Mattei T J, Karnack C M, Rihn T L, Eder R A
Hosp Pharm. 1985 Apr;20(4):235-7, 240-1.
Until recently, the mechanism to gain the attention of hospital decision makers on the potential implication of pharmacists' involvement in the drug use review process was missing. However, integrating clinical pharmacy services with quality assurance activities appears to provide a mechanism to reduce patient risk and cost while maintaining the quality of patient care services provided. The department of pharmacy at The Mercy Hospital of Pittsburgh, through the hospital-wide quality assurance committee (QAC) and pharmacy evaluation committee (PEC), has developed concurrent drug the reviews. The concurrent warfarin review conducted by the department of pharmacy is described in detail to illustrate the process that is followed in the development and implementation of a concurrent drug use review. The concurrent review of warfarin was initiated and, in general, criteria were met and few variations occurred. Interventions by staff pharmacists were effective in further improving compliance with certain criteria. Although it was not proven that the incidence of hemorrhage was actually decreased, the QAC felt that such an approach would serve to decrease the likelihood of hemorrhage as warfarin therapy is initiated in the hospital. Similar drug use reviews have been developed for aminoglycosides, third-generation cephalosporins, piperacillin, cefoxitin, cefazolin, vancomycin, phenytoin, and the digoxin-quinidine interaction. The objective of these reviews is also to reduce patient risk and costs associated with drug use. Therefore, in today's hospital environment, a mechanism to improve the visibility of the pharmacist's involvement in the health care process is to integrate clinical pharmacy services with quality assurance activities.
直到最近，还缺乏一种机制，能够让医院决策者关注药剂师参与药物使用评估过程的潜在影响。然而，将临床药学服务与质量保证活动相结合，似乎提供了一种既能降低患者风险和成本，又能维持所提供患者护理服务质量的机制。匹兹堡慈善医院药房通过全院质量保证委员会（QAC）和药房评估委员会（PEC）开展了同步药物评估。详细描述了药房进行的华法林同步评估，以说明同步药物使用评估的制定和实施过程。华法林同步评估启动后，总体上符合标准，很少出现偏差。药剂师的干预有效地进一步提高了对某些标准的依从性。虽然尚未证实出血发生率确实降低，但质量保证委员会认为，在医院启动华法林治疗时，这种方法有助于降低出血的可能性。针对氨基糖苷类、第三代头孢菌素、哌拉西林、头孢西丁、头孢唑林、万古霉素、苯妥英以及地高辛 - 奎尼丁相互作用，也开展了类似的药物使用评估。这些评估的目的同样是降低患者风险以及与药物使用相关的成本。因此，在当今的医院环境中，提高药剂师参与医疗保健过程可见度的一种机制，就是将临床药学服务与质量保证活动相结合。
