• Sue Sendelbach, Kristin E Sandau, Lisa Smith, Robert Kreiger, Steven Hanovich, and Marjorie Funk.
• Sue Sendelbach (retired) was director of nursing research, Abbott Northwestern Hospital/Minneapolis Heart Institute/Allina Health, Minneapolis, Minnesota. Kristin E. Sandau is a professor of nursing, Bethel University, and a staff nurse, United Hospital/Allina Health, St Paul, Minnesota. Lisa Smith is a staff nurse in the cardiovascular laboratory, United Hospital/Allina Health. Steven Hanovich is an intensivist, United Hospital/Allina Health and information services medical director, Allina Health. Robert Kreiger is a senior scientific advisor, Courage/Kenny Center/Allina Health, Minneapolis, Minnesota. Marjorie Funk is Helen Porter Jayne and Martha Prosser Jayne Professor Emerita of Nursing, Yale University School of Nursing, West Haven, Connecticut.
• Am. J. Crit. Care. 2019 Mar 1; 28 (2): 109-116.

BackgroundAlthough electrocardiographic monitoring is common in hospitalized patients, many patients receive unnecessary monitoring, contributing to patients' inconvenience, clinicians' alarm fatigue, and delayed admissions.ObjectiveTo evaluate the impact of implementation of an electronic order set based on the American Heart Association practice standards for electrocardiographic monitoring on the occurrence of appropriate monitoring.MethodsThe sample for this preintervention-to-postintervention quasi-experimental study consisted of 297 adult patients on medical, surgical, neurological, oncological, and orthopedic patient care units that used remote electrocardiographic monitoring in a 627-bed hospital in Minneapolis, Minnesota. The intervention was the introduction into the electronic health record of order sets prompting physicians to order electrocardiographic monitoring per the American Heart Association practice standards. Indications for monitoring according to the practice standards and adverse outcomes (unexpected transfer to intensive care unit, death, code blue events, and call for the rapid response team) were compared before and after implementation of the order set.ResultsImplementation of the order set was associated with an increase in appropriate monitoring (48.0% to 61.2%; P = .03); the largest increase was in ordering by medical residents (30.8% to 76.5%; P = .001). No significant increase in adverse patient outcomes was noted.ConclusionsImplementation of the practice standards via an electronic order set was associated with a statistically significant increase in appropriate monitoring, with no increase in adverse events. Use of electronic order sets is an effective and safe way to enhance appropriate electrocardiographic monitoring.

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