Date of Award

Spring 5-22-2021

Document Type

Doctor of Nursing Practice Final Manuscript

Degree Name

Doctor of Nursing Practice



First Advisor

Michael Terry, DNP, FNP, PMHNP

Second Advisor

John Kelsoe, MD


Abstract Background: The effects of psychotropic drugs on cardiac repolarization have increasingly gained attention in research and clinical practice over the last 2 decades. The absolute risk of cardiac arrhythmia, such as the polymorphic ventricular tachycardia, Torsades de Pointes (TdP), is low (14 per 10,000 patients/year) and sudden cardiac death as a consequence of all cardiac arrhythmias is less frequent (Braillon et al., 2017). TdP can occur at therapeutic doses of second-generation antipsychotics and antidepressants and with a corrected Q-T (QTc) interval >500 ms. Many psychotropic medications can delay cardiac repolarization thereby producing prolonged QTc in the electrocardiogram (ECG). Emergency departments (EDs) are a frequent point of care for patients diagnosed with psychiatric medical disorders taking one or more psychotropic medications.

Purpose of Project: Using evidence-based practice, this project standardizes the cardiac assessment of psychiatric patients in the ED who were on one or more psychotropic medications by performing a 12-lead ECG on arrival to rule out QTc prolongation, thus reducing the risk of polymorphic ventricular tachyarrhythmia.

Outcomes: Fifty patient-ECGs were evaluated and compared by psychotropic medication; all were within normal range. Recommend continuance of ECG protocol to assess for the possibility of QTc prolongation and to prevent its progression to TdP.