❤️ Electrocardiogram (EKG) Procedure

To establish a standardized process for obtaining accurate, high-quality 12-lead electrocardiograms while ensuring patient safety, proper equipment use, correct lead placement, and timely provider review.

Purpose

An electrocardiogram (EKG) records the electrical activity of the heart and assists providers in evaluating cardiac rhythm, conduction abnormalities, ischemia, and other cardiovascular conditions. Medical Assistants are responsible for obtaining technically accurate tracings and promptly notifying the provider of any concerns.

Policy

EKGs may only be performed under a valid provider order or standing clinic protocol. Medical Assistants obtain the tracing but do not independently interpret diagnostic findings.

EKG Workflow

1️⃣Verify Patient Identity
2️⃣Review Provider Order
3️⃣Prepare Patient
4️⃣Apply Electrodes
5️⃣Obtain 12-Lead EKG
6️⃣Provider Review & Documentation

Common Indications

Diagnostic Evaluation

  • Chest pain.
  • Palpitations.
  • Shortness of breath.
  • Dizziness or syncope.
  • Irregular heart rhythm.
  • Hypertension evaluation.

Routine Monitoring

  • Medication monitoring.
  • Pre-operative evaluation.
  • Baseline cardiac assessment.
  • Chronic cardiac disease follow-up.
  • Provider-requested screening.

Pre-Procedure Assessment

  • Verify the patient using two approved identifiers.
  • Confirm the provider order.
  • Explain the procedure to the patient.
  • Review allergies to adhesives.
  • Assess for implanted cardiac devices.
  • Ask the patient to remove jewelry from the chest area when possible.
  • Obtain baseline vital signs if ordered or indicated.
  • Ensure the patient has been resting quietly for several minutes before the tracing.

Patient Preparation

Position the patient comfortably in the supine position whenever possible. Expose only the areas necessary for lead placement while maintaining patient privacy and dignity throughout the procedure.

Required Equipment

EKG Equipment

  • 12-lead EKG machine.
  • Patient cable and lead wires.
  • Disposable electrodes.
  • Conductive prep supplies as needed.
  • Printer paper.

Clinical Supplies

  • Alcohol wipes.
  • Skin prep materials if needed.
  • Gloves.
  • Disposable razor (if clinically necessary).
  • Biohazard waste container.

Do NOT Perform the EKG Until the Provider Is Notified If:

  • The patient reports active crushing chest pain or rapidly worsening symptoms.
  • The patient is unresponsive or unstable.
  • The provider order is unclear.
  • The patient cannot be safely positioned.
  • The EKG equipment is malfunctioning.
  • The patient refuses the procedure.

Electrode Placement & Patient Preparation

Proper electrode placement is essential for obtaining an accurate diagnostic-quality tracing. Incorrect placement may produce abnormal results and require the EKG to be repeated.

  • Perform hand hygiene before patient contact.
  • Verify the patient using two approved identifiers.
  • Position the patient comfortably in the supine position whenever possible.
  • Ensure arms and legs are relaxed and uncrossed.
  • Clean oily or sweaty skin with alcohol if needed.
  • Clip excessive chest hair only when necessary to improve electrode adhesion.
  • Allow skin to dry completely before applying electrodes.
  • Apply electrodes according to manufacturer recommendations and clinic protocol.
Patient Comfort

Explain each step before placing electrodes. Preserve patient privacy by exposing only the areas necessary for lead placement and covering the patient whenever possible.

Obtaining a High-Quality Tracing

Once all electrodes are secured, verify that the patient remains still while the tracing is obtained.

1️⃣ Verify Electrode Adhesion
2️⃣ Ask Patient to Relax
3️⃣ Minimize Movement
4️⃣ Acquire 12-Lead EKG
5️⃣ Review Tracing Quality
6️⃣ Submit to Provider

Tips for Reducing Artifact

  • Ask the patient not to talk during the recording.
  • Encourage normal breathing unless instructed otherwise.
  • Ensure all electrodes remain firmly attached.
  • Keep lead wires untangled and supported.
  • Reduce nearby electrical interference whenever possible.
  • Repeat the tracing if excessive artifact prevents adequate review.

Immediate Provider Notification

Medical Assistants do not interpret EKGs; however, they must recognize situations requiring prompt provider notification based on clinic protocol and the patient's condition.

Notify the Provider Immediately If:

  • The patient develops worsening chest pain.
  • Shortness of breath significantly increases.
  • The patient becomes dizzy or loses consciousness.
  • The patient develops severe diaphoresis.
  • Vital signs become unstable.
  • The patient cannot tolerate completion of the procedure.
  • The EKG machine displays a critical alert according to manufacturer instructions.
  • The provider specifically requests immediate review of all tracings.

Equipment Cleaning & Infection Prevention

Clean and disinfect reusable equipment between every patient according to clinic infection prevention policies and manufacturer recommendations.

  • Discard all single-use electrodes after each patient.
  • Disinfect reusable lead wires as recommended.
  • Clean patient cables if contaminated.
  • Wipe the EKG machine after each use.
  • Restock supplies before returning the machine to service.
  • Perform hand hygiene after patient care.

Documentation Requirements

  • Date and time the EKG was obtained.
  • Reason for the EKG.
  • Confirmation of provider order.
  • Patient tolerance of the procedure.
  • Any difficulty obtaining the tracing.
  • Whether the tracing was repeated.
  • Confirmation that the provider received or reviewed the tracing according to clinic workflow.
  • Patient education provided.
  • Any provider notifications.
Documentation should objectively describe the procedure performed, the patient's response, and communication with the provider. Medical Assistants should not document independent interpretation of EKG findings.

Quality Assurance

Medical Assistant

  • Verify patient identity.
  • Prepare the patient appropriately.
  • Apply electrodes correctly.
  • Obtain a diagnostic-quality tracing.
  • Clean equipment after use.
  • Complete documentation.

Provider

  • Order the EKG.
  • Review and interpret the tracing.
  • Communicate results and treatment plan.
  • Initiate additional evaluation when indicated.

Leadership

  • Maintain staff competency.
  • Ensure EKG equipment is maintained and calibrated.
  • Monitor documentation quality.
  • Audit adherence to clinic procedures.

EKG Procedure Checklist

✅ Verify patient using two identifiers
✅ Confirm provider order
✅ Explain the procedure to the patient
✅ Position the patient appropriately
✅ Prepare the skin and apply electrodes
✅ Obtain a high-quality 12-lead tracing
✅ Repeat tracing if excessive artifact is present
✅ Notify the provider according to clinic protocol
✅ Clean and disinfect equipment
✅ Dispose of single-use supplies appropriately
✅ Upload or attach the tracing in RXNT
✅ Complete documentation

Sawubona Standard

An EKG may be routine for our team, but it can be stressful for the patient. Every interaction should be calm, respectful, and reassuring. By obtaining high-quality tracings, protecting patient privacy, communicating clearly, and ensuring prompt provider review, we support timely clinical decision-making while demonstrating The Neighborhood Clinic's commitment to safe, compassionate, and patient-centered care.