A closed-book, multiple-choice examination following this article tests your under standing of the following objectives:1. discuss advantages of automated decision support tools. 2. describe the steps taken to improve documentation of QT intervals. 3. discuss risk factors for torsade de pointes.To read this article and take the CNE test online, visit www.ajcconline.org and click "CNE Articles in This Issue." No CNE test fee for AACN members.By Kristin E. sandau, RN, phd, CNE, sue sendelbach, RN, phd, CCNs, Linda Fletcher, MHI, Joel Frederickson, phd, Barbara J. drew, RN, phd, and Marjorie Funk, RN, phd 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 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) Background Prolongation of QT IntervalOn the electrocardiogram (ECg), the QT interval represents both depolarization and repolarization of the ventricles.3 For practical clinical purposes, however, the QT interval is used as an indirect measure of ventricular repolarization because the start of the QRs complex is easy to identify; thus, measurement of the QT interval is initiated at the beginning of the QRs complex and terminated at the end of the T wave.4 patients with a prolonged QT interval are at risk for Tdp, a polymorphic ventricular tachycardia characterized by twisting points of the QRs complex a...
Background Continuous ST-segment monitoring can be used to detect early and transient cardiac ischemia. The American Heart Association and American Association of Critical-Care Nurses recommend its use among specific patients, but such monitoring is routine practice in only about half of US hospitals. Objective To determine cardiologists’ awareness and practice standards regarding continuous ST-segment monitoring and the physicians’ perceptions of appropriate patient selection, benefits and barriers, and usefulness of this technology. Methods An electronic survey was sent to a random sample of 915 US cardiologists from a pool of 4985 certified cardiologists. Results Of 200 responding cardiologists, 55% were unaware of the consensus guidelines. Of hospitals where respondents admitted patients, 49% had a standard of practice for using continuous ST-segment monitoring for cardiac patients. Most cardiologists agreed or strongly agreed that patients in the cardiovascular laboratory (87.5%) and intensive care unit (80.5%) should have such monitoring. Cardiologists routinely ordered ST monitoring for patients with acute coronary syndrome (67%) and after percutaneous coronary intervention (60%). The primary factor associated with higher perceptions for benefits, clinical usefulness, and past use of continuous ST-segment monitoring was whether or not hospitals in which cardiologists practiced had a standard of practice for using this monitoring. A secondary factor was awareness of published consensus guidelines for such monitoring. Conclusion Respondents (55%) were unaware of published monitoring guidelines. Hospital leaders could raise awareness by multidisciplinary review of evidence and possibly incorporating continuous ST-segment monitoring into hospitals’ standards of practice.
The current study used latent class analysis to identify subgroups of collegiate Christian evangelicals and to compare them on a range of cross-sectional and longitudinal indicators of personal attitudes and campus climate. Items from the Interfaith Diversity Experiences and Attitudes Longitudinal Survey (IDEALS) formed the basis of this study. We identified 3 subgroups who differed in terms of their appreciation of outside groups, knowledge of other groups, and ratings of campus climate. Our results provide insight into the evangelical experience in higher education and provide additional support for the argument that "evangelical" should be viewed as a heterogeneous population.
Continuous ST-segment (cST-seg) monitoring has been shown to help identify early and transient cardiac ischemia. American Heart Association and American Association of Critical Care Nurses recommend its use among specific patient populations. Investigators examined factors associated with cardiologists’ reported benefits, barriers, and perceptions of usefulness for cST-seg monitoring. A random sample (n=200) within a national pool of 4,985 cardiologists registered with the vendor Epocrates® was electronically surveyed. Cardiologists agreed/ strongly agreed that benefits of cST-seg monitoring included early identification of potential ischemia (83.5%), and early identification of reocclusion after PCI (74%) or fibrinolytics (72.5%). Cardiologists agreed/strongly agreed that barriers included false positive alarm for ischemia (61.5%); lack of understanding of this technology by nursing staff (56.5%); extra phone calls based on inaccurate monitoring (48%); lack of understanding of this technology by other physicians (47%); and extra cost/ treatment due to false positive alarms (43%). Cardiologists agreed/strongly agreed that cST-seg monitoring identifies patients who need further tests (69%) and is clinically useful in detecting transient myocardial ischemia (65%). The primary factor associated with higher benefits, clinical usefulness, and past use of cST-seg monitoring by cardiologists was whether or not their hospitals had a standard of practice for using cST-seg monitoring. The secondary factor was awareness of published consensus guidelines for cST-seg monitoring. Findings may indicate that when cardiologists are given the opportunity to work with a hospital that provides guidelines and experience in cST-seg monitoring, they may be more likely to appreciate its benefits and clinical utility. Clinical leaders should initiate multi-disciplinary efforts to review the level of evidence for possible incorporation of cST-seg monitoring into their hospitals’ standards of practice. Findings will help direct further research and interdisciplinary education in appropriate use of technology by critical care nurses and cardiologists.
The current study used latent class analysis to identify subgroups of collegiate Christian evangelicals and to compare them on a range of cross-sectional and longitudinal indicators of personal attitudes and campus climate. Items from the Interfaith Diversity Experiences and Attitudes Longitudinal Survey (IDEALS) formed the basis of this study. We identified three subgroups who differed in terms of their appreciation of outside groups, knowledge of other groups, and ratings of campus climate. Our results provide insight into the evangelical experience in higher education and provide additional support for the argument that “evangelical” should be viewed as a heterogeneous population.
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