Ensuring Accurate ST-Segment Monitoring

Scope and Impact of the Problem

ST-segment monitoring can enable the detection of silent ischemia and result in changes in clinical management.^1-6 Changes in the ST segment also add prognostic information that can potentially influence treatment decisions.^7-15 Although the evidence supports the treatment of detected myocardial ischemia, no randomized clinical trials have been done to test the effect of continuous ST-segment monitoring on clinical outcomes. Ischemia is present in hospitalized patients with acute coronary syndrome (ACS, unstable angina) and is also potentially present in noncardiac critically ill patients and in patients undergoing noncardiac surgery who have coronary disease or cardiac risk factors.^2,4,5,16-32

A lack of awareness is apparent with respect to recommendations for ST-segment monitoring, and ST-segment monitoring is underused in clinical practice.^33,34 Accurate ST-segment monitoring requires nurses to have a high level of knowledge and skill for accuracy and for effective clinical decision-making. Deficits in nursing knowledge related to the assessment of injury and ischemia based on changes in ST segments and T waves have been documented.^35-38