
abstract: BACKGROUND
  In-hospital telemetry monitoring is important for diagnosis and treatment of patients at risk of developing life-threatening arrhythmias. It is widely used in critical and non-critical care wards. Nurses are responsible for correct electrode placement, thus ensuring optimal quality of the monitoring. The aims of this study were to determine whether a complex educational intervention improves (a) optimal electrode placement, (b) hygiene, and (c) delivery of critical information to patients (reason for monitoring, limitations in cellular phone use, and not to leave the ward without informing a member of staff).
  
  
  METHODS
  A prospective interventional study design was used, with data collection occurring over two six-week periods: before implementation of the intervention (n=201) and after the intervention (n=165). Standard abstraction forms were used to obtain data on patients' clinical characteristics, and 10 variables related to electrode placement and attachment, hygiene and delivery of critical information.
  
  
  RESULTS
  At pre-intervention registration, 26% of the electrodes were misplaced. Twelve per cent of the patients received information about limiting their cellular phone use while monitored, 70% were informed of the purpose of monitoring, and 71% used a protective cover for their unit. Post-intervention, outcome measures for the three variables improved significantly: use of protective cover (p<0.001), information about the purpose of monitoring (p=0.005) and information about limitations in cellular phone use (p=0.003). Nonetheless, 23% of the electrodes were still misplaced.
  
  
  CONCLUSIONS
  The study highlights the need for better, continued education for in-hospital telemetry monitoring in coronary care units, and other units that monitor patients with telemetry.
authors.affiliation: Department of Heart Disease, Haukeland University Hospital, Norway trond.roed.pettersen@helse-bergen.no.
authors.forename: Trond R
authors.initials: TR
authors.lastname: Pettersen
authors.affiliation: Department of Heart Disease, Haukeland University Hospital, Norway Institute of Nursing, Bergen University College, Norway.
authors.forename: Nina
authors.initials: N
authors.lastname: Fålun
authors.affiliation: Department of Heart Disease, Haukeland University Hospital, Norway Department of Clinical Science, University of Bergen, Norway.
authors.forename: Tone M
authors.initials: TM
authors.lastname: Norekvål
mesh_terms: D000328:Adult; D000368:Aged; D001145:Arrhythmias, Cardiac / Q000175:diagnosis / Q000451:nursing / Q000628:therapy*; D002304:Cardiac Pacing, Artificial / Q000379:methods; D003325:Coronary Care Units; D004562:Electrocardiography; D004567:Electrodes, Implanted; D005260:Female; D006786:Hospitals, Urban; D006801:Humans; D006920:Hygiene; D007297:Inpatients / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods*; D009664:Norway; D024802:Nurse's Role; D010353:Patient Education as Topic / Q000458:organization & administration*; D011446:Prospective Studies; D058996:Quality Improvement; D012720:Severity of Illness Index; D013686:Telemetry / Q000379:methods*; D055815:Young Adult
keywords: Cardiac arrhythmias; hygiene; nursing; patient information; telemetry