Pharmacist Monitoring of QTc Interval–Prolonging Medications in Critically Ill Medical Patients: A Pilot Study

Ng, Tien M. H.; Bell, Adrienne; Hong, Chandra; Hara, Jill; Touchette, Daniel R.; Danskey, Karine N.; Lindsay, Tanya T.; Puumala, Susan E.

doi:10.1345/aph.1k458

Cited by 51 publications

(30 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The incidence of aLQTS and torsades de pointes may be high in hospitalized patients, especially ICU patients, because of the multiple classes of QT-prolonging medications prescribed and an increase in the incidence of other potential risk factors. 21 Our study is the first one in which the frequency of aLQTS was determined in consecutive ICU patients regardless of medications or risk factors. In studies by Ng and colleagues, the frequency of aLQTS in a subset of ICU patients who received a known QTc-prolonging medication was 46.6% 25 and 58.4%.…”

Section: Discussionmentioning

confidence: 99%

“…In studies by Ng and colleagues, the frequency of aLQTS in a subset of ICU patients who received a known QTc-prolonging medication was 46.6% 25 and 58.4%. 21 Other research [26][27][28][29] on the frequency of aLQTS has focused on patients in units other than ICUs.…”

Section: Discussionmentioning

confidence: 99%

“…Two medications in this class, grepafloxacin and sparfloxacin, have been withdrawn from the market because of adverse cardiac events and deaths. 50 Ng et al 21 found a high frequency (58.4%) of aLQTS associated with the use of levofloxacin in ICU patients. Falagas et al 51 also have reported levofloxacin-induced aLQTS.…”

Section: Medications and Alqtsmentioning

confidence: 99%

See 2 more Smart Citations

Acquired Long QT Syndrome: Frequency, Onset, and Risk Factors in Intensive Care Patients

Kozik

Wung

2012

Critical Care Nurse

View full text Add to dashboard Cite

Background Acquired long QT syndrome is a reversible condition that can lead to torsades de pointes and sudden cardiac death. Objective To determine the frequency, onset, frequency of medications, and risk factors for the syndrome in intensive care patients. Methods In a retrospective chart review of 88 subjects, hourly corrected QT intervals calculated by using the Bazett formula were collected. Acquired long QT syndrome was defined as a corrected QT of 500 milliseconds or longer or an increase in corrected QT of 60 milliseconds or greater from baseline level. Risk factors and medications administered were collected from patients’ medical records. Results The syndrome occurred in 46 patients (52%); mean time of onset was 7.4 hours (SD, 9.4) from time of admission. Among the 88 patients, 52 (59%) received a known QTc-prolonging medication. Among the 46 with the syndrome, 23 (50%) received a known QT-prolonging medication. No other risk factor studied was significantly predictive of the syndrome. Conclusions Acquired long QT syndrome occurs in patients not treated with a known QT-prolonging medication, indicating the importance of frequent QT monitoring of all intensive care patients.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Acquired Long QT Syndrome: Frequency, Onset, and Risk Factors in Intensive Care Patients

Kozik

Wung

2012

Critical Care Nurse

View full text Add to dashboard Cite

show abstract

“…Ng et al 496 evaluated a pharmacistled intervention (n=149 pa tients), resulting in patients randomized to the interven tion of pharmacist involvement and a specific QTc algo rithm having less frequent QTc prolongation. Haugaa et al 497 evaluated an institutionwide (n=1145) QT alert sys tem that identified ECGs with QTc ≥0.50 seconds, with a "semiurgent" email alert to the prescriber.…”

Section: Practical Considerations To Implementing Practice Standardsmentioning

confidence: 99%

Update to Practice Standards for Electrocardiographic Monitoring in Hospital Settings: A Scientific Statement From the American Heart Association

Sandau¹,

Funk²,

Auerbach³

et al. 2017

Circulation

186

214

View full text Add to dashboard Cite

Background and Purpose: This scientific statement provides an interprofessional, comprehensive review of evidence and recommendations for indications, duration, and implementation of continuous electro cardiographic monitoring of hospitalized patients. Since the original practice standards were published in 2004, new issues have emerged that need to be addressed: overuse of arrhythmia monitoring among a variety of patient populations, appropriate use of ischemia and QT-interval monitoring among select populations, alarm management, and documentation in electronic health records. Methods: Authors were commissioned by the American Heart Association and included experts from general cardiology, electrophysiology (adult and pediatric), and interventional cardiology, as well as a hospitalist and experts in alarm management. Strict adherence to the American Heart Association conflict of interest policy was maintained throughout the consensus process. Authors were assigned topics relevant to their areas of expertise, reviewed the literature with an emphasis on publications since the prior practice standards, and drafted recommendations on indications and duration for electrocardiographic monitoring in accordance with the American Heart Association Level of Evidence grading algorithm that was in place at the time of commissioning. Results: The comprehensive document is grouped into 5 sections: (1) Overview of Arrhythmia, Ischemia, and QTc Monitoring; (2) Recommendations for Indication and Duration of Electrocardiographic Monitoring presented by patient population; (3) Organizational Aspects: Alarm Management, Education of Staff, and Documentation; (4) Implementation of Practice Standards; and (5) Call for Research. Conclusions: Many of the recommendations are based on limited data, so authors conclude with specific questions for further research.

show abstract

“…Ng et al 8 randomized 149 patients to a standard care group versus an intervention group (addition of algorithm by pharmacist). QTc interval prolongation occurred less often in the intervention group (19%) than in the standard care group (39%), and the algorithm-generated recommendations received a 70% acceptance rate from the physician team.…”

Section: Process For Organizational Changementioning

confidence: 99%

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

Sandau¹,

Sendelbach²,

Fletcher³

et al. 2015

American Journal of Critical Care

View full text Add to dashboard Cite

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...

show abstract

Pharmacist Monitoring of QTc Interval–Prolonging Medications in Critically Ill Medical Patients: A Pilot Study

Abstract: In this preliminary study, pharmacist monitoring of QTc interval-prolonging drugs using a simple algorithm was feasible and reduced the risk of QTc interval prolongation. Further studies that monitor other proarrhythmic medications are warranted.

Cited by 51 publications

References 22 publications

Acquired Long QT Syndrome: Frequency, Onset, and Risk Factors in Intensive Care Patients

Acquired Long QT Syndrome: Frequency, Onset, and Risk Factors in Intensive Care Patients

Update to Practice Standards for Electrocardiographic Monitoring in Hospital Settings: A Scientific Statement From the American Heart Association

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

Contact Info

Product

Resources

About