Department of Pharmacy Services, University of Kentucky HealthCare, Lexington, KY 40536, USA.
Ann Pharmacother. 2010 Mar;44(3):447-55. doi: 10.1345/aph.1M527. Epub 2010 Feb 2.
Several thousand people are bitten annually by venomous snakes in the US. While the development of ovine Crotalidae polyvalent immune Fab antivenin (FabAV) for Crotalinae snakebite envenomations has greatly changed the way this clinical presentation is treated, multiple issues complicate its use. From patient assessment and evaluation, to medication preparation and administration, to the management of adverse drug reactions, the use of this antidote carries with it multiple points of possible medication variances. The inappropriate use of this agent can result in adverse patient consequences and a significant financial burden for both the hospital and the patient.
To describe an evidence-based, multidisciplinary approach that was taken to ensure optimal, safe, and cost-effective treatment of patients with FabAV.
Following an analysis of the available literature, a multidisciplinary committee was formed to construct a protocol for use of FabAV. This group included clinical pharmacists, pharmacy administrators, emergency medicine physicians who specialized in wilderness medicine and pharmacy residents.
A multidisciplinary FabAV usage protocol was constructed and implemented to ensure appropriate patient evaluation, FabAV use and preparation, monitoring, and follow-up. This protocol was based on the available literature and the expert opinion of the committee. Through the use of a 24-hour in-house pharmacy resident on-call system, clinical pharmacy services were provided to ensure a multidisciplinary approach to the care of these patients emergently. Although limited, initial data show that this approach is effective and may result in substantial cost savings.
Initial results from implementation of a protocol for use of FabAV have limited inappropriate use, reduced medication wastage, and decreased costs.
美国每年有数千人被毒蛇咬伤。虽然羊源蝮蛇多价免疫 Fab 抗蛇毒血清（FabAV）的开发极大地改变了治疗这种临床症状的方式，但仍存在多个问题使其使用复杂化。从患者评估和评估，到药物准备和管理，再到药物不良反应的管理，使用这种解毒剂可能存在多个药物差异点。这种药物的不当使用会导致患者不良后果，并给医院和患者带来巨大的经济负担。
描述一种循证的多学科方法，以确保使用 FabAV 对患者进行最佳、安全和具有成本效益的治疗。
在对现有文献进行分析后，成立了一个多学科委员会来制定 FabAV 使用的方案。该小组包括临床药师、药房管理人员、专门从事野外医学和药学住院医师的急诊医学医师。
制定并实施了多学科 FabAV 使用方案，以确保对患者进行适当的评估、FabAV 的使用和准备、监测和随访。该方案基于现有文献和委员会的专家意见。通过使用内部 24 小时药房住院医师值班系统，提供临床药学服务，以确保多学科紧急护理这些患者。尽管数据有限，但初步结果表明，这种方法是有效的，并且可能会带来巨大的成本节约。
实施 FabAV 使用方案的初步结果表明，不适当的使用减少了，药物浪费减少了，成本降低了。
