Date of Graduation

Summer 8-12-2016

Document Type

Restricted Project/Capstone - USF access only

Degree Name

Master of Science in Nursing (MSN)

College/School

School of Nursing and Health Professions

First Advisor

Elena Capella

Second Advisor

Carlee Stewart Balzaretti

Abstract

The leadership theme of focus for this Clinical Nurse Leader (CNL) initiative is care environment management. The CNL assumes the role of a systems analyst/risk anticipator in order to ensure quality improvement in the process of electrocardiogram (ECG) acquisition and the implications this has on patient outcomes. The ultimate goal of this project was to increase the quality of ECGs that are obtained within the ED by 50% before the end of August 2016. This specific aim statement address the global aim statement by focusing on improving the process of how ECGs are acquired, which will improve patient outcomes by promoting patient safety and preventing medical errors caused by inaccurate ECGs.

The emergency department (ED) was the clinical microsystem that was targeted for this CNL project. At this particular institution, the ED technicians have been designated with the responsibility of obtaining ECGs. It was noted that 60% of ECGs that were acquired within this ED were considered erroneous due to improper lead placement, gross artifact interference or inaccurate patient information. Relying on findings presented by Mahler, Wolcott, Swoboda, Wang and Arnold (2011), the project was designed to provide training and education to the ED technicians though an ECG skills workshop. These sessions were devised to be four hours long, which would allow for a didactic setting that consists of a lecture and hands on portion.

Although the original project proposed training sessions take place over a period of four hours, the actual implementation required classes be adjusted to two hours to accommodate staffing needs within the ED. Additionally, education on ECG recognition was also removed from the workshop’s agenda. Visual aids were incorporated into the teaching to help demonstrate proper lead placement as recommended by Jevon (2010). Each ED technician was given a survey, after completion of the workshop, to help assess the effectiveness of training. Results from the survey showed that 92% of the ED technicians who attended the teaching sessions felt more competent in their ECG skill set due to the newly gained knowledge on how to operate the machine and identify proper lead placement. The original projected goal of this initiative was to increase the quality of ECGS by 50% before the end of August 2016 when compared to previous findings. Modification of the expected outcomes from a 50% increase to 40% was necessary in order to account for the absence of ECG recognition education. These numbers will need to be validated through the collection and analysis of ED ECGs for a period of a month, following the recent implementation of the project.

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