Accuracy of cardiac monitoring (electrode placement, lead selection, interval assessment, and rhythm interpretation) is an important component of patient safety in hospitalized patients who meet the criteria for dysrhythmia monitoring. Quality dysrhythmia monitoring requires nurses to have high levels of knowledge and skill for accuracy and effective clinical decision-making. Gaps in practice related to dysrhythmia monitoring have been documented.1–4  Inaccurate placement of electrodes can affect the morphology (shape) of the QRS complex and result in misinterpretation of a rhythm.5,6 

  1. Ensure proper placement of electrodes to obtain accurate diagnosis of cardiac rhythm (see Figure). Palpate patient to ensure proper intercostal spaces. Electrodes should be placed under the breast tissue in women. [level B]

  2. Provide proper skin preparation for electrocardiography (ECG) electrodes. Change ECG electrodes daily. [level B]

  3. Individualize limits on heart-rate alarms and other alarm settings on...

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