Improving Nurses' Ability to Identify Anatomic Location and Leads on 12-Lead Electrocardiograms with ST Elevation Myocardial Infarction

BACKGROUND: ST segment elevation on the electrocardiogram (ECG) signifies complete occlusion of a coronary artery. Nurses play a significant role in obtaining, interpreting, and communicating 12-lead ECG findings. AIMS: We evaluate a hand held paper tool to determine if it assists nurses; (1) identify the presence of ST elevation myocardial infarction (STEMI), (2) location, and (3) leads. METHODS: A pre-test/post-test design was used. At pre-test, nurses from the emergency department (ED), coronary care unit (CCU), and the progressive care (PC) were given 6 patient scenarios (3 STEMI and 3 non-STEMI) and a corresponding 12-lead ECG. This was followed by a brief in-service on how to use the hand held tool. The nurse then interpret the same six ECGs (in a different order) using the hand held tool. RESULTS: Seventy-five nurses participated. Identification of STEMI location improved when the tool was used. Lead identification improved in 2 of the 3 STEMI scenarios. Overall, nurses' ability to correctly identify the 3 non-ischemic ECGs was low, and in one ECG was lower when the tool was used. CONCLUSION: For ECGs with a STEMI pattern an easy-to-learn tool improves nurses' ability to identify STEMI location. Nurses require education for identifying ECG leads, and non-ischemic ECG patterns.