药师主导的多学科干预持续改善女性腹部手术患者术后恶心呕吐。

Pharmacist-driven multidisciplinary initiative continuously improves postoperative nausea and vomiting in female patients undergoing abdominal surgery.

机构信息

Department of Pharmacy, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.

Northern Jiangsu People's Hospital, Yangzhou, China.

出版信息

J Clin Pharm Ther. 2020 Oct;45(5):959-967. doi: 10.1111/jcpt.13110. Epub 2020 Feb 5.

DOI:10.1111/jcpt.13110

PMID:32022296

Abstract

WHAT IS KNOWN AND OBJECTIVE

The incorrect or insufficient prophylaxis of postoperative nausea and vomiting (PONV) is common in practice. A clinical pharmacist-led guidance team (CPGT) was established and included in general surgery teams.

OBJECTIVE

This study aimed to evaluate the effects of the CPGT on the improvement of PONV and prophylaxis administration.

METHODS

A prospective before-after study was conducted on 156 female patients undergoing abdominal surgery at a Chinese tertiary teaching hospital from December 2016 to December 2017. A total of 82 patients were enrolled in the preintervention period, and 74 patients were included in the post-intervention period. The CPGT established the evidence-based criteria for prophylactic anti-emetic administration and conducted interventions, including a review of medical records, provision of feedback, educational outreach, and dedicated support. Primary outcomes included the incidence of PONV within 24 hours of surgery, administered number of prophylactic anti-emetics, and accuracy of the timing for prophylactic anti-emetics. Outcomes were analysed by logistic regression or multivariable linear regression.

RESULTS AND DISCUSSION

After intervention, patients reported significantly less PONV (33.78% vs 56.10%; odds ratio [OR]: 0.29; numbers needed to treat [NNT]: 3.47), vomiting (29.73% vs 45.12%; OR: 0.42; NNT: 5.16) and nausea (31.08% vs 56.10%; OR: 0.24; NNT: 3.19) within 24 hours of surgery. The accuracy of the timing for prophylactic anti-emetics significantly increased (OR: 3.66; P: .003). Anaesthesiologists administered increased numbers of prophylactic anti-emetics (OR: 5.82; P < .001). The improvement of PONV did not decrease during the four-month period after intervention (P: .639).

WHAT IS NEW AND CONCLUSION

The CPGT is a valuable service model to continuously improve PONV and optimize prophylaxis administration.

摘要

已知和目的

术后恶心和呕吐（PONV）的预防措施不正确或不充分在实践中很常见。成立了一个由临床药师领导的指导小组（CPGT），并将其纳入普通外科团队。

目的

本研究旨在评估 CPGT 对改善 PONV 和预防措施管理的效果。

方法

对 2016 年 12 月至 2017 年 12 月在中国一家三级教学医院接受腹部手术的 156 名女性患者进行了前瞻性前后对照研究。共有 82 名患者纳入干预前，74 名患者纳入干预后。CPGT 为预防止吐药的应用制定了循证标准，并进行了干预，包括病历审查、提供反馈、教育外展和专门支持。主要结果包括术后 24 小时内 PONV 的发生率、预防性止吐药的使用次数以及预防性止吐药的时间准确性。通过逻辑回归或多变量线性回归分析结果。

结果与讨论

干预后，患者报告的 PONV（33.78% vs 56.10%；比值比 [OR]：0.29；需要治疗的人数 [NNT]：3.47）、呕吐（29.73% vs 45.12%；OR：0.42；NNT：5.16）和恶心（31.08% vs 56.10%；OR：0.24；NNT：3.19）在术后 24 小时内明显减少。预防用止吐药时间的准确性显著提高（OR：3.66；P：.003）。麻醉师开具了更多数量的预防性止吐药（OR：5.82；P<.001）。干预后四个月内，PONV 的改善并没有减少（P：.639）。