Computer-assisted interventions to improve QTC documentation in patients receiving QT-prolonging drugs
Background Many medications commonly used in hospitals can cause prolonged corrected QT interval (QTc), putting patients at risk for torsade de pointes (TdP), a potentially fatal arrhythmia. However, documentation of QTc for hospitalized patients receiving QT-prolonging medications is often not consistent with American Heart Association standards. Objective To examine effects of education and computerized documentation enhancements on QTc documentation. Methods A quasi-experimental multisite study among 4011 cardiac-monitored patients receiving QTc-prolonging medications within a 10-hospital health care system was conducted to compare QTc documentation before (n=1517), 3 months after (n = 1301), and 4 to 6 months after (n = 1193) an intervention. The intervention included (1) online education for 3232 nurses, (2) electronic notifications to alert nurses when a patient received at least 2 doses of a QT-prolonging medication, and(3) computerized calculation of QTc in electronic health records after nurses had documented heart rate and QT interval. Results QTc documentation for inpatients receiving QTcprolonging drugs increased significantly from baseline (17.3%) to 3 months after the intervention (58.2%; P< .001) within the 10 hospitals and had increased further 4 to 6 months after the intervention (62.1%, P= .75). Patients at larger hospitals were significantly more likely to have their QTc documented (46.4%) than were patients at smaller hospitals (26.2%; P< .001). Conclusion A 3-step system-wide intervention was associatedwith an increase in QTc documentation for patients at risk for drug-induced TdP, and improvements persisted over time. Further study is needed to assess whether increased QTc documentation decreases occurrence of drug-induced TdP.
American Journal of Critical Care
Sandau, Kristin E.; Sendelbach, Sue; Fletcher, Linda; Frederickson, Joel; Drew, Barbara J.; and Funk, Marjorie, "Computer-assisted interventions to improve QTC documentation in patients receiving QT-prolonging drugs" (2015). Nursing Faculty Publications. 14.