Effectiveness of pharmacist dosing adjustment for critically ill patients receiving continuous renal replacement therapy: a comparative study.
Effectiveness of pharmacist dosing adjustment for critically ill patients receiving continuous renal replacement therapy: a comparative study.
复制标题
接受连续肾脏替代治疗的危重患者药剂师剂量调整的有效性：一项比较研究
DOI：
10.2147/tcrm.s59187
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发表时间：
2014
影响因子：
2.8
通讯作者：
Wu BH
中科院分区：
文献类型：
--
作者：
Jiang SP;Zhu ZY;Wu XL;Lu XY;Zhang XG;Wu BH
背景连续性肾脏替代治疗（CRRT）对药物清除的影响是复杂的;药剂师调整这些患者的剂量可能是有利的。本研究旨在描述接受CRRT的重症患者的药剂师剂量调整的开发和实施，并检查药剂师干预的有效性。方法在某大学附属医院重症监护室（ICU）进行对比研究。干预组中接受CRRT的患者接受药剂师提供的专业药房给药服务，而非干预组中的患者接受常规医疗护理，没有药剂师参与。比较两个阶段，以评价药剂师剂量调整的结果。结果药师对CRRT患者提出剂量调整建议233条，其中212条（90.98%）被医师接受。CRRT相关变量的变化（n=144，61.81%）是给药错误的最常见风险因素，而抗生素（n=168，72.10%）是最常与给药错误相关的药物。药剂师剂量调整使每例接受CRRT的重症患者节省了2，345.98美元的ICU成本。干预组可疑药物不良事件发生率明显低于干预前（35/27 vs 18/11，P<0.001）。然而，ICU住院时间和药剂师剂量调整后的死亡率无显著差异，分别为8.93天vs 7.68天（P=0.26）和30.10% vs 27.36%（P=0.39）。结论药师对CRRT患者的剂量调整得到了医生的认可，并与较低的药物不良事件发生率和ICU费用节省有关。这些结果可能支持战略的发展，包括药剂师在多学科ICU团队。
Background The impact of continuous renal replacement therapy (CRRT) on drug removal is complicated; pharmacist dosing adjustment for these patients may be advantageous. This study aims to describe the development and implementation of pharmacist dosing adjustment for critically ill patients receiving CRRT and to examine the effectiveness of pharmacist interventions. Methods A comparative study was conducted in an intensive care unit (ICU) of a university-affiliated hospital. Patients receiving CRRT in the intervention group received specialized pharmacy dosing service from pharmacists, whereas patients in the no-intervention group received routine medical care without pharmacist involvement. The two phases were compared to evaluate the outcome of pharmacist dosing adjustment. Results The pharmacist carried out 233 dosing adjustment recommendations for patients receiving CRRT, and 212 (90.98%) of the recommendations were well accepted by the physicians. Changes in CRRT-related variables (n=144, 61.81%) were the most common risk factors for dosing errors, whereas antibiotics (n=168, 72.10%) were the medications most commonly associated with dosing errors. Pharmacist dosing adjustment resulted in a US$2,345.98 ICU cost savings per critically ill patient receiving CRRT. Suspected adverse drug events in the intervention group were significantly lower than those in the preintervention group (35 in 27 patients versus [vs] 18 in eleven patients, P<0.001). However, there was no significant difference between length of ICU stay and mortality after pharmacist dosing adjustment, which was 8.93 days vs 7.68 days (P=0.26) and 30.10% vs 27.36% (P=0.39), respectively. Conclusion Pharmacist dosing adjustment for patients receiving CRRT was well accepted by physicians, and was related with lower adverse drug event rates and ICU cost savings. These results may support the development of strategies to include a pharmacist in the multidisciplinary ICU team.