Lew K H, Malyuk D L
Royal Columbian Hospital, New Westminster, British Columbia.
Can J Hosp Pharm. 1991 Oct;44(5):239-43.
An aminoglycoside dosing service (ADS) has been in existence at the Hospital since 1984. As part of an overall Quality Assurance (QA) plan for the service, an audit was conducted to ensure that all necessary data were available to allow for proper interpretation of the serum aminoglycoside levels. The initial audit revealed complete documentation of required data in 75% of PRE-dose levels and 63% of POST-dose levels drawn. Several problems were identified: staff were not aware of procedures on how to complete the serum antibiotic level requisition forms; inaccurate assumptions of infusion times were made by pharmacists; and discrepancies were found to exist in the Hospital's Laboratory Manual and Pharmacy Intravenous Medication Manual. Corrective action was initiated through: education on proper documentation on the serum antibiotic level requisition forms through the hospital-wide distributed Pharmacy Bulletin; revision of the Hospital's Laboratory Manual and Pharmacy Intravenous Medication Manual; communication with head nurses to emphasize the need for documentation of infusion times; and active follow-up with nurses on missing information by the clinical pharmacist. A re-audit was initiated following implementation of the corrective actions. Complete documentation of required data increased to 93% with PRE-dose levels and 84% with POST-dose levels. This improvement was statistically significant (p less than 0.001).
自1984年起，我院就设有氨基糖苷类药物剂量服务（ADS）。作为该服务整体质量保证（QA）计划的一部分，我们进行了一次审核，以确保所有必要数据都可用，以便对血清氨基糖苷类药物水平进行正确解读。初步审核发现，在抽取的给药前水平中，75%的所需数据有完整记录，给药后水平中这一比例为63%。发现了几个问题：工作人员不了解如何填写血清抗生素水平申请表的流程；药剂师对输注时间的假设不准确；医院的《实验室手册》和《药房静脉用药手册》存在差异。通过以下方式采取了纠正措施：通过全院分发的《药房简报》对血清抗生素水平申请表的正确填写进行培训；修订医院的《实验室手册》和《药房静脉用药手册》；与护士长沟通，强调记录输注时间的必要性；临床药剂师积极跟进护士缺失的信息。在采取纠正措施后进行了重新审核。所需数据的完整记录在给药前水平提高到了93%，给药后水平提高到了84%。这一改善具有统计学意义（p小于0.001）。
