Objectives: To determine whether dedicated pharmacy services improve the rate of electrocardiogram (ECG) monitoring in patients at risk for medication-induced QTc interval prolongation. In addition, determine how pediatric institutions currently monitor patients at risk for medication-induced QTc interval prolongation.
Methods: A pharmacist-driven monitoring protocol to detect medication-induced QTc interval prolongation was developed using published literature. If patients were prescribed 3 or more medications known to prolong the QTc interval, they were recommended to have a baseline ECG to assess the QTc interval. If 3 or more QTc interval-prolonging medications were administered for 5 or more days, a follow-up ECG was recommended. Patients prescribed medications known to prolong the QTc interval were identified. Prior to pharmacist intervention, electronic medical records were reviewed to determine if baseline and follow-up ECGs were obtained in patients meeting criteria for monitoring. A dedicated pharmacist then prospectively reviewed charts and recommended monitoring. The rate of monitoring during the intervention and baseline period was compared. To determine current practice at pediatric institutions, a survey was distributed to pharmacists.
Results: Pharmacist intervention improved the rate of ECG monitoring in patients at risk for medication-induced QTc interval prolongation from 47.8% to 100% (p = 0.0009). Of the 55 survey participants, 6 stated their institution had QTc interval monitoring procedures in place, 35 did not have any, and 3 had procedures in process.
Conclusions: Targeted pharmacist intervention improved the rate of ECG monitoring in patients at risk for medication-induced prolonged QTc interval. Our research and survey data reveal that institutions could benefit from targeted pharmacist intervention to monitor patients for medication-induced QTc interval prolongation.
Keywords: QTc interval; adverse effect; medication interactions; pediatrics; pharmacist intervention; torsade de pointes.