QUASI-EXPERIMENTAL STUDY TO IMPROVE NURSES' QT-INTERVAL MONITORING: RESULTS OF QTIP STUDY

Background A collaboration led by the American Heart Association recently released the scientific statement Prevention of Torsade de Pointes in Hospital Settings. Patients receiving proarrhythmic drugs, who have electrolyte disturbances, or who have brady arrhythmias require QT-interval monitoring. Prior studies have demonstrated that physicians have a poor level of proficiency at calculating QT intervals. The ability of nurses at calculating QT intervals remains untested. Objectives To evaluate nurses' knowledge and ability to perform QT/QTc interval monitoring. Methods At a single institution, 47 QT-education classes were provided to 480 eligible nurses who regularly perform cardiac monitoring. All nurses completed a researcher-developed knowledge test at baseline and after the QT-related education intervention. Results Overall 379 nurses participated (mean age 39 [SD, 10] years), 71% had more than 5 years' nursing experience. Total test scores increased after intervention (46% vs 77%, P<.001). Education significantly improved marking of the QT/RR intervals (QT: 65% vs 91%, RR: 83% vs 90%, P <=.001 and P=.02) and measurement of the QT/RR intervals (QT: 47% vs 84%, RR: 35% vs 71% P <=.001 and P <=.001). Calculation of the QTc interval also increased significantly (6% vs 52%, P<.001). Conclusions Our study results demonstrate that nurses' baseline ability to perform QT interval monitoring is extremely poor. An unacceptable amount of error persists after an educational intervention. Accurate computer-assisted methods are needed to reduce the error associated with manual QT-interval monitoring. (American Journal of Critical Care. 2012;21(3):195-201)