Zembles Tracy N, Gaertner Katherine M, Gutzeit Michael F, Willoughby Rodney E
Children's Hospital and Health System, Milwaukee, WI.
University of Wisconsin-Madison School of Pharmacy, Madison, WI.
Am J Health Syst Pharm. 2016 Mar 15;73(6):405-8. doi: 10.2146/ajhp150499.
One hospital's implementation of revised American Academy of Pediatrics (AAP) guidelines for palivizumab prophylaxis of respiratory syncytial virus (RSV) infection is described.
Revised AAP guidelines for RSV prophylaxis in infants and young children at increased risk for RSV infection recommend that up to five doses of palivizumab be administered during the RSV season. The guidelines also recommend that inpatients not receive monthly palivizumab prophylaxis and that infants and young children eligible for prophylaxis during the RSV season receive a dose of palivizumab two or three days before discharge or promptly after discharge. To ensure compliance with the revised AAP guidelines, a 296-bed hospital implemented a quality-improvement project including (1) efforts by the antimicrobial stewardship pharmacist and the chief medical officer to notify and educate healthcare providers regarding institutional adoption of the guidelines, (2) reinforcement of guideline adherence by clinical pharmacists during daily bedside rounds and via prospective review of all palivizumab orders, and (3) a medication-use evaluation (MUE) to assess adherence to the guidelines. The MUE results showed that during the 2014-15 RSV season (after implementation of the practice changes), the number of palivizumab doses administered at the hospital declined by 56% from the previous RSV season, with 97% of doses administered for appropriate indications.
Standardized, comprehensive guidelines with defined criteria for palivizumab prophylaxis of RSV infection resulted in $303,227 of cost savings without a discernible change in nosocomial transmission, or morbidity, or mortality. Hospital infection-control practices controlled nosocomial RSV transmission.
描述一家医院实施美国儿科学会（AAP）修订的关于帕利珠单抗预防呼吸道合胞病毒（RSV）感染指南的情况。
修订后的AAP关于对RSV感染风险增加的婴幼儿进行RSV预防的指南建议，在RSV季节给予多达五剂帕利珠单抗。该指南还建议住院患者不接受每月一次的帕利珠单抗预防，且在RSV季节有资格接受预防的婴幼儿在出院前两到三天或出院后立即接受一剂帕利珠单抗。为确保遵守修订后的AAP指南，一家拥有296张床位的医院实施了一项质量改进项目，包括：（1）抗菌药物管理药师和首席医疗官努力通知并教育医疗服务提供者有关机构采用该指南的情况；（2）临床药师在每日床边查房时以及通过对所有帕利珠单抗医嘱的前瞻性审查来加强对指南的遵守；（3）进行药物使用评估（MUE）以评估对指南的遵守情况。MUE结果显示，在2014 - 15年RSV季节（实施实践改变后），该医院使用的帕利珠单抗剂量较上一个RSV季节减少了56%，其中97%的剂量用于适当的适应症。
针对帕利珠单抗预防RSV感染制定的具有明确标准的标准化、综合性指南节省了303,227美元的成本，同时医院内传播、发病率或死亡率没有明显变化。医院感染控制措施控制了医院内RSV的传播。
