Brancaccio Adam, Giuliano Christopher, McNorton Kelly, Delgado George
Adam Brancaccio, Pharm..D., BCPS, is Clinical Pharmacist Generalist-Internal Medicine, University of Michigan Health System, Ann Arbor, and Adjunct Clinical Faculty, University of Michigan College of Pharmacy, Ann Arbor; at the time of writing, he was Postgraduate Year 1 Pharmacy Practice Resident, Department of Pharmacy, St. John Hospital and Medical Center (SJHMC), Detroit, MI. Christopher Giuliano, Pharm.D., is Assistant Professor, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, and Clinical Specialist, Internal Medicine, Department of Pharmacy, SJHMC. Kelly McNorton, Pharm.D., BCPS, is Clinical Pharmacy Specialist, Critical Care; and George Delgado Jr., Pharm.D., is Clinical Pharmacy Specialist, Emergency Medicine/Infectious Diseases, Department of Pharmacy, SJHMC.
Am J Health Syst Pharm. 2014 Nov 1;71(21):1862-9. doi: 10.2146/ajhp140039.
The use of a combined physician-and pharmacist-directed phenytoin loading dose program in an emergency department (ED) was evaluated.
This single-center, observational, preimplementation-postimplementation study evaluated adult patients who received a phenytoin loading dose in the ED. The primary outcome compared the proportion of optimal phenytoin loading doses in the preimplementation and postimplementation groups. The postimplementation group was further stratified into pharmacist- and prescriber-dosing groups. Other outcomes evaluated included the numbers of appropriate serum phenytoin concentrations measured, adverse drug reactions (ADRs), and recurrence of seizures within 24 hours of loading dose administration in the preimplementation and postimplementation groups.
There was no difference in the proportion of optimal phenytoin loading doses between the preimplementation and postimplementation groups (50% versus 62%, respectively; p=0.19). When stratified by individual groups, the rate of optimal phenytoin loading doses increased by 64% in the postimplementation pharmacist group (50% versus 82%, p=0.007), while the rate in the prescriber-dosing group remained relatively unchanged (50% versus 49%, p=0.91). The number of appropriate serum phenytoin concentrations significantly improved in the postimplementation versus preimplementation group (65% versus 40%, p=0.025). Rates of ADRs and recurrence of seizures did not differ across the study groups.
No change in the percentage of optimal phenytoin loading doses in the ED was observed after implementation of a combined pharmacist- and physician- dosing program. When stratified into pharmacist or prescriber dosing, the pharmacist-led dosing program significantly improved the proportion of patients who received optimal phenytoin loading doses.
评估在急诊科（ED）采用医生和药剂师共同指导的苯妥英钠负荷剂量方案的效果。
这项单中心、观察性、实施前-实施后研究评估了在急诊科接受苯妥英钠负荷剂量的成年患者。主要结局比较了实施前和实施后两组中苯妥英钠最佳负荷剂量的比例。实施后组进一步分为药剂师给药组和处方医生给药组。评估的其他结局包括实施前和实施后两组中在负荷剂量给药后24小时内测量的苯妥英钠血清浓度合适的次数、药物不良反应（ADR）以及癫痫复发情况。
实施前和实施后两组中苯妥英钠最佳负荷剂量的比例没有差异（分别为50%和62%；p = 0.19）。按个体分组分层时，实施后药剂师组中苯妥英钠最佳负荷剂量的比例增加了64%（50%对82%，p = 0.007），而处方医生给药组的比例相对保持不变（50%对49%，p = 0.91）。实施后组与实施前组相比，苯妥英钠血清浓度合适的次数显著改善（65%对40%，p = 0.025）。各研究组之间的药物不良反应率和癫痫复发率没有差异。
实施药剂师和医生联合给药方案后，急诊科苯妥英钠最佳负荷剂量的百分比没有变化。当分为药剂师或处方医生给药时，药剂师主导的给药方案显著提高了接受苯妥英钠最佳负荷剂量患者的比例。
