Clark Kacie E, Briand Mary E, Kapoor Om, Pirasteh Ameen
1 Department of Pharmacy, Baptist Medical Center Jacksonville, Jacksonville, FL, USA.
2 Department of Infectious Disease, Baptist Medical Center Jacksonville, Jacksonville, FL, USA.
J Pharm Pract. 2019 Aug;32(4):399-403. doi: 10.1177/0897190018758557. Epub 2018 Feb 21.
This quasi-experimental study compared the aztreonam utilization in patients with self-reported beta-lactam allergies admitted to an inpatient service between two study periods (pre- and post-implementation). Post-implementation followed the initiation of a standardized beta-lactam allergy questionnaire, a student pharmacist-driven performance improvement project for beta-lactam allergy documentation. Interviews clarified the allergy, reaction history, and any previous tolerance of beta-lactams. If receiving aztreonam at the time of the questionnaire, recommendations were made for changes in therapy if deemed appropriate by the pharmacist.
A total of 95 patients were included in the pre-implementation group versus 65 patients in the post-implementation group. Baseline characteristics were similar. The average number of aztreonam doses per 1000 patient-days in the post-implementation group was decreased (21.23 vs 9.05, = .003). The average number of days of therapy per 1000 patient-days in the post-implementation group was decreased (8.79-4.24, = .016). An increase in the number of aztreonam de-escalations was observed post-implementation ( = .003). A total of 122 questionnaires were completed with 114 allergy documentation updates. There were no reported instances of adverse events.
Utilization of a standardized beta-lactam allergy questionnaire as a pharmacy education tool resulted in a statistically significant decrease in aztreonam utilization, based on doses, days of therapy, and de-escalations.
这项准实验研究比较了在两个研究阶段（实施前和实施后）入住住院服务的自我报告有β-内酰胺类药物过敏患者的氨曲南使用情况。实施后遵循标准化的β-内酰胺类药物过敏问卷的启动，这是一个由学生药剂师推动的改善β-内酰胺类药物过敏记录的绩效改进项目。通过访谈明确过敏情况、反应史以及之前对β-内酰胺类药物的耐受性。如果在问卷填写时正在使用氨曲南，药剂师认为合适的话会提出治疗方案变更建议。
实施前组共纳入95例患者，实施后组为65例患者。基线特征相似。实施后组每1000患者日的氨曲南剂量平均数有所下降（21.23对9.05，P = 0.003）。实施后组每1000患者日的治疗天数平均数下降（8.79 - 4.24，P = 0.016）。实施后观察到氨曲南降阶梯使用次数增加（P = 0.003）。共完成122份问卷，其中114份更新了过敏记录。未报告不良事件实例。
将标准化的β-内酰胺类药物过敏问卷作为药学教育工具使用，在氨曲南的使用剂量、治疗天数和降阶梯使用方面导致了统计学上显著的下降。
