A call for standardized national guidelines on QT/QTc monitoring in Canada

2021 ◽  
Vol 32 (2) ◽  
pp. 14-19
Author(s):  
Kathleen Hutton ◽  
Darlene Hutton
Keyword(s):  
Critical Care ◽  
Qt Interval ◽  
Medical Personnel ◽  
Critical Care Nurses ◽  
Cardiac Monitoring ◽  
Qtc Interval ◽  
National Guidelines ◽  
Canadian Guideline ◽  
Knowledge Based ◽  
The Individual

Background: With QT-prolonging drugs being trialed for the treatment of COVID-19, national health associations allude to the importance of proficient QT interval assessment. However, in Canada there is no policy in place that clearly identifies a single method for routine QT monitoring. Aim: To demonstrate the need for a clear Canadian guideline for the measurement of the QT/QTc interval and to advocate for a standardized approach to education. Methods: This paper uses a medical anthropological approach to scale this practice gap from the individual provider to the institutions that govern practice and education. Nurses and emergency medical personnel from hospitals across Canada were polled with questionnaires on their confidence and knowledge of assessing the QT/QTc interval. We seek to identify causes for the widespread lack of confidence that goes beyond the context of nursing and is interdisciplinary in nature. Findings: Of the 292 participants who were polled, roughly 75% report measuring the QT interval. However, more than 50% of participants are not confident in their measurement. Although critical care nurses report the highest levels of confidence, the rate of correct answers amongst the whole of participants on knowledge-based questions is shockingly low (only nine percent attempted to provide a value for the QTc; 34% of those who were unsure of the normal QTc say they were not taught). Ninety percent of participants report they do not analyze the QTc, with critical care nurses accounting for 34% of participants. Conclusion: The lack of consensus on a QTc formula and the absence of clear guidelines on this well-documented issue exacerbate the continued gap in practice observed in our findings. We urge leading organizations to create a national guideline that supports a standardized approach to QT/QTc measurement that can be taught to and used by not only critical care nurses, but everyone in healthcare who provides cardiac monitoring.

scholarly journals Antipsychotics in routine treatment are minor contributors to QT prolongation compared to genetics and age

2021 ◽  
pp. 026988112110034
Author(s):  
Leif Hommers ◽  
Maike Scherf-Clavel ◽  
Roberta Stempel ◽  
Julian Roth ◽  
Matthias Falter ◽  
...  
Keyword(s):  
Qt Interval ◽  
Multivariate Regression Analysis ◽  
Cardiac Repolarization ◽  
Qtc Interval ◽  
Serum Concentrations ◽  
Drug Induced ◽  
Individual Level ◽  
Main Determinants ◽  
The Individual ◽  
Polygenic Variation

Background: Drug-induced prolongation of cardiac repolarization limits the treatment with many psychotropic drugs. Recently, the contribution of polygenic variation to the individual duration of the QT interval was identified. Aims: To explore the interaction between antipsychotic drugs and the individual polygenic influence on the QT interval. Methods: Retrospective analysis of clinical and genotype data of 804 psychiatric inpatients diagnosed with a psychotic disorder. The individual polygenic influence on the QT interval was calculated according to the method of Arking et al. Results: Linear regression modelling showed a significant association of the individual polygenic QT interval score (ßstd = 0.176, p < 0.001) and age (ßstd = 0.139, p < 0.001) with the QTc interval corrected according to Fridericia’s formula. Sex showed a nominal trend towards significance (ßstd = 0.064, p = 0.064). No association was observed for the number of QT prolonging drugs according to AZCERT taken. Subsample analysis ( n = 588) showed a significant association of potassium serum concentrations with the QTc interval (ßstd = −0.104, p = 0.010). Haloperidol serum concentrations were associated with the QTc interval only in single medication analysis ( n = 26, ßstd = 0.101, p = 0.004), but not in multivariate regression analysis. No association was observed for aripiprazole, clozapine, quetiapine and perazine, while olanzapine and the sum of risperidone and its metabolite showed a negative association. Conclusions: Individual genetic factors and age are main determinants of the QT interval. Antipsychotic drug serum concentrations within the therapeutic range contribute to QTc prolongation on an individual level.

scholarly journals Effect of Haemodialysis on QTc in Newly Diagnosed Chronic Kidney Disease Patients

2020 ◽  
Author(s):  
Siddharth Gosavi ◽  
TV Pradeep ◽  
Amogh Ananda Rao ◽  
Sissmol Davis ◽  
Bharat Pulavarti ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Qt Interval ◽  
General Medicine ◽  
Cardiac Monitoring ◽  
Qtc Interval ◽  
Newly Diagnosed ◽  
Qtc Prolongation ◽  
Sodium Potassium ◽  
Non Invasive

