Maddox Megan L, DeBoer Erica C, Hammerquist Rhonda J
Medication Safety Officer, Sanford Medical Center , Sioux Falls, South Dakota.
Clinical Nurse Leader, Sanford Medical Center , Sioux Falls, South Dakota .
Hosp Pharm. 2014 May;49(5):444-8. doi: 10.1310/hpj4905-444.
For beta-lactams, the parameter that best predicts bacterial killing is the length of time the antibiotic concentration exceeds the minimum inhibitory concentration (MIC). Studies have demonstrated improved outcomes with extended infusion (4-hour) piperacillin-tazobactam (P-TZ) compared with traditional immediate infusions.
To describe how one institution made the conversion from immediate infusion of P-TZ to a 4-hour extended infusion utilizing an approved automatic therapeutic substitution, staff education, and smart pump technology, and to examine the impact of this conversion on patient length of stay and pharmacy costs.
With approval from the Pharmacy and Therapeutics (P&T), Antimicrobial Stewardship, and Medical Executive Committees, the decision was made to automatically convert all P-TZ orders to a standardized 4-hour infusion given every 8 to 12 hours depending on renal function. The medical records of all adult patients receiving P-TZ during 12 months pre implementation and 24 months post implementation of a 4-hour extended infusion of P-TZ were retrospectively analyzed for length of stay and mortality. The cost of P-TZ was also assessed during these time periods.
With the help of smart pump technology, our institution successfully completed a conversion to 4-hour extended infusion P-TZ. Through this conversion, pharmacy expenditure of P-TZ was reduced by 38%; the total cost savings was $387,980.62 for the 24-month postintervention phase. Extended infusion P-TZ reduced hospital length of stay by 0.6 days (P < .05), resulting in an additional cost savings of $1,689,480 for the 24-month postintervention phase. A conservative estimate of total cost savings to the hospital in the first 24 months, including the reduction in P-TZ expenditures, was $2,077,460.
对于β-内酰胺类抗生素，最能预测细菌杀灭效果的参数是抗生素浓度超过最低抑菌浓度（MIC）的时间长度。研究表明，与传统的快速输注相比，延长输注时间（4小时）的哌拉西林-他唑巴坦（P-TZ）可改善治疗结果。
描述一家机构如何通过批准的自动治疗替换、员工教育和智能泵技术，从快速输注P-TZ转换为4小时延长输注，并研究这种转换对患者住院时间和药房成本的影响。
经药学与治疗学（P&T）、抗菌药物管理和医疗执行委员会批准，决定根据肾功能将所有P-TZ医嘱自动转换为每8至12小时一次的标准化4小时输注。对在实施4小时延长输注P-TZ之前12个月和之后24个月期间接受P-TZ治疗的所有成年患者的病历进行回顾性分析，以评估住院时间和死亡率。同时还评估了这些时间段内P-TZ的成本。
在智能泵技术的帮助下，我们机构成功完成了向4小时延长输注P-TZ的转换。通过这种转换，P-TZ的药房支出减少了38%；在干预后的24个月阶段，总成本节省了387,980.62美元。延长输注P-TZ使住院时间缩短了0.6天（P < 0.05），在干预后的24个月阶段又额外节省了1,689,480美元。对医院在最初24个月的总成本节省进行保守估计，包括P-TZ支出的减少，为2,077,460美元。
