Horng Michelle, Brunsman Allison C, Smoot Thomas, Starosta Kaitlin, Smith Zachary R.
Department of Pharmacy, The University of Texas MD Anderson Cancer Center, Houston, TX.
Department of Pharmacy, Henry Ford Hospital, Detroit, MI.
Am J Health Syst Pharm. 2018 Mar 1;75(5 Suppl 1):S13-S23. doi: 10.2146/ajhp161017.
Results of a study to apply lean methodology to an inpatient pharmacy workflow to optimize timely administration of Centers for Medicare and Medicaid Services (CMS)-approved antibiotics for patients with severe sepsis or septic shock are presented.
This quasi-experimental study was conducted at an 802-bed institution using lean methodology to assess the inpatient pharmacy workflow for dispensing antibiotics to adult patients. The preintervention and postintervention phases occurred from February to September, 2015, and from October 2015 to May 2016, respectively. Patients were included if they were hospitalized with an intensive care department 9 or 10 code for severe sepsis or septic shock, had an order for a CMS-approved antibiotic, and met clinical criteria for severe sepsis or septic shock. Patients were excluded if they received first-dose antibiotics in the emergency department. The primary outcome was time from CMS-approved antibiotic order entry to medication administration. Secondary outcomes included timeliness of individual workflow dispensing parameters, patient outcomes, and compliance with the newly implemented workflow.
A total of 102 patients were included, 54 in the preintervention and 48 in the postintervention group. Baseline demographics between the groups were similar. There was a significant reduction in the median time from order entry to antibiotic administration by 40 minutes (preintervention phase 120 minutes versus postintervention phase 80 minutes, = 0.014). Time from order verification to administration was significantly reduced. There was no difference in other secondary outcomes.
Lean methodology was successfully used to reduce time to antibiotic administration, which led to improved compliance with the newly implemented sepsis CMS core measure.
本文介绍了一项研究结果，该研究将精益方法应用于住院药房工作流程，以优化为严重脓毒症或感染性休克患者及时使用医疗保险和医疗补助服务中心（CMS）批准的抗生素。
这项准实验研究在一家拥有802张床位的机构进行，采用精益方法评估向成年患者分发抗生素的住院药房工作流程。干预前和干预后阶段分别为2015年2月至9月以及2015年10月至2016年5月。如果患者因严重脓毒症或感染性休克在重症监护病房9或10编码住院、有CMS批准的抗生素医嘱且符合严重脓毒症或感染性休克的临床标准，则纳入研究。如果患者在急诊科接受了首剂抗生素，则排除在外。主要结局是从CMS批准的抗生素医嘱录入到用药的时间。次要结局包括各个工作流程分发参数的及时性、患者结局以及对新实施工作流程的依从性。
共纳入102例患者，干预前组54例，干预后组48例。两组间的基线人口统计学特征相似。从医嘱录入到抗生素给药的中位时间显著减少了40分钟（干预前阶段为120分钟，干预后阶段为80分钟， = 0.014）。从医嘱核实到给药的时间显著减少。其他次要结局无差异。
精益方法成功用于减少抗生素给药时间，这导致对新实施的脓毒症CMS核心指标的依从性提高。
