Makela E H, Davis S K, Piveral K, Miller W A, Pleasants R A, Gadsden R H, Leman R B
Thomas B. Finan Center, Cumberland, MD 21502.
Am J Hosp Pharm. 1988 Jan;45(1):126-30.
The appropriateness of serum digoxin concentration (SDC) orders was evaluated with respect to indication for use, sampling time, and action taken by physicians when the reported SDC was out of the normal therapeutic range; the effect of the two data-collection methods used (retrospective and concurrent audits) on the results was studied. Criteria for the appropriate use of SDCs were approved by the medical staff through the pharmacy and therapeutics committee. Patients on adult medicine services were entered into the study as daily SDC determinations were reported by the clinical laboratory. Most of the SDCs were evaluated using approved criteria by primary pharmacist clinicians who were concurrently monitoring drug therapy and participating with the treatment team. A retrospective audit of the same patients was conducted, using only chart review. A total of 134 SDCs involving 78 patients were evaluated. Concurrent-audit results indicated that 18.7% of the SDCs were ordered without an appropriate indication, 16.4% were sampled incorrectly with respect to proper timing, and 8.2% did not result in dosage adjustments when indicated. With respect to appropriate sampling time and overall use of SDCs, significantly more SDCs met the standards under concurrent audit than under retrospective audit. The retrospective chart review method of auditing may not detect as much pertinent information as is desirable.
我们根据使用指征、采样时间以及当报告的血清地高辛浓度（SDC）超出正常治疗范围时医生所采取的措施，评估了SDC检测医嘱的合理性；研究了两种数据收集方法（回顾性审核和同步审核）对结果的影响。合理使用SDC的标准由医务人员通过药学与治疗学委员会批准。随着临床实验室报告每日SDC测定结果，成人内科服务的患者被纳入研究。大多数SDC由主要药剂师临床医生根据批准的标准进行评估，这些临床医生同时监测药物治疗并参与治疗团队。仅通过病历审查对同一批患者进行了回顾性审核。共评估了涉及78名患者的134次SDC。同步审核结果表明，18.7%的SDC检测医嘱没有适当的指征，16.4%的采样时间不正确，8.2%在有指征时未进行剂量调整。关于适当的采样时间和SDC的总体使用情况，同步审核下符合标准的SDC显著多于回顾性审核。回顾性病历审查审核方法可能无法检测到足够多的相关信息。
