Practical Approaches to Antipsychotic-Associated Corrected QT Interval Prolongation in Patients With Serious Mental Illness: A Review of Cases.

Background: There is no consensus for assessment and management of patients with serious mental illness (SMI) who are at risk for cardiac morbidity and mortality due to antipsychotic-associated QTc prolongation. Objective: The objective of this review was to assess methods for risk scoring, QT correction calculation, and clinical management in SMI patients with antipsychotic-associated QTc prolongation. Methods: A search was performed in PubMed for case reports that described QTc prolongation in adult patients with schizophrenia or bipolar disorder prescribed an antipsychotic. Reports published in North America between 2000 and 2020 were eligible. The Mayo, Tisdale, and RISQ-PATH scoring tools were applied to cases to categorize risk level. Results: Seventeen cases were included. Most patients were prescribed a second-generation antipsychotic for schizophrenia, with baseline and maximum QTc values of 429 milliseconds and 545 milliseconds, respectively. The Mayo scoring tool identified 17 (100%) cases as "high risk," Tisdale identified 9 (53%) cases as "moderate risk" and 7 (41%) cases as "low risk," while RISQ-PATH identified 9 (53%) cases as "not low risk" and 8 (47%) cases as "low risk." Three cases reported the QT correction formula utilized (18%). The most common intervention to address antipsychotic-associated QTc prolongation was switching to a different antipsychotic (35%). Approximately one third of patients experienced Torsades de Pointes. Conclusion: There is a lack of standardization for antipsychotic-associated QTc prolongation risk assessment and management in patients with SMI. This review provides real-world data representing actual clinical practice.

Concentrated Learning Experiences Across Two Different Health-Systems.

BACKGROUND: While many public pharmacy schools have an adjoining health-system to accommodate their students, some pharmacy programs form partnerships with non-affiliated health-systems to precept students. These health-systems often afford students the opportunity to complete multiple rotations within a single organization, offering decreased onboarding time and more longitudinal experiences. INNOVATION: Two autonomous partnerships were developed with independent healthcare systems for concentrated learning experiences during the advanced pharmacy practice experiences year. Each program differs in student requirements and is overseen by the practice site, with participation by area faculty. KEY FINDINGS: A survey assessed professional skill set development, achievement of program goals during the experiential year, and student satisfaction of a concentrated learning experience. A comparison between programs was completed to assess for consistency in student experiences. Nineteen students (83%) responded to the survey. Students from both health-systems reported similarities in professional skill growth. Likewise, all students reported achievement of program goals and overall satisfaction with their experiential training. CONCLUSIONS: Independently managed concentrated learning experiences provided evidence of consistent growth in student professional development and achievement of programmatic goals. Partnerships with non-affiliated healthcare systems can provide a rich training ground for student learners.