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 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).


CONCLUSIONS
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).
Kristin E. Sandau is a professor of nursing at Bethel University, St Paul, Minnesota. Sue Sendelbach is director of nursing research at Abbott-Northwestern Hospital, Minneapolis, Minnesota. At the time of the study, Linda Fletcher was a senior business analyst at Allina Health, Minneapolis, Minnesota. Joel Frederickson is a professor and chair of the Department of Psychology at Bethel University. Barbara J. Drew is the David Mortara Distinguished Professor in Physiological Nursing Research and a clinical professor of medicine, cardiology at the University of California, San Francisco. Marjorie Funk is the Helen Porter Jayne and Martha Prosser Jayne Professor of Nursing at the Yale University School of Nursing, New Haven, Connecticut. k-sandau@bethel.edu.
Kristin E
KE
Sandau
Kristin E. Sandau is a professor of nursing at Bethel University, St Paul, Minnesota. Sue Sendelbach is director of nursing research at Abbott-Northwestern Hospital, Minneapolis, Minnesota. At the time of the study, Linda Fletcher was a senior business analyst at Allina Health, Minneapolis, Minnesota. Joel Frederickson is a professor and chair of the Department of Psychology at Bethel University. Barbara J. Drew is the David Mortara Distinguished Professor in Physiological Nursing Research and a clinical professor of medicine, cardiology at the University of California, San Francisco. Marjorie Funk is the Helen Porter Jayne and Martha Prosser Jayne Professor of Nursing at the Yale University School of Nursing, New Haven, Connecticut.
Sue
S
Sendelbach
Kristin E. Sandau is a professor of nursing at Bethel University, St Paul, Minnesota. Sue Sendelbach is director of nursing research at Abbott-Northwestern Hospital, Minneapolis, Minnesota. At the time of the study, Linda Fletcher was a senior business analyst at Allina Health, Minneapolis, Minnesota. Joel Frederickson is a professor and chair of the Department of Psychology at Bethel University. Barbara J. Drew is the David Mortara Distinguished Professor in Physiological Nursing Research and a clinical professor of medicine, cardiology at the University of California, San Francisco. Marjorie Funk is the Helen Porter Jayne and Martha Prosser Jayne Professor of Nursing at the Yale University School of Nursing, New Haven, Connecticut.
Linda
L
Fletcher
Kristin E. Sandau is a professor of nursing at Bethel University, St Paul, Minnesota. Sue Sendelbach is director of nursing research at Abbott-Northwestern Hospital, Minneapolis, Minnesota. At the time of the study, Linda Fletcher was a senior business analyst at Allina Health, Minneapolis, Minnesota. Joel Frederickson is a professor and chair of the Department of Psychology at Bethel University. Barbara J. Drew is the David Mortara Distinguished Professor in Physiological Nursing Research and a clinical professor of medicine, cardiology at the University of California, San Francisco. Marjorie Funk is the Helen Porter Jayne and Martha Prosser Jayne Professor of Nursing at the Yale University School of Nursing, New Haven, Connecticut.
Joel
J
Frederickson
Kristin E. Sandau is a professor of nursing at Bethel University, St Paul, Minnesota. Sue Sendelbach is director of nursing research at Abbott-Northwestern Hospital, Minneapolis, Minnesota. At the time of the study, Linda Fletcher was a senior business analyst at Allina Health, Minneapolis, Minnesota. Joel Frederickson is a professor and chair of the Department of Psychology at Bethel University. Barbara J. Drew is the David Mortara Distinguished Professor in Physiological Nursing Research and a clinical professor of medicine, cardiology at the University of California, San Francisco. Marjorie Funk is the Helen Porter Jayne and Martha Prosser Jayne Professor of Nursing at the Yale University School of Nursing, New Haven, Connecticut.
Barbara J
BJ
Drew
Kristin E. Sandau is a professor of nursing at Bethel University, St Paul, Minnesota. Sue Sendelbach is director of nursing research at Abbott-Northwestern Hospital, Minneapolis, Minnesota. At the time of the study, Linda Fletcher was a senior business analyst at Allina Health, Minneapolis, Minnesota. Joel Frederickson is a professor and chair of the Department of Psychology at Bethel University. Barbara J. Drew is the David Mortara Distinguished Professor in Physiological Nursing Research and a clinical professor of medicine, cardiology at the University of California, San Francisco. Marjorie Funk is the Helen Porter Jayne and Martha Prosser Jayne Professor of Nursing at the Yale University School of Nursing, New Haven, Connecticut.
Marjorie
M
Funk
D003194:Computer-Assisted Instruction; D004282:Documentation / Q000592:standards*; D004509:Education, Nursing, Continuing; D004562:Electrocardiography / Q000187:drug effects*; D001330:Electronic Data Processing; D057286:Electronic Health Records; D006276:Health Facility Size; D006801:Humans; D015397:Program Evaluation; D058996:Quality Improvement; D017010:Reminder Systems; D016171:Torsades de Pointes / Q000139:chemically induced / Q000517:prevention & control