Introduction: Continuous cardiac monitoring (CCM) is vital for observing patients at risk of arrhythmia. It can, however, restrict mobility and increase the risk of falls and delirium in susceptible patients. Its use should therefore be rationalised and regularly reviewed to ensure ongoing monitoring remains indicated.
In our centre, there are currently no guidelines for the use or review of CCM. This represents a barrier to regular, judicious review of patients’ ongoing need for monitoring. It may delay removal and prolong monitoring, thus increasing the associated risks. We aimed to standardize practice relating to CCM, to reduce unnecessary monitoring and develop resources promoting safe and consistent use of CCM.
Methods: A retrospective analysis of monitored cardiology patients at our centre. The appropriateness of ongoing monitoring was assessed against 2020 BHRS guidance.1 The standard of documentation regarding initiation and clinical review of patients’ monitoring data whilst in situ was also audited. Quantitative and qualitative survey data was collected from ward nurses to establish prior training and confidence in rhythm recognition.
Results: The notes of 21 monitored patients were reviewed, between 19 October 2023 and 27 October 2023. Of these, 13 (62%) were monitored due to coronary disease, 7 (33%) for arrhythmia, and 1 patient (5%) for non-cardiac disease. When assessed against BHRS criteria, 14 (67%) had a clear indication for ongoing CCM. Only 10 patients (45%) had documentation of the requirement for CCM on the day of initiation. Ten patients (45%) had a documented review of their rhythm data whilst being monitored.
Eleven ward nurses were surveyed during the data collection visits. Of these, 9 (82%) underwent formal training on starting their role, however only 7 (64%) were confident that they had sufficient skill in rhythm recognition to manage CCM. Fifty per cent of those lacking confidence had received formal training and attributed their lack of confidence to deskilling, having been trained several years ago.
Conclusions: These data reflect that a significant proportion of our inpatients are monitored unnecessarily or for longer than required. This has implications for the prioritization of CCM as a finite resource, but also on patient safety, given the associated risks of prolonged monitoring. Suboptimal documentation may be a contributory factor, as the lack of a clear indication for CCM makes assessment for removal challenging. Whilst rhythm recognition training was accessed by the majority of those surveyed, the lack of confidence amongst ward nurses indicates that our current education programme needs refining. Both refresher sessions and educational resources may help limit the deskilling of those trained some time ago. Implications for our department: A trust guideline for CCM has now been developed, highlighting common indications for monitoring with anticipated durations. It emphasizes the importance of clear documentation and regular review, providing a framework against which to assess monitoring for removal. Several resources are under development to complement this, including an online guide for new doctors demonstrating how to operate the central monitoring unit. The department is also expanding monitoring training to offer refresher sessions to experienced nurses and include new doctors at the point of induction. ❑