Introduction: Cardiovascular disease and mortality is twice as common in patients with Chronic Kidney Disease (CKD) compared to the general population. The QT interval which depicts ventricular repolarisation, is a crude non-invasive marker of susceptibility to ventricular arrhythmias. Effects of haemodialysis on corrected QT (QTc) interval in newly diagnosed CKD patients is undocumented till date. Aim: To assess the effect of haemodialysis on QTc in patients with newly diagnosed CKD. Materials and Methods: This was a prospective cohort study of 50 newly diagnosed CKD patients admitted for their first session of haemodialysis in the Departments of General Medicine and Nephrology, at Bapuji Hospital between October and November 2019. ECGs were recorded before the first and after the third session of haemodialysis. Serum electrolytes (sodium, potassium, chloride, phosphorous and calcium), blood sugar and haemoglobin levels before haemodialysis were recorded. QT interval was calculated and corrected using Bazett’s and Framingham’s methods. Descriptive statistics, simple and multiple linear regression were used for analysis using Microsoft® Excel. Results: The mean predialysis QTc was 0.434 seconds and postdialysis QTc was 0.477 seconds. QTc prolongation was observed in 44 (88%) patients (mean=0.042 seconds). The QTc prolongation correlated positively with postdialysis QTc (p=0.00001, Framingham; p=0.0009, Bazett) (RBazett=0.61 and RFramingham=0.74). Conclusion: Substantial QTc prolongation after three sessions of haemodialysis screens a population that has a greater risk of adverse cardiovascular events. This warrants vigilant cardiac monitoring in patients on haemodialysis.

scholarly journals Effect of Hydroxychloroquine and Azithromycin on QT Interval Prolongation and Other Cardiac Arrhythmias in COVID-19 Confirmed Patients

2021 ◽  
Vol 2021 ◽  
pp. 1-7 ◽  
Author(s):  
Seyed Parsa Eftekhar ◽  
Sohrab Kazemi ◽  
Mohammad Barary ◽  
Mostafa Javanian ◽  
Soheil Ebrahimpour ◽  
...  
Keyword(s):  
High Risk ◽  
Qt Interval ◽  
Therapy Group ◽  
Torsade De Pointes ◽  
Cardiac Monitoring ◽  
Qtc Interval ◽  
Interval Prolongation ◽  
Qt Interval Prolongation ◽  
Significant Difference ◽  
The Mean

Background. Hydroxychloroquine with or without azithromycin was one of the common therapies at the beginning of the COVID-19 pandemic. They can prolong QT interval, cause torsade de pointes, and lead to sudden cardiac death. We aimed to assess QT interval prolongation and its risk factors in patients who received hydroxychloroquine with or without azithromycin. Methods. This study was a retrospective cohort study. One hundred seventy-two confirmed COVID-19 patients were included in this study, hospitalized at Babol University of Medical Sciences hospitals between March 5, 2020, and April 3, 2020. Patients were divided into two groups: hydroxychloroquine alone and hydroxychloroquine with azithromycin. Electrocardiograms were used for outcome assessment. Results. 83.1% of patients received hydroxychloroquine plus azithromycin vs. 16.9% of patients who received only hydroxychloroquine. The mean age of patients was 59.2 ± 15.4 .The mean of posttreatment QTc interval in the monotherapy group was shorter than the mean of posttreatment QTc interval in the combination therapy group, but it had no significant statistical difference ( 462.5 ± 43.1 milliseconds vs. 464.3 ± 59.1 milliseconds; p = 0.488 ). Generally, 22.1% of patients had a prolonged QTc interval after treatment. Male gender, or baseline QTc ≥ 450 milliseconds, or high-risk Tisdale score increased the likelihood of prolonged QTc interval. Due to QTc prolongation, fourteen patients did not continue therapy after four days. Conclusions. Hospitalized patients treated by hydroxychloroquine with or without azithromycin had no significant difference in prolongation of QT interval and outcome. The numbers of patients with prolonged QT intervals in this study emphasize careful cardiac monitoring during therapy, especially in high-risk patients.

Assisted suicide, recent judicial decisions, and implications for critical care nurses

1997 ◽  
Vol 17 (5) ◽  
pp. 71-79 ◽  
Author(s):  
GS Wlody
Keyword(s):  
Critical Care ◽  
Assisted Suicide ◽  
Healthcare Providers ◽  
Supreme Court Decision ◽  
The United States ◽  
Critical Care Nurses ◽  
Value Systems ◽  
Physician Assisted Suicide ◽  
Death With Dignity Act ◽  
The Individual

