Jennings Heath R, Miller Eric C, Williams Tina S, Tichenor Sherry S, Woods Eugene A
Department of Pharmacy Services, Saint Joseph HealthCare, Lexington, Kentucky, USA.
Jt Comm J Qual Patient Saf. 2008 Apr;34(4):196-200. doi: 10.1016/s1553-7250(08)34024-0.
The conventional standard of care for many patients at Saint Joseph HealthCare, a three-hospital system in Kentucky, includes the use of anticoagulant therapy. In view of the morbidity and mortality associated with anticoagulation-related complications, the prevention of bleeding and thrombotic adverse drug events was identified as a primary process improvement initiative.
Following establishment of an interdisciplinary team, formal evaluations of anticoagulant-use practices and associated patient outcomes occurred via several mechanisms. A variety of process improvement activities were conducted, including the creation of a pharmacist-managed hospital anticoagulant therapy service. A pharmacist consult service for the medical staff provided initiation, management, and monitoring of anticoagulation, including bridge therapy and reversal if necessary.
The rate of thrombotic events decreased from 4.6% in 2004 to 3.9% in 2006 and further decreased to 0.0% for patients managed by collaborative physician and pharmacist practice. Hospitalwide bleeding and thrombotic reactions decreased from a monthly average of 11.52 events per 1,000 anticoagulant doses dispensed in 2004 to 0.07 in 2006. A cost-benefit evaluation indicated an annual savings of up to $9.8 million in avoidable costs.
In this interdisciplinary project, anticoagulant safety was integrated throughout the institution, and a variety of medication safety systems were successfully employed.
在肯塔基州一个拥有三家医院的圣约瑟夫医疗系统中，许多患者的传统标准护理包括使用抗凝治疗。鉴于与抗凝相关并发症的发病率和死亡率，预防出血和血栓形成的药物不良事件被确定为主要的流程改进举措。
在成立跨学科团队后，通过多种机制对抗凝药物使用实践及相关患者结局进行了正式评估。开展了各种流程改进活动，包括设立由药剂师管理的医院抗凝治疗服务。为医务人员提供的药剂师咨询服务对抗凝治疗进行启动、管理和监测，包括桥接治疗以及必要时的逆转治疗。
血栓形成事件的发生率从2004年的4.6%降至2006年的3.9%，对于由医生和药剂师协作管理的患者，该发生率进一步降至0.0%。全院范围内的出血和血栓形成反应从2004年每1000剂抗凝药物每月平均发生11.52起事件降至2006年的0.07起。成本效益评估表明，可避免成本每年节省高达980万美元。
在这个跨学科项目中，抗凝安全性在整个机构中得到整合，并且成功采用了多种药物安全系统。
