title: Nursing-Based Dysrhythmia Detection on a Dedicated Stroke Unit Using a Unit-Based Cardiac Telemetry Monitoring System.
abstract: BACKGROUND
  Acute stroke care includes cardiac rhythm monitoring in the first 24 hours. The method of monitoring varies, as do the reported findings. The nurses' role in this process can be intensive, including primary response and review of all data. Competency is critical as the acute stroke setting can be associated with life-threatening dysrhythmias as well as the detection of atrial fibrillation that affects therapy. Limited studies exist to evaluate the effectiveness of a unit-based cardiac monitoring system for which the bedside nurse has primary responsibility.
  
  
  OBJECTIVE
  The goal was to determine if a unit-based cardiac monitoring system for which the bedside nurse was responsible detected clinically significant dysrhythmias.
  
  
  METHODS
  Stroke unit nurses completed a mandatory education program on identifying common dysrhythmias and using the monitoring equipment along with a structured algorithm for cardiac dysrhythmia detection. The nurse was responsible for all alarms as well as review of their patients' data. Their findings were recorded and reviewed by a cardiology team after the 24-hour monitoring was completed. A total of 300 consecutive stokes, transient ischemic attack, and possible stroke patients were enrolled.
  
  
  RESULTS
  Nurses identified 96% of all significant dysrhythmias. Twenty-eight percent of the stroke patients had a dysrhythmia, of which 79% were atrial fibrillation/atrial flutter. The bedside nurses did identify all 8 new atrial fibrillation cases.
  
  
  CONCLUSIONS
  Stroke unit nurses who complete an educational program can identify dysrhythmias on their patients' unit-based cardiac monitoring systems and can improve patient outcomes.
authors.affiliation: Cheryl Jastrzebski, MSN, RN, CNRN, CMSRN Stroke Program Coordinator, MacNeal Hospital, Berwyn, Illinois. Erika Hernandez, BSN, RN, CVRN, CMSRN Cardiovascular Coordinator, MacNeal Hospital, Berwyn, Illinois. Susan Nadis, MD Neurologist, MacNeal Hospital, Berwyn, Illinois. Robert Lichtenberg, MD Cardiologist, MacNeal Hospital, Berwyn, Illinois.
authors.forename: Cheryl
authors.initials: C
authors.lastname: Jastrzebski
authors.forename: Erika
authors.initials: E
authors.lastname: Hernandez
authors.forename: Susan
authors.initials: S
authors.lastname: Nadis
authors.forename: Robert
authors.initials: R
authors.lastname: Lichtenberg
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001145:Arrhythmias, Cardiac / Q000175:diagnosis* / Q000451:nursing*; D004562:Electrocardiography; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000150:complications* / Q000451:nursing; D008297:Male; D008875:Middle Aged; D024802:Nurse's Role; D020521:Stroke / Q000150:complications* / Q000451:nursing; D013686:Telemetry; D055815:Young Adult