The passage of the Oregon Death With Dignity Act on November 8, 1994, heralded a wake-up call for healthcare professionals. Oregon, the first state to systematically "ration care" was thought to be a fertile ground for testing new and, some say, radical concepts in healthcare and government. Although the act was not implemented because it was tied up in legal action until February 1997, the fact that more than 50% of the voters in Oregon voted for it mandates that healthcare providers listen to their patients. Patients want more control of their pain, the way they die, and the resources spent on their care in the final days of their lives. Thoughts of future suffering engender great fear on the part of healthcare consumers. Concern exists that physician-assisted suicide in the ICU will affect not only physicians but also nurses, pharmacists, respiratory therapists, and other clinicians as terminally ill patients make requests for assisted suicide while in the acute and critical care setting of the hospital. Critical care nurses must examine their value systems, review the Code for Nurses, and make their own decisions about participation in deliberately ending lives of patients. With the impending Supreme Court decision due in July 1997, the court may leave these issues to the individual states, opening the door for assisted suicide to occur throughout the United States. Therefore, the possibility will remain that critical care nurses may be put in positions in which physicians are providing assistance to patients who wish to commit suicide and are requesting nurses' assistance to do so.

scholarly journals Hydroxychloroquine and azithromycin: As a double edge sword for COVID-19?

2021 ◽  
Author(s):  
Seyed Parsa Eftekhar ◽  
Sohrab Kazemi ◽  
Mohammad Barary ◽  
Mostafa Javanian ◽  
Soheil Ebrahimpour ◽  
...  
Keyword(s):  
High Risk ◽  
Qt Interval ◽  
Torsade De Pointes ◽  
Post Treatment ◽  
Cardiac Monitoring ◽  
Qtc Interval ◽  
Qt Interval Prolongation ◽  
Number Of Patients ◽  
Significant Difference ◽  
The Mean

AbstractBackgroundHydroxychloroquine with or without azithromycin was one of the common therapies at the beginning of the COVID-19 pandemic. They can prolong QT interval, cause Torsade de pointes, and lead to sudden cardiac death. We aimed to assess QT interval prolongation and its risk factors in patients who received hydroxychloroquine with or without azithromycin.MethodsThis was a retrospective cohort study. 172 patients with COVID-19 included, hospitalized at hospitals of Babol University of Medical Sciences between March 5, 2020, and April 3, 2020. Patients were divided into two groups: hydroxychloroquine alone and hydroxychloroquine with azithromycin. Electrocardiograms were used for outcome assessment.Results83.1% of patients received hydroxychloroquine plus azithromycin vs 16.9% of patients who received only hydroxychloroquine. The mean age of patients was 59.2 ± 15.4. The mean of post-treatment QTc interval in the monotherapy group was shorter than the mean of post-treatment QTc interval in the combination therapy group but it had no significant statistical difference (462.5 ± 43.1 milliseconds vs 464.3 ± 59.1 milliseconds; P = 0.488). Generally, 22.1% of patients had a prolonged QTc interval after treatment. Male gender, or baseline QTc ≥ 450 milliseconds, or high-risk Tisdale score increased the likelihood of prolonged QTc interval. Due to QTc prolongation, 14 patients did not continue therapy after 4 days.ConclusionHospitalized patients treated with hydroxychloroquine with or without azithromycin, had no significant difference in prolongation of QT interval and outcome. But the number of patients with prolonged QT intervals in this study emphasizes careful cardiac monitoring during therapy; especially in high-risk patients.

Positive Emotion Skills Intervention to Address Burnout in Critical Care Nurses

2020 ◽  
Vol 31 (2) ◽  
pp. 167-178
Author(s):  
Elaine O. Cheung ◽  
Alison Hernandez ◽  
Emma Herold ◽  
Judith T. Moskowitz
Keyword(s):  
Critical Care ◽  
Positive Emotion ◽  
Critical Care Nurses ◽  
Workplace Stress ◽  
Empirically Supported ◽  
Novel Approach ◽  
The Face ◽  
As Stress ◽  
The Individual ◽  
Emotion Skills

Critical care nurses experience high levels of workplace stress, which can lead to burnout. Many medical centers have begun offering wellness programs to address burnout in their nursing staff; however, most of these programs focus on reducing negative states such as stress, depression, and anxiety. A growing body of evidence highlights the unique, independent role of positive emotion in promoting adaptive coping in the face of stress. This article describes a novel approach for preventing burnout in critical care nurses: an intervention that explicitly aims to increase positive emotion by teaching individuals empirically supported skills. This positive emotion skills intervention has been used successfully in other populations and can be tailored for critical care nurses. Also discussed are recommendations for addressing burnout in intensive care unit nurses at both the individual and organizational levels.

scholarly journals Critical Care Nurses on Duty: Information-Rich but Time-Poor

2007 ◽  
Vol 2 (1) ◽  
pp. 131
Author(s):  
Suzanne Lewis
Keyword(s):  
Critical Care ◽  
Information Seeking ◽  
Critical Care Unit ◽  
Information Needs ◽  
Information Sources ◽  
Computer Systems ◽  
Critical Care Nurses ◽  
Information Seeking Behavior ◽  
Knowledge Based ◽  
Seeking Behavior

