American journal of hospital pharmacy
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The use of a nursing-workload-index indicator generated by the Medicus patient classification system was explored as a means of simplifying and validating a manual pharmacy-workload-reporting system. The pharmacy department of this 290-bed hospital monitors 14 activities in its productivity-measurement process. In an effort to validate this process, a 20-week study was conducted to evaluate the relationship between the nursing-workload-index data and the number of hours required to provide pharmaceutical services. ⋯ A significant correlation was found between the nursing index and the number of hours earned for pharmacy activities (with or without hours earned for processing admissions and discharges). Significant correlations were also found when the patient-days indicator was used, but those relationships were not as strong. The nursing-workload-index indicator studied was useful in validating the workload data generated by the pharmacy department.
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Basic cardiac electrophysiology and how it applies to antiarrhythmic drug therapy are reviewed. Normal impulse propagation through the heart proceeds in sequence from the sinoatrial (SA) node, through the atrial specialized conducting system, the atrioventricular (AV) node, the His-Pur-kinje system, and into the ventricles. The cardiac cell maintains a resting membrane potential until an electrical stimulus depolarizes the cell and generates an action potential. ⋯ The electrophysiology of quinidine, procainamide, disopyramide, lidocaine, tocainide, phenytoin, flecainide, amiodarone, and bretylium tosylate is discussed to detail the relationship between drug action and antiarrhythmic efficacy. The electrophysiologic effects of beta-blocking agents and calcium-channel antagonists are also presented. This basic primer on cardiac electrophysiology should provide the practitioner with an improved understanding of the effects, indications, and limitations of antiarrhythmic drugs.
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Efficacy, safety, and cost factors related to aminoglycoside therapy, which is the treatment of choice for mixed infections of the skin, respiratory tract, and abdominal cavity, are reviewed. The cost of therapy must include all measurable costs of drug preparation, administration, monitoring, and potential toxicity or treatment failure. These costs are often difficult to quantify, as are potential differences in efficacy. ⋯ Nomograms and pharmacokinetic models, which can be used with computers and hand-held calculators, are useful for predicting initial doses and modifying subsequent doses. Aminoglycoside therapy is important in selected patients, but the comparative efficacy and safety of these drugs remains insufficiently assessed. Pharmacokinetic monitoring is helpful in assuring safe and effective dosing of aminoglycosides.
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As a part of an evaluation of the need for a satellite pharmacy to serve two pediatric critical-care units, an observational study was conducted to determine the incidence of medication errors in the units. A pharmacist observed nurses preparing and administering medications in 18 12-hour shifts. Of the nine shifts observed in each unit, five were day shifts and four were night shifts. ⋯ Of 147 errors, 124 (84.4%) occurred with medications with a high potential for serious consequences. The error rates were similar on the day and night shifts in the PICU (42.1% and 31.3%, respectively), but they were significantly higher on the day shifts than the night shifts in the ICN (24.5% and 8.4%, respectively). The number of medication errors in the two units was substantial, and steps were taken to implement a 24-hour pediatric critical-care satellite pharmacy with unit dose drug distribution to reduce the incidence of errors.