Accurate clinical documentation is critical, especially during emergency situation. This article gives a detailed view on best documentation practices for pacemaker care and the use of ECG monitoring.

1. Documentation
for Pacemaker
Care
Accurate clinical
documentation is
critical, especially
during emergency
situation. This article
gives a detailed view
on best documentation
practices for
pacemaker care and
the use of ECG
monitoring.
Medical Transcription Services

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Pacemaker is a cardiovascular implantable electronic device (CIED) that sends small
electrical impulses to the heart muscle to maintain a suitable heart rate or to stimulate the
lower chambers of the heart (ventricles). This device may be also used to treat fainting
spells (syncope), congestive heart failure and hypertrophic cardiomyopathy. Depending
upon the condition of the patient, this device is implanted permanently or used
temporarily (in emergency situations). In all cases, accurate documentation via medical
transcription is essential for providing better care for patients undergoing pacemaker
implementation. Let’s take a detailed into the documentation requirements for pacemaker
care.
Important Documentation Elements
The crucial documentation elements are as follows:
 Type of pacemaker used
 Date and time of pacemaker placement
 Physician who inserted the device
 Reason for placement
 Pacemaker settings
 Patient’s LOC and vital signs, noting which arm you used to take the blood
pressure reading
 Complications (infection, chest pain, pacemaker malfunction or arrhythmias)
 Interventions performed and their results (for example, using X-rays to verify
correct electrode placement and information obtained from a 12-lead ECG)
You should obtain and include rhythm strips in the medical record during the following
times:
 Before, during and after the placement of pacemaker
 Change in pacemaker settings anytime
 The patient receives treatment resulting from a pacemaker complication anytime

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If the patient has a transcutaneous pacemaker (a temporary means used for pacing a
patient's heart during a medical emergency), you should make sure the following details
are documented.
 Reason for using this kind of pacing
 Time when the pacing started
 Location of the electrodes
ECG Monitoring and Documentation
An electrocardiogram (ECG) is the recording of the electrical activity of the heart, which
can point out the changes in the patient’s condition and aid diagnosis. The electrodes
placed at specific points on the skin detect the heart’s electrical impulses during
conduction and displayed them as a graphic waveform on an ECG machine or cardiac
monitor. You can study the patient’s condition by monitoring the waveform. Either 12-
lead or continual ECG monitoring can be performed. However, patients on continual
ECG monitoring need to be nursed in high observation areas where alarms are easily
heard.
So, why is ECG monitoring important for pacemaker care? By monitoring pacemaker
function with ECG monitoring, you can find out the problems with the pacemaker (for
example, improper sensing, failure to pace and so on). For example, compared to
permanent pacemakers, temporary transve1nous pacemakers are associated with a higher
risk of loss of capture. This is because temporary transvenous lead wires are stiffer than
permanent lead wires in order to facilitate rapid insertion from remote venous access
points and lack of active and passive fixation mechanisms of permanent leads. So, it is
very important to monitor the patients with temporary pacemakers until pacing is no
longer necessary and the device is either removed or replaced with a permanent device.
When the ECG monitoring continues, you should document the following:

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 Capture
 Sensing rate
 Intrinsic beats
 Competition of paced and intrinsic rhythms
The accuracy of documentation for pacemaker care is critical, especially when it comes
to emergency care. In order to avoid copy-paste issues with EMR documentation, you
can follow an integrated approach of EMR and transcription in which the recordings are
transcribed and reviewed after which the transcribed data is populated into the relevant
EMR fields.