• Marjorie Funk, Kristopher P Fennie, Krista A Knudson, and Halley Ruppel.
• Marjorie Funk is the Helen Porter Jayne and Martha Prosser Jayne Professor Emerita of Nursing, Yale School of Nursing, West Haven, Connecticut.
• Am. J. Crit. Care. 2021 Jan 1; 30 (1): 384438-44.

BackgroundElectrocardiographic telemetry monitors are ubiquitous in hospitals. Dedicated monitor watchers, either on the unit or in a centralized location, are often responsible for observing telemetry monitors and responding to their alarms. The impact of use of monitor watchers is not known.ObjectivesTo evaluate the association of monitor-watcher use with (1) nurses' knowledge of electrocardiographic (ECG) monitoring and (2) accuracy of arrhythmia detection.MethodsBaseline data from 37 non-intensive care unit cardiac patient care areas in 17 hospitals in the Practical Use of the Latest Standards for Electrocardiography trial were analyzed. Nurses' knowledge (n = 1136 nurses) was measured using a validated, 20-item online test. Accuracy of arrhythmia detection (n = 1189 patients) was assessed for 5 consecutive days by comparing arrhythmias stored in the monitor with nurses' documentation. Multiple regression was used to evaluate the association of use of monitor watchers with scores on the ECG-monitoring knowledge test. The association of monitor-watcher use with accuracy of arrhythmia detection was examined by χ2 analysis.ResultsOf the 37 units, 13 (35%) had monitor watchers. Use of monitor watchers was not independently associated with ECG-monitoring knowledge (P = .08). The presence of monitor watchers also was not significantly associated with the accuracy of arrhythmia detection (P = .94).ConclusionAlthough the use of monitor watchers was not associated with diminished nurses' knowledge of ECG monitoring, it also was not associated with more accurate arrhythmia detection. If implementing a monitor-watcher program, critical safety points, such as ensuring closed-loop communication, must be considered.©2021 American Association of Critical-Care Nurses.

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