Harvin Andre, Mellett John J J, Knoell Daren, Mirtallo Jay, Naseman Ryan W, Brown Nicole, Tubbs Crystal R
OptumRx, Kernersville, NC.
Ohio State University Wexner Medical Center, Columbus, OH.
Am J Health Syst Pharm. 2018 Jan 1;75(1):e50-e56. doi: 10.2146/ajhp150787.
The implementation of a prioritized scoring tool to improve time to pharmacist intervention is described.
At the Ohio State University Wexner Medical Center, pharmacists are accepted providers of therapeutic drug monitoring of vancomycin and aminoglycosides. At the onset of this initiative and despite the implementation of an integrated electronic medical record (EMR), management of pharmacokinetically monitored medications was conducted using a paper monitoring form. The potential for transcription errors during this process provided an opportunity for improvement. For these reasons, the department of pharmacy focused its initial efforts for a patient scoring system on the pharmacokinetics scoring module. Adjustment of associated medications based on pharmacokinetic values was a core function of pharmacists of the institution and was expected to be conducted without fail. Vancomycin was used as the index surrogate pharmacokinetically monitored medication within the module for testing and validation because of the clear expectations and standardized resources available to pharmacists to complete the task. The pharmacokinetics scoring module was designed specifically for the function of dosing management, searching throughout the EMR and concisely displaying the information a pharmacist needs to make a clinical decision. Importantly, integration of the scoring module reduced the time to intervention from hours to minutes. The median time to intervention was reduced to within a clinical working shift (8 hours) with the scoring module versus 24 hours or longer with the paper monitoring system.
The implementation of an internally developed pharmacokinetics scoring module built into the EMR substantially reduced the time to clinical intervention for pharmacokinetic monitoring of vancomycin drug levels.
描述一种用于缩短药剂师干预时间的优先评分工具的实施情况。
在俄亥俄州立大学韦克斯纳医学中心，药剂师是万古霉素和氨基糖苷类药物治疗药物监测的认可提供者。在该计划启动时，尽管实施了集成电子病历（EMR），但对药代动力学监测药物的管理仍使用纸质监测表。在此过程中出现转录错误的可能性提供了改进的机会。出于这些原因，药学部将其患者评分系统的初步工作重点放在药代动力学评分模块上。根据药代动力学值调整相关药物是该机构药剂师的核心职能，并且预计会无一遗漏地进行。由于药剂师有明确的期望和可用的标准化资源来完成任务，万古霉素被用作该模块内进行测试和验证的药代动力学监测指标替代药物。药代动力学评分模块是专门为给药管理功能设计的，它在整个电子病历中进行搜索，并简洁地显示药剂师做出临床决策所需的信息。重要的是，评分模块的集成将干预时间从数小时缩短至数分钟。使用评分模块时，干预的中位时间减少到一个临床工作班次（8小时）内，而使用纸质监测系统时为24小时或更长时间。
在电子病历中实施内部开发的药代动力学评分模块，显著缩短了对万古霉素药物水平进行药代动力学监测的临床干预时间。