Objective – To describe critical care nurses’ on-duty information-seeking behavior. Design – Participatory action research using ethnographic methods. Setting – A twenty-bed critical care unit in a 275-bed community (non-teaching) hospital. Subjects – A purposive sample of six registered nurses (RNs) working shifts in the critical care unit. Methods – The researcher accompanied six RNs on various shifts (weekdays and weekends, day and night shifts) in the critical care unit and used participant observation and in-context interviews to record fifty hours of the subjects’ information-seeking behavior. Transcripts were written up and checked by the subjects for accuracy and validity. The resulting rich data was analyzed using open coding (concepts which emerged during data gathering, for example “nurse’s personal notes”); in vivo coding (participant-supplied concepts, for example “reading on duty”); and axial coding (hierarchical, researcher-developed concepts such as “information behaviors, information sources, information uses, and information kinds”) (147). Main results – The critical care nurses constantly sought information from people (patients, family members, other health care workers), patient records, monitors, and other computer systems and noticeboards, but very rarely from published sources such as books or online databases. Barriers to information acquisition included equipment failure, illegible handwriting, unavailable people, social protocols (for example physician – nurse interaction), difficult navigation of computer systems, and mistakes caused by simultaneously using multiple complex systems. Conclusion – Critical care nurses’ information behavior is strongly patient-centric. Knowledge-based information sources are rarely consulted on duty due to time constraints and the perception that this would take time away from patient care. In seeking to meet the knowledge-based information needs of this group, librarians should be wary of traditional, academic models of information delivery. Instead, they should consider a tailored ready reference service incorporating quality and quantity filtering.

A guideline for competency of the critical care nurse

1996 ◽  
Vol 5 (3) ◽  
pp. 217-226 ◽  
Author(s):  
J Scribante ◽  
ME Muller ◽  
J Lipman
Keyword(s):  
Critical Care ◽  
South African ◽  
Professional Competence ◽  
High Standard ◽  
Critical Care Nurses ◽  
Critical Care Nursing ◽  
Care Nurse ◽  
Critical Care Nurse ◽  
Care Patterns ◽  
The Individual

BACKGROUND: To maintain a high standard of quality nursing care the individual critical care nurse s competencies should be determined objectively. Few international guidelines describe the qualities required by critical care nurses to function effectively in a critical care unit. These guidelines often focus only on the education and training of critical care nurses. OBJECTIVE: To formulate and describe guidelines for the competency requirements of registered critical care nurses. METHOD: A focus group interview, a qualitative research method, was conducted as an open conversation in which each participant could ask questions, comment, or respond to comments. Interaction among the respondents was encouraged to stimulate in-depth discussion. The study was conducted within the framework of South African critical care nursing. RESULTS: The four main categories that were identified are as follows: professional competence, cognitive competence, interpersonal skills, and critical care patterns of interaction. These are described in detail along with a formulated guideline for critical care nurse competency requirements. CONCLUSION: This study describes an attempt to formulate objective guidelines for critical care nurses competency requirements.

Preventing Torsades de Pointes by Careful Cardiac Monitoring in Hospital Settings

2007 ◽  
Vol 18 (3) ◽  
pp. 285-293 ◽  
Author(s):  
Claire E. Sommargren ◽  
Barbara J. Drew
Keyword(s):  
At Risk ◽  
Critical Care ◽  
Qt Interval ◽  
Care Setting ◽  
Torsades De Pointes ◽  
Warning Signs ◽  
Critical Care Setting ◽  
Cardiac Monitoring ◽  
Polymorphic Ventricular Tachycardia ◽  
Electrolyte Disorders

In the electrocardiogram, the QT interval represents the time it takes the ventricular myocardium to repolarize. Prolongation of the QT interval indicates congenital or acquired abnormality of cardiac membrane channels. In the critical care setting, acquired long QT interval most commonly results from administration of common pharmacologic agents, including some antiarrhythmics and antibiotics. Patients with prolonged QT interval may be at risk for developing torsades de pointes and cardiac arrest. Furthermore, new-onset bradyarrhythmias and electrolyte disorders may increase this risk. Warning signs of impending sustained torsades de pointes include occurrence of polymorphic ventricular ectopic complexes, T-wave alternans, and nonsustained polymorphic ventricular tachycardia. Measurement and documentation of the QT interval, corrected for heart rate (QTc), is an important component of cardiac monitoring in the critical care setting. When prolonged QTc occurs in patients at risk, specific clinical interventions must be implemented to prevent the occurrence of torsades de pointes.

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