First reported 26 Oct 2015•Latest report 25 Nov 2025
Definition
What this concern includes
Includes failures of controls specifically dedicated to detecting, investigating, referring, monitoring or managing prolonged QTc or long-QT syndrome, including ECG surveillance during relevant medication treatment and referral to cardiology or other appropriate specialist services.
Not included
Excludes generic ECG, cardiology referral or medication-monitoring deficiencies where prolonged QTc or long-QT syndrome is not the identified safety concern.
Excludes other arrhythmias, electrolyte abnormalities or medication risks unless the assertion explicitly concerns prolonged QTc or long-QT syndrome.
Excludes failures limited to treatment decisions after adequate QTc assessment and monitoring when the QTc safety process itself was reliable.
Excludes generic clinical training, documentation or communication deficiencies unless they directly impair the dedicated prolonged-QTc or long-QT safety process.
Reports
4
Distinct published reports
Individual concerns
7
A report can raise multiple concerns
Date range
2015–2025
First to latest report issue date
Stated actions
19
Described in published responses
Reports over time
Reports over time
Reports about this concern issued each year.
* 2026 is projected from reports observed to 7 Sep 2026.
Most frequent recipients
Most frequent recipients
Reports about this concern sent to each recipient.
Department of Health and Social Care1
Herefordshire and Worcestershire Health and Care NHS Trust1
Medicines and Healthcare products Regulatory Agency1
National Institute for Health and Care Excellence1
NHS Derby and Derbyshire Integrated Care Board1
Royal College of Psychiatrists1
Sherwood Forest Hospitals NHS Foundation Trust1
NHS trust2
Executive non-departmental public body1
Integrated care board1
Medicines and medical devices regulator1
Ministerial department1
Professional body1
Concerns and responses across reports
Only concerns grouped under this recurring concern are included. Select any concern, action or position to view the source wording.
Nottinghamshire
Concerns raised2
Lack of a robust process for necessary referral and investigation of prolonged QTc syndrome
Lack of medical staff understanding of the importance of identifying prolonged QTc syndrome
This report raised 1 other concern. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.6
Action
Monitor incidents for prolonged-QT recognition trends and escalate concerns to the appropriate specialty.
Stated by Sherwood Forest Hospitals NHS Foundation TrustStated in progressThe respondent said that this action was in progress when they made their response on 3 December 2025.
Action
Issue the prolonged-QT clinical pathway to Trust staff through the intranet.
Stated by Sherwood Forest Hospitals NHS Foundation TrustStated completedThe respondent said that this action was complete when they made their response on 3 December 2025.
Action
Complete specialty and divisional sign-off of amendments to the prolonged-QT clinical pathway.
Stated by Sherwood Forest Hospitals NHS Foundation TrustStated in progressThe respondent said that this action was in progress when they made their response on 3 December 2025.
Action
Deliver teaching for medical staff on measuring QT intervals and relevant prolonged-QT cut-offs.
Stated by Sherwood Forest Hospitals NHS Foundation TrustStated completedThe respondent said that this action was complete when they made their response on 3 December 2025.
Action
Disseminate the QT-measurement teaching presentation to current medical consultants for wider educational use.
Stated by Sherwood Forest Hospitals NHS Foundation TrustStated completedThe respondent said that this action was complete when they made their response on 3 December 2025.
Action
Include QT-measurement learning and pathway signposting in specialty and divisional governance reports.
Stated by Sherwood Forest Hospitals NHS Foundation TrustStated plannedThe respondent said that this action was planned when they made their response on 3 December 2025.
Derby and Derbyshire
Concerns raised1
Lack of clear and consistent guidance on ECGs during annual monitoring of long-term antipsychotic medication
This report raised 1 other concern. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.4
Action
Share the report with the Clinical Knowledge Summaries publisher to support awareness of the ECG-monitoring concern.
Stated by National Institute for Health and Care ExcellenceStated completedThe respondent said that this action was complete when they made their response on 14 July 2025.
