Shaw Alexander R, Chaijamorn Weerachai, Clark John S, Mueller Bruce A
Clinical Pharmacy Department, University of Michigan College of Pharmacy, Ann Arbor, MI.
Faculty of Pharmacy, University of Siam, Bangkok, Thailand.
Am J Health Syst Pharm. 2018 Jun 1;75(11):808-815. doi: 10.2146/ajhp160741.
Results of a study to determine time and cost requirements for final preparation of continuous renal replacement therapy (CRRT) products are reported.
A 3-phase observational study was conducted at a tertiary care university hospital to evaluate costs associated with manual addition of phosphate and/or potassium to 3 commercial 5-L CRRT products. In the first phase of the study, pharmacy workflow processes for solution preparation were established; in the second phase, pharmacist and pharmacy technician time spent in the CRRT workflow and all materials used were observed and recorded. In the third phase, time and personnel requirements were analyzed in economic terms to estimate final preparation costs.
Through direct observation over 35 days, the CRRT workflow was observed and work times recorded for 511 bag preparations. The main cost contributors were the base CRRT solution and electrolyte additive prices. Technician compounding time differed substantially by solution brand and the need for electrolyte addition. Pharmacist verification time did not differ meaningfully by product.
Preparation and verification of premade CRRT solutions that contained physiological electrolyte concentrations required less technician and pharmacist time than solutions that needed addition of electrolytes in the pharmacy. Personnel costs, which were a small part of the total cost of dispensed CRRT bags, were higher for technicians than pharmacists. The baseline costs of the solutions and the electrolyte additives, if needed, were the main contributors to total cost.
报告一项关于确定连续性肾脏替代治疗（CRRT）产品最终制备所需时间和成本的研究结果。
在一家三级护理大学医院进行了一项三阶段观察性研究，以评估手动向3种市售5升CRRT产品中添加磷酸盐和/或钾的相关成本。在研究的第一阶段，建立了溶液制备的药房工作流程；在第二阶段，观察并记录了药剂师和药房技术员在CRRT工作流程中花费的时间以及所使用的所有材料。在第三阶段，从经济角度分析了时间和人员需求，以估算最终制备成本。
通过35天的直接观察，观察了CRRT工作流程，并记录了511袋制剂的工作时间。主要成本因素是基础CRRT溶液和电解质添加剂的价格。技术员配制时间因溶液品牌和添加电解质的需求而有很大差异。药剂师的核查时间在不同产品之间没有显著差异。
与需要在药房添加电解质的溶液相比，制备和核查含有生理电解质浓度的预制CRRT溶液所需的技术员和药剂师时间更少。人员成本在已配CRRT袋的总成本中占比很小，技术员的人员成本高于药剂师。溶液和电解质添加剂（如有需要）的基线成本是总成本的主要贡献因素。
