Vipond Jane M, Heiberger Amy L, Thompson Paul A, Huber Jody N
Department of Pharmaceutical Services, Sanford USD Medical Center, Sioux Falls, S.Dak.
Department of Pharmacy Practice, South Dakota State University College of Pharmacy and Allied Health Professions, Brookings, S.Dak.
Pediatr Qual Saf. 2018 May 18;3(3):e079. doi: 10.1097/pq9.0000000000000079. eCollection 2018 May-Jun.
Methadone and lorazepam prescribing discrepancies for the use of iatrogenic withdrawal were observed among providers. A standardized pharmacist-managed methadone and lorazepam taper protocol was implemented at a pediatric tertiary care facility with the aim to reduce the length of taper for patients with iatrogenic withdrawal.
A multidisciplinary team of nurses, pharmacists, and physicians reviewed the current literature, then developed and implemented a standardized withdrawal taper protocol. Outcomes were compared with a retrospective control group using past prescribing practices. The primary endpoint was the length of methadone and/or lorazepam taper. Secondary endpoints included evaluation for significant differences between the control and standardized protocol groups regarding additional breakthrough withdrawal medications, pediatric intensive care unit (PICU) and hospital length of stay. We also evaluated provider satisfaction with the protocol.
The standardized protocol group included 25 patients who received methadone and/or lorazepam taper. A retrospective control group contained 24 patients. Median methadone taper length before protocol implementation was 9.5 days with an interquartile range (IQR) of 5.5-14.5 days; after protocol implementation, it was 6.0 (IQR, 3.0-9.0) days ( = 0.0145). Median lorazepam taper length before protocol implementation was 13.0 (IQR, 8.0-18.0) days; after protocol implementation, it was 6.0 (4.0-7.0) days ( = 0.0006). A statistical difference between PICU length of stay, hospital length of stay, or the number of additional medications for breakthrough withdrawal was not found.
The use of a standardized withdrawal protocol resulted in shorter taper duration for both the methadone and lorazepam groups. There was no difference in PICU or hospital length of stay.
在医疗服务提供者中观察到美沙酮和劳拉西泮在医源性戒断使用方面的处方差异。在一家儿科三级护理机构实施了标准化的由药剂师管理的美沙酮和劳拉西泮减量方案，目的是缩短医源性戒断患者的减量时间。
由护士、药剂师和医生组成的多学科团队查阅了当前文献，然后制定并实施了标准化的戒断减量方案。使用过去的处方做法将结果与回顾性对照组进行比较。主要终点是美沙酮和/或劳拉西泮的减量时间。次要终点包括评估对照组和标准化方案组在额外的突破性戒断药物、儿科重症监护病房（PICU）住院时间和医院住院时间方面的显著差异。我们还评估了医疗服务提供者对该方案的满意度。
标准化方案组包括25例接受美沙酮和/或劳拉西泮减量的患者。回顾性对照组有24例患者。方案实施前美沙酮减量的中位时间为9.5天，四分位间距（IQR）为5.5 - 14.5天；方案实施后为6.0天（IQR，3.0 - 9.0天）（P = 0.0145）。方案实施前劳拉西泮减量的中位时间为13.0天（IQR，8.0 - 18.0天）；方案实施后为6.0天（4.0 - 7.0天）（P = 0.0006）。未发现PICU住院时间、医院住院时间或突破性戒断额外药物数量方面的统计学差异。
使用标准化的戒断方案使美沙酮组和劳拉西泮组的减量持续时间缩短。PICU或医院住院时间没有差异。
