Vincent William R, Martin Craig A, Winstead P Shane, Smith Kelly M, Gatz Jennifer, Lewis Daniel A
Arnold & Marie Schwartz College of Pharmacy and Health Sciences, Long Island University, Brooklyn, NY, USA.
J Am Med Inform Assoc. 2009 Jan-Feb;16(1):47-53. doi: 10.1197/jamia.M2559. Epub 2008 Oct 24.
To examine the effects of computerized requests for pharmacist-to-dose (PTD), an advanced clinical decision support tool for dosing guidance, on antimicrobial therapy with vancomycin and aminoglycosides, describe PTD request utilization, and identify factors that may prolong this process.
A retrospective review was conducted of patients hospitalized from Jan 2004 to Jun 2006 with suspected pneumonia who received vancomycin, tobramycin, or gentamicin via PTD (study) or routine provider order entry (control).
The primary endpoint was time to pharmacist completion of PTD request. Secondary data points included medication turn-around times for first doses of vancomycin or aminoglycosides and for first doses of any antibiotic, dose adjustment for renal dysfunction, medication errors, and time of order entry. Multivariate analysis was conducted to identify predictors of total time to pharmacist verification and time to administration of first doses of vancomycin or aminoglycosides.
Median time for pharmacist completion of PTD requests was 29 minutes. Delays were noted in the study group (n = 49) by comparison with the control group (n = 48) for median time to first dose of vancomycin or aminoglycoside (185 vs. 138 min, p = 0.45) and for any antibiotic (134 vs. 118 min, p = 0.42), respectively. Fewer medication errors were reported in the study group (5 vs. 18 errors, p = 0.002). In a multivariate model, PTD was not significantly predictive of time to pharmacy verification or medication turn-around time.
Pharmacists completed pharmacist-to-dose consultations for dosing guidance of vancomycin and aminoglycosides within a median of 30 minutes. Implementation of a computerized request for clinical pharmacists to provide medication-related clinical decision support increased medication turn-around time of vancomycin and aminoglycosides and reduced medication errors. Consultation of clinical pharmacists by computerized request for initial antibiotic dosing of medications with narrow therapeutic windows is an option for medication-related clinical decision support but providers should be aware that consultation may delay medication turn-around time.
研究药师给药剂量计算机化请求（PTD）这一用于给药指导的先进临床决策支持工具对万古霉素和氨基糖苷类抗菌治疗的影响，描述PTD请求的使用情况，并确定可能延长该过程的因素。
对2004年1月至2006年6月因疑似肺炎住院并通过PTD（研究组）或常规医嘱录入（对照组）接受万古霉素、妥布霉素或庆大霉素治疗的患者进行回顾性研究。
主要终点是药师完成PTD请求的时间。次要数据点包括万古霉素或氨基糖苷类首剂以及任何抗生素首剂的用药周转时间、肾功能不全时的剂量调整、用药错误和医嘱录入时间。进行多变量分析以确定药师核实总时间以及万古霉素或氨基糖苷类首剂给药时间的预测因素。
药师完成PTD请求的中位时间为29分钟。与对照组（n = 48）相比，研究组（n = 49）万古霉素或氨基糖苷类首剂的中位时间（185对138分钟，p = 0.45）以及任何抗生素首剂的中位时间（134对118分钟，p = 0.42）均出现延迟。研究组报告的用药错误较少（5例对18例错误，p = 0.002）。在多变量模型中，PTD对药师核实时间或用药周转时间无显著预测作用。
药师在中位时间30分钟内完成了万古霉素和氨基糖苷类给药指导的药师给药剂量咨询。实施临床药师提供药物相关临床决策支持的计算机化请求增加了万古霉素和氨基糖苷类的用药周转时间并减少了用药错误。通过计算机化请求临床药师对治疗窗窄的药物进行初始抗生素给药咨询是药物相关临床决策支持的一种选择，但医护人员应意识到咨询可能会延迟用药周转时间。
