Adherence to ECG Monitoring Before Initiating Antipsychotics in Psychiatric Inpatients at Sultan Qaboos University Hospital: A Clinical Audit

Background: Antipsychotic medications are associated with QT interval prolongation and an increased risk of serious arrhythmias. Clinical guidelines, therefore, recommend baseline electrocardiogram (ECG) monitoring prior to initiation. This audit evaluated the compliance of baseline ECG monitoring before the initiation of antipsychotic medications in psychiatric inpatients at Sultan Qaboos University Hospital (SQUH) and explored the association of demographic and clinical factors. Methods: A retrospective review was conducted of all psychiatric inpatients who were started on antipsychotics from January to December 2023. The records were checked to see if the ECGs were documented before the treatment. Descriptive statistical analysis, chi-square test, and t-test were applied to the data of age, sex, medical comorbidities, and prescribed antipsychotics. Results: Out of 90 patients included in the analysis, 43 (47.8%) had a baseline ECG documented, and 47 (52.2%) had none. Patients of older age were more likely to have ECG monitoring performed (mean age 33.7 vs. 28.3 years, p = 0.090), but it was not statistically significant. There were no significant differences between gender, type of antipsychotic, or medical comorbidities. Conclusion: These findings demonstrate that ECG monitoring before the initiation of antipsychotic medications at SQUH was found to be less than optimal. To enhance patient safety, standardized protocols, clinician education, and follow-up audits are needed.