Implementation of a Pharmacist-Driven Monitoring Protocol for Individuals Receiving Multiple QT-Prolonging Medications in aCommunity Hospital

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Background: Torsades de pointes is a life-threatening polymorphic ventricular tachycardia, associated with QT interval lengthening on an electrocardiogram. Hospitalized individuals are routinely administered multiple medications with the potential to prolong the QTc interval. This quality improvement project sought to implement a pharmacist-driven protocol to identify and monitor individuals on multiple QT-prolonging medications using pharmacovigilance software, VigiLanz®, and the Tisdale risk score, aiming to reduce adverse drug reactions (ADRs) in a community hospital. Methods: This was a single-center prospective quality improvement project of individuals admitted to the hospital from February through March 2024. Individuals with two or more scheduled QT-prolonging medications and calculated Tisdale scores of 11 or greater were included. The primary outcomes included the proportion of individuals requiring therapy modification and/or ECG monitoring. Secondary outcomes include the number of corresponding VigiLanz® alerts fired, the type of pharmacy intervention made, and the acceptance rate. Results: Among individuals with at least two QT-prolonging medications, 17 (12%) were considered high-risk for QT-interval prolongation. The median number of interacting medications per individual was two, with the most common being antidepressants, 13 (34.2%). Additionally, 15 (88%) individuals required pharmacist-driven interventions, including therapy modifications or electrocardiogram monitoring. Notably, 95% of these pharmacist interventions were accepted. Conclusion: Implementation of a pharmacist-led QT monitoring protocol can enhance the safety of medications that may cause Torsades de Pointes. By systematically identifying individuals at high risk for QT prolongation, this quality improvement project facilitated appropriate and timely interventions.

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