Action
Update local antipsychotic prescribing guidance to recommend ECG monitoring after dose changes and ideally annually.
Stated by NHS Derby and Derbyshire Integrated Care BoardStated plannedThe respondent said that this action was planned when they made their response on 14 July 2025.
Action
Review NICE’s response and implement any necessary local updates or further actions arising from changes to national ECG monitoring guidance.
Stated by NHS Derby and Derbyshire Integrated Care BoardStated in progressThe respondent said that this action was in progress when they made their response on 14 July 2025.
Action
Share the ratified learning report and guidance updates with primary-care clinicians and relevant system networks through existing communications and governance meetings.
Stated by NHS Derby and Derbyshire Integrated Care BoardStated plannedThe respondent said that this action was planned when they made their response on 14 July 2025.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.1
Position
Agilio Software, the CKS publisher, is responsible for further changes and detailed information about CKS prescribing content.
Stated by National Institute for Health and Care ExcellenceRedirects responsibilityThe respondent said that another organisation was responsible for deciding or taking action.
Surrey
Concerns raised3
Failure to undertake an ECG before commencing QT-prolonging medication
Failure to undertake regular ECG monitoring during continuing treatment with multiple psychotropic medication
Failure to recognise the QT-prolonging potential of multiple psychotropic medication
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.4
Action
Review continuing medical education initiatives to ensure comprehensive coverage of the medication-safety issue in College materials.
Stated by Royal College of PsychiatristsStated plannedThe respondent said that this action was planned when they made their response on 19 February 2017.
Action
Publicise the medication-safety concerns to Royal College of Psychiatrists members and fellows.
Stated by Royal College of PsychiatristsStated plannedThe respondent said that this action was planned when they made their response on 19 February 2017.
Action
Determine how best to raise the medication-safety concerns with old-age psychiatrists.
Stated by Royal College of PsychiatristsStated plannedThe respondent said that this action was planned when they made their response on 19 February 2017.
Action
Review the product information for olanzapine, mirtazapine and indapamide to assess QT-prolongation warnings.
Stated by Medicines and Healthcare products Regulatory AgencyStated completedThe respondent said that this action was complete when they made their response on 19 February 2017.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.1
Position
Existing product warnings appropriately address QT-prolongation risks, so no regulatory changes are currently proposed.
Stated by Medicines and Healthcare products Regulatory AgencyExisting arrangements considered sufficientThe respondent said that existing arrangements were sufficient, so no further action was needed.
Worcestershire
Concerns raised1
Failure to perform ECG traces for prisoners receiving the specified medication combination
This report raised 3 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.5
Action
Provide routine annual ECGs to patients prescribed antipsychotic medicines, including relevant interacting combinations.
Stated by Herefordshire and Worcestershire Health and Care NHS TrustStated completedThe respondent said that this action was complete when they made their response on 26 October 2015.
Action
Sample-audit annual ECG provision for all patients who should have received one.
Stated by Herefordshire and Worcestershire Health and Care NHS TrustStated plannedThe respondent said that this action was planned when they made their response on 26 October 2015.
Action
Provide an additional ECG when a patient's antipsychotic medication is changed, regardless of the annual ECG date.
Stated by Herefordshire and Worcestershire Health and Care NHS TrustStated plannedThe respondent said that this action was planned when they made their response on 26 October 2015.
Action
Book ECGs when antipsychotic treatment is initiated and provide new receptions taking antipsychotics with an ECG within one month of arrival.
Stated by Herefordshire and Worcestershire Health and Care NHS TrustStated plannedThe respondent said that this action was planned when they made their response on 26 October 2015.
Action
Provide whole-nursing-team training to recognise medicines requiring ECG referral.
Stated by Herefordshire and Worcestershire Health and Care NHS TrustStated plannedThe respondent said that this action was planned when they made their response on 26 October 2015.
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Includes failures of controls specifically dedicated to detecting, investigating, referring, monitoring or managing prolonged QTc or long-QT syndrome, including ECG surveillance during relevant medication treatment and referral to cardiology or other appropriate specialist services.
