Implementation of a Pharmacist-Led Patient Monitoring Tool to Identify Critically Ill Patients at Increased Risk of QTc Interval Prolongation
CCCF ePoster library. Mao L. Oct 26, 2015; 114777; P39
Lynda Mao
Lynda Mao
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Abstract
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P39


Topic: Quality Assurance/Quality Improvement Project


Implementation of a Pharmacist-Led Patient Monitoring Tool to Identify Critically Ill Patients at Increased Risk of QTc Interval Prolongation



Lynda Mao, C. Simpson, P. Newman

Department of Pharmacy Services, Kingston General Hospital, Kingston, Canada | Cardiology, Kingston General Hospital, Kingston, Canada | N/A, N/A, Kingston, Canada

Introduction:

There has been increased emphasis on assessing patient risk factors to prevent the development of corrected QT (QTc) interval prolongation and subsequent Torsades de Pointes, a potentially fatal ventricular arrhythmia. Critical care patients represent a significant group at risk as they receive a large number of drugs and have multiple preexisting risk factors.



Objectives:

The objective of this project was to develop and implement a pharmacist-led monitoring tool which utilizes a validated risk score to identify critically ill patients at risk of QTc interval prolongation.



Methods:

A prospective cohort study was conducted in adult patients admitted to a 33-bed mixed medical/surgical Level 3 Critical Care Service at a tertiary teaching institution. A monitoring tool containing a previously validated risk score to predict the development of QTc interval prolongation was developed to track orders for potential QTc interval prolonging drugs and pharmacist interventions. Daily QTc interval measurements were collected through chart review for at-risk patients and pharmacists were surveyed on the effectiveness and feasibility of the tool in identifying at-risk patients in their daily practice. Data was reported using descriptive statistics.



Results:

One hundred and thirty patients were included in the analysis after a two-month data collection period. The proportion of patients in the low, moderate, and high risk groups was 52%, 23%, and 25%, respectively. QTc interval prolongation (an increase in QTc >60 ms from admission or QTc >500 ms) was detected in 1 out of every 10 patients. There was a trend towards an increase in QTc interval prolongation in high risk patients compared to low and moderate risk patients. Pharmacists intervened on one-third of QTc interval prolonging drug orders and found the tool was useful for risk stratification but was difficult to routinely apply to all patients.



Conclusion:

The monitoring tool aided pharmacists in identifying and monitoring critical care patients at-risk of QTc interval prolongation and may have assisted in guiding interventions to improve patient safety. Its use could be extended to pharmacists on other clinical services when assessing and monitoring patients for QTc interval prolongation.



References:
Tisdale JE et al. Circ Cardiovasc Qual Outcomes. 2013. 6(4):479-87.
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