Much attention recently has focused on drugs that prolong the QT interval, potentially leading to fatal cardiac dysrhythmias (e.g., torsade de pointes). We provide a detailed review of the published evidence that supports or does not support an association between drugs and their risk of QT prolongation. The mechanism of drug-induced QT prolongation is reviewed briefly, followed by an extensive evaluation of drugs associated with QT prolongation, torsade de pointes, or both. Drugs associated with QT prolongation are identified as having definite, probable, or proposed associations. The role of the clinician in the prevention and management of QT prolongation, drug-drug interactions that may occur with agents known to affect the QT interval, and the impact of this adverse effect on the regulatory process are addressed.
A number of technological advances are becoming incorporated into institutional pharmacy practice in order to reduce the frequency and severity of medication errors. One of these has great promise. They deal with intravenous (IV) medication safety systems, wherein customized drug software is interfaced with “intelligent” infusion pumps. This paper describes the implementation and initial evaluation of Hospira's MedNet decision support infusion software in a five-hospital health care system in Pennsylvania. All of the steps are reviewed (identification of stakeholders, evaluation of software capabilities, evaluation of institution-specific practices, decisions regarding standard operating procedures, writing of the drug libraries, and preparation for “going live”) in detail. In addition, the initial results of the system are described, especially with respect to potential medication errors avoided. The well-documented medication error avoidance potential of such systems has proven useful in a clinical setting.
Pensacola, Florida, as a clinical pharmacist specialist, a role he maintained for 5 years. In 2013, Dr. Durham joined the faculty of the Auburn University Harrison School of Pharmacy, where he teaches infectious diseases in various courses throughout the curriculum. He maintains a practice site at the Central Alabama Veterans Health Care System, where he specializes in the area of infectious diseases. Dr. Durham holds a dual board certification as a Board Certified Pharmacotherapy Specialist (BCPS) and a Board Certified Infectious Diseases Pharmacist (BCIDP). He has published more than 20 peer-reviewed articles in respected journals and several book chapters. He is an active speaker each year at national, state, and local conferences, where he educates health care professionals on topics related to infectious diseases and antimicrobial stewardship.
Pharmacy technicians are integral to the success of parenteral compounding programs in pharmacies around the country. Their positions may vary depending on practice site, but technicians are critical to the pharmacy team, and it is imperative that they be appropriately trained to take on their roles and responsibilities. Numerous national pharmacy organizations support the need for a national standard for pharmacy technician training, education, certification, and regulatory oversight in all practice settings. Parenteral nutrition (PN) is a highly specialized compounded product with potential for errors in ordering, transcribing, preparation, labeling, and administration. All compounding personnel involved in the process of delivering PN, including technicians, must be trained on the proper techniques, applicable technology, and risk of errors. This article outlines the landscape of training as it specifically pertains to pharmacy technicians and shares proceedings from key pharmacy meetings in the past 5 years that advocate for national standards.
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