Oh T, Franko T G
Department of Pharmacy, Mercy Hospital, Miami, FL 33133.
Am J Hosp Pharm. 1991 Jul;48(7):1471-7.
The implementation of a comprehensive therapeutic interchange program is described. The need to reduce the number of telephone calls to physicians about nonformulary drug orders, reduce drug costs, and maximize the effectiveness of drug therapy prompted the development of an automatic therapeutic interchange program at a 273-bed nonteaching community hospital. Pharmacists and physicians agreed that a telephone call to discuss every nonformulary drug order was unnecessary. The pharmacy department presented the automatic interchange program to the pharmacy and therapeutics committee. The program was reviewed by the committee, the hospital attorney, and medical staff members and was instituted in 1986 for drug products, such as vitamins and antacids, for which interchanges are noncontroversial. A newsletter describing the program was distributed, and inservice education sessions were held. A reminder was placed on order forms that an interchange for nonformulary drugs would be made unless the nonformulary agent was deemed "medically necessary" by the physician. In such cases, the physician is contacted to discuss the therapeutic alternative. As acceptance of the program and cost efficiencies were demonstrated, more controversial agents were phased in during subsequent years. It was difficult to obtain approval to add some agents, such as third-generation cephalosporins, to the program, but noncompliance and confusion have been minimal. An automatic therapeutic interchange program has worked well at this institution since 1986.
本文描述了一个全面治疗性药品替换计划的实施情况。一家拥有273张床位的非教学社区医院，为减少因非处方药物订单而给医生打电话的次数、降低药品成本并使药物治疗效果最大化，促使其开发了一个自动治疗性药品替换计划。药剂师和医生一致认为，就每一个非处方药物订单进行电话讨论并无必要。药房部门将自动替换计划提交给了药事与治疗学委员会。该计划经过委员会、医院律师和医务人员的审核，并于1986年开始实施，用于维生素和抗酸剂等替换争议较小的药品。分发了一份介绍该计划的时事通讯，并举办了在职教育课程。在订单表格上设置了提醒，除非医生认为非处方药物“有医学必要”，否则将进行非处方药物的替换。在这种情况下，会联系医生讨论治疗替代方案。随着该计划的接受度和成本效益得到证明，后续几年逐步纳入了更具争议性的药物。很难获得批准将某些药物（如第三代头孢菌素）添加到该计划中，但不遵守规定和混乱情况一直很少。自1986年以来，自动治疗性药品替换计划在该机构运行良好。
