Computer-Assisted Interventions To Improve QTc Documentation in Patients Receiving QT-Prolonging Drugs.

Link to article at PubMed

Computer-Assisted Interventions To Improve QTc Documentation in Patients Receiving QT-Prolonging Drugs.

Am J Crit Care. 2015 Mar;24(2):e6-e15

Authors: Sandau KE, Sendelbach S, Fletcher L, Frederickson J, Drew BJ, Funk M

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 QTc-prolonging 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 associated with 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. 2015;24:e6-e15).

PMID: 25727282 [PubMed - in process]

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