Charani Esmita, Gharbi Myriam, Hickson Mary, Othman Shokri, Alfituri Aisha, Frost Gary, Holmes Alison
Faculty of Medicine, The National Centre for Infection prevention and Management, Imperial College London, London, UK.
Therapy Services, Imperial College Healthcare NHS Trust, London, UK.
BMJ Open. 2015 Apr 2;5(4):e006092. doi: 10.1136/bmjopen-2014-006092.
Patient weight is a key measure for safe medication management and monitoring of patients. Here we report the recording of patient's body weight on admission in three hospitals in West London and its relationship with the prescription of antibiotic drugs where it is essential to have the body weight of the patient.
A prospective cross-sectional study was conducted in three teaching hospitals in West London. Data were collected during March 2011-September 2011 and July 2012-August 2012, from adult admissions units, medical and surgical wards. Data from each ward were collected on a single day to provide a point prevalence data on weight recording. Patient medication charts, nursing and medical notes were reviewed for evidence of weight and height recording together with all the medication prescribed for the patients. An observational study collecting data on the weight recording process was conducted on two randomly selected wards to add context to the data.
Data were collected on 1012 patients. Weight was not recorded for 46% (474) of patients. Eighty-nine patients were prescribed a narrow therapeutic antibiotic, in 39% (35/89) of these weight was not recorded for the patient. Intravenous vancomycin was the most commonly prescribed antibiotic requiring therapeutic monitoring. In total 61 patients were receiving intravenous vancomycin and of these 44% (27/61) did not have their weight recorded. In the observational study, the most frequently identified barrier to weight not being recorded was interruptions to the admission process.
Despite the clinical importance of body weight measurement it is poorly recorded in hospitalised patients, due to interruptions to the workflow and heavy staff workloads. In antibiotics a correct, recent patient weight is required for accurate dosing and to keep drugs within the narrow therapeutic index, to ensure efficacy of prescribing and reduce toxicity.
患者体重是安全用药管理及患者监测的一项关键指标。在此，我们报告伦敦西部三家医院患者入院时的体重记录情况，以及其与抗生素处方的关系，因为获取患者体重对于抗生素处方至关重要。
在伦敦西部的三家教学医院开展了一项前瞻性横断面研究。于2011年3月至2011年9月以及2012年7月至2012年8月期间，从成人入院科室、内科和外科病房收集数据。每个病房的数据在同一天收集，以提供体重记录的时点患病率数据。查阅患者用药图表、护理及医疗记录，以获取体重和身高记录的证据以及患者所开具的所有药物。在两个随机选择的病房进行了一项关于体重记录过程的数据收集观察性研究，以补充数据背景。
收集了1012例患者的数据。46%（474例）的患者体重未被记录。89例患者被开具了治疗窗窄的抗生素，其中39%（35/89）的患者体重未被记录。静脉注射万古霉素是最常开具的需要治疗监测的抗生素。共有61例患者接受静脉注射万古霉素，其中44%（27/61）的患者体重未被记录。在观察性研究中，体重未被记录最常被识别出的障碍是入院流程受到干扰。
尽管体重测量具有临床重要性，但由于工作流程中断和工作人员工作量大，住院患者的体重记录情况不佳。在使用抗生素时，需要准确的近期患者体重以进行精确给药，并使药物保持在窄治疗指数范围内，以确保处方的有效性并降低毒性。
