Connelly J F
North Carolina Baptist Hospitals, Winston-Salem 27157.
Hosp Pharm. 1994 Nov;29(11):992, 996-8, 1001.
To provide effective ranitidine therapy at the lowest possible cost to institutions and patients, the main study objectives were to develop a dosage intervention strategy for intermittent intravenous ranitidine and to document the resultant cost savings through cost-minimization analysis. During a 6-week baseline phase, a pharmacy resident prospectively monitored all patients in the intensive care unit receiving intravenous ranitidine and evaluated appropriateness of dose according to creatinine clearance. Staff pharmacists collected identical data during the 6-week intervention phase but also made recommendations for dosage interval adjustment. In patients with creatinine clearance rates less than 50 mL per minute, the mean number of doses per patient treatment-day was reduced from 2.33 +/- 0.81 during baseline phase to 1.56 +/- 0.70 during intervention phase (P < 0.001). The hospital cost per patient treatment-day was decreased by 33%, from $5.29 +/- 1.83 to $3.54 +/- 1.59 (P < 0.001). Thus a program of prospective monitoring and verbal interventions by pharmacists effectively reduced the number of inappropriate ranitidine doses and hospital cost.
为了以机构和患者可能承担的最低成本提供有效的雷尼替丁治疗，主要研究目标是制定间歇性静脉注射雷尼替丁的剂量干预策略，并通过成本最小化分析记录由此产生的成本节约情况。在为期6周的基线期，一名药学住院医师前瞻性监测重症监护病房中所有接受静脉注射雷尼替丁的患者，并根据肌酐清除率评估剂量的合理性。在为期6周的干预期，药师收集相同的数据，同时还对给药间隔调整提出建议。在肌酐清除率低于每分钟50毫升的患者中，每位患者每日治疗剂量的平均数从基线期的2.33±0.81降至干预期的1.56±0.70（P<0.001）。每位患者每日治疗的医院成本降低了33%，从5.29±1.83美元降至3.54±1.59美元（P<0.001）。因此，药师进行前瞻性监测和口头干预的方案有效地减少了雷尼替丁剂量不当的情况，并降低了医院成本。
