How does training impact ICU RN’s compliance with monitoring, and confidence with measuring a manual QTc?

By Karolina Jedrzejewska, RN

Background

Prolonged QTc interval can indicate potential risk for arrhythmias; causes include electrolyte abnormalities, drugs, and severe diseases. To prevent adverse arrhythmias, it is crucial for nurses to accurately monitoring QTc. Although a critical care standard of care, Intensive Cardiac Care Unit (ICCU) daily calculations were incorporated into practice only 21% of the time. Also, no prior standardization approach existed in calculating QTc, and accuracy in measuring QT was only 31.8%. Knowledge gap was widespread.

PICO Question

How does training impact ICU RN’s compliance with monitoring, and confidence with measuring a manual QTc?

Methods

Unit and administrative leaders decided to adopt QTc measurement as a standard of care for all ICCU patients. A standardized method of calculating QTc interval via the central monitors was chosen to promote accuracy and decrease variability. These monitors contain built-in calipers and a QTc formula.

Teaching materials were created and disseminated via multiple modalities. They included; staff meetings, emails, face-to-face encounters with project peer champions and the clinical nurse specialist, and hand-outs. Planned post-implementation data collection included chart audits for daily QTc documentation and accuracy, as well as knowledge survey for ICCU nurses.

Results

Knowledge gaps have been discovered across the continuum of nurses’ experience. After two months, compliance with daily QTc measurement and documentation using central monition calipers more than tripled to 80%. Measurement accuracy doubled to 60%. At 3 months post initiation of education, QTc documentation compliance sustain high at 87%. In addition, hand-outs allowed for quick reference for high risk medications, and predisposing factors for prolonging QTc.

Discussion

ICCU patients receive many QTc prolonging medications which may put them at risk for dangerous arrhythmias. Critical care nurses are at the forefront of assessing and trending QTc intervals, as well as troubleshooting to prevent adverse events.  Promising results for completing measurements indicate the value of the new standard of practice.

Conclusion

Clinical leaders’ commitment to the initiative and education on a standardized process were key strategies having a significant impact. After two months, compliance with daily QTc measurement and documentation using the central monitor calipers more than tripled, and accuracy in measuring QTc interval doubled.