Chanas Tyler, Hockman Rebecca, Rice Terran, Cox-Hall Heather, Mallow-Corbett Stephanie, Alexander Bryan T
Department of Pharmacy, Vidant Medical Center, Greenville, NC, USA.
Department of Pharmacy Services, 12350University of Virginia Health System, Charlottesville, VA, USA.
J Pharm Pract. 2020 Oct;33(5):618-627. doi: 10.1177/0897190019826484. Epub 2019 Feb 6.
Though previous studies have shown benefit with pharmacist-managed dosing of antibiotics, many institutions still do not offer such services. Our objective was to determine and report novel outcomes associated with the implementation of a pharmacist-managed pharmacokinetic/pharmacodynamic consult service and to assess the impact of direct pharmacist involvement in therapeutic drug monitoring.
Retrospective cohort study of patients who received vancomycin or an aminoglycoside in the medical intensive care unit from January 5, 2013, to January 6, 2015, divided into 2 groups: before/after implementation of the consult service on January 6, 2014.
Nine-hundred sixty-two patients were included. Groups were similar at baseline. There were fewer critical values after implementation of the consult service (40.8% vs 27.3%, < .001). The intervention group had significantly more vancomycin troughs within therapeutic range (15.4% vs 32.8%, = .019). Time from order entry to medication administration was shorter when pharmacists entered the medication order, although this difference was nonsignificant (103 minutes vs 77 minutes, = .054).
Implementation of a pharmacist-managed dosing and monitoring program led to significantly decreased rates of critical value drug concentrations and increased rates of therapeutic concentrations, with a 25% (NS) decreased time-to-antibiotic administration, therefore demonstrating the additive value of the pharmacist-managed over pharmacist-monitored approach.
尽管先前的研究表明药剂师管理抗生素给药具有益处，但许多机构仍未提供此类服务。我们的目标是确定并报告与实施药剂师管理的药代动力学/药效学咨询服务相关的新结果，并评估药剂师直接参与治疗药物监测的影响。
对2013年1月5日至2015年1月6日在医疗重症监护病房接受万古霉素或氨基糖苷类药物治疗的患者进行回顾性队列研究，分为两组：2014年1月6日咨询服务实施前/后。
共纳入962例患者。两组在基线时相似。咨询服务实施后临界值较少（40.8%对27.3%，P<0.001）。干预组万古霉素谷浓度在治疗范围内的比例显著更高（15.4%对32.8%，P=0.019）。当药剂师录入医嘱时，从医嘱录入到给药的时间更短，尽管这种差异不显著（103分钟对77分钟，P=0.054）。
实施药剂师管理的给药和监测计划导致临界值药物浓度显著降低，治疗浓度比例增加，抗生素给药时间减少25%（无统计学意义），因此证明了药剂师管理方法相对于药剂师监测方法的附加价值。
