Gagnon David J, Roberts Russel, Sylvia Lynne
David J. Gagnon, Pharm.D., is Postgraduate Year 2 Resident-Critical Care, Department of Pharmacy, Maine Medical Center, Portland; at the time of writing, he was Postgraduate Year 1 Pharmacy Practice Resident, Department of Pharmacy, Tufts Medical Center, Boston, MA. Russel Roberts, Pharm.D., is Senior Clinical Pharmacy Specialist-Medical Intensive Care Unit, Department of Pharmacy, Tufts Medical Center. Lynne Sylvia, Pharm.D., is Senior Clinical Pharmacy Specialist-Cardiology, Department of Pharmacy, Tufts Medical Center, and Clinical Professor, School of Pharmacy, Northeastern University, Boston.
Am J Health Syst Pharm. 2014 Dec 1;71(23):2080-4. doi: 10.2146/ajhp140176.
Quality improvements achieved by applying the systems approach to assess the clinical effectiveness, operational efficiency, and financial feasibility of a pharmacist-managed vancomycin dosing service are described.
Faced with increased patient volumes and resource demands, the pharmacy department at Tufts Medical Center conducted an evaluation of its adult inpatient vancomycin dosing service using the systems approach, which emphasizes multidisciplinary assessment of system inputs, processes, and outcomes and consensus-building methods to identify needed changes and recommended action steps. A multidisciplinary committee composed of representatives of the medical center's pharmacy, internal medicine, infectious diseases, nursing, phlebotomy, and clinical laboratory services was assembled; in a series of three moderated monthly sessions, committee members deliberated and ultimately reached consensus on a list of action items. Relative to a concurrent intradepartmental assessment of the vancomycin dosing service based solely on pharmacist feedback, the systems approach identified a greater number and wider array of needed improvements in key program areas. Quality improvements implemented as a direct result of the systems-based analysis included a policy change authorizing pharmacists to order serum vancomycin determinations without physician cosignature and inclusion of a vancomycin dosing algorithm in the institutional antibiotic dosing guide. Future changes based on deliverable action items will result in a structured process to help direct program resources toward the patients most in need of pharmacist-managed vancomycin dosing services.
The systems approach allowed for a comprehensive multidisciplinary evaluation of the service, as indicated by the identification of process improvements not identified by the department of pharmacy alone.
描述通过应用系统方法评估由药剂师管理的万古霉素给药服务的临床有效性、运营效率和财务可行性所实现的质量改进。
面对患者数量增加和资源需求，塔夫茨医疗中心药房对其成人住院患者万古霉素给药服务进行了评估，采用系统方法，该方法强调对系统输入、流程和结果进行多学科评估以及采用建立共识的方法来确定所需的变更和推荐的行动步骤。组建了一个由医疗中心药房、内科、传染病科、护理、采血和临床实验室服务代表组成的多学科委员会；在一系列三次每月举行的有主持人的会议中，委员会成员进行了审议并最终就一系列行动项目达成了共识。相对于仅基于药剂师反馈对万古霉素给药服务进行的同期部门内评估，系统方法在关键项目领域确定了更多数量和更广泛的所需改进。基于系统分析直接实施的质量改进包括一项政策变更，授权药剂师在无需医生副署的情况下开具血清万古霉素测定医嘱，以及在机构抗生素给药指南中纳入万古霉素给药算法。基于可交付行动项目的未来变更将产生一个结构化流程，以帮助将项目资源导向最需要药剂师管理的万古霉素给药服务的患者。
系统方法允许对该服务进行全面的多学科评估，这体现在识别出仅由药房部门未识别出的流程改进方面。
