Department of Clinical Pharmacology and Toxicology, St Vincent's Hospital Sydney, Sydney, Australia.
St Vincent's Clinical School, Faculty of Medicine, The University of New South Wales, Sydney, Australia.
Br J Clin Pharmacol. 2021 Nov;87(11):4273-4282. doi: 10.1111/bcp.14844. Epub 2021 Apr 15.
Accurate documentation of medication administration time is imperative for many therapeutic decisions, including dosing of intravenous antimicrobials. The objectives were to determine (1) the discrepancy between actual and documented administration times for antimicrobial infusions and (2) whether day of the week, time of day, nurse-to-patient ratio and drug impacted accuracy of documented administration times.
Patient and dosing data were collected (June-August 2019) for 55 in-patients receiving antimicrobial infusions. "Documented" and "actual" administration times (n = 660) extracted from electronic medication management systems and smart infusion pumps, respectively, were compared. Influence of the day (weekday/weekend), time of day (day/evening/night), nurse-to-patient ratio (high 1:1/low 1:5) and drug were examined. Monte Carlo simulation was used to predict the impact on dose adjustments for vancomycin using the observed administration time discrepancies compared to the actual administration time.
The median discrepancy between actual and documented administration times was 16 min (range, 2-293 min), with discrepancies greater than 60 minutes in 7.7% of administrations. Overall, discrepancies (median [range]) were similar on weekends (17 [2-293] min) and weekdays (16 [2-188] min), and for high (16 [2-157] min) and low nurse-to-patient ratio wards (16 [2-293] min). Discrepancies were smallest for night administrations (P < .05), and antimicrobials with shorter half-lives (P < .0001). The observed discrepancies in vancomycin administration time resulted in a different dose recommendation in 58% of cases (30% higher, 28% lower).
Overall, there were discrepancies between actual and documented antimicrobial infusion administration times. For vancomycin, these discrepancies in administration time were predicted to result in inappropriate dose recommendations.
准确记录药物给药时间对于许多治疗决策至关重要，包括静脉用抗菌药物的给药剂量。本研究的目的是确定：(1) 抗菌药物输注的实际给药时间与记录的给药时间之间的差异；(2) 给药时间的差异是否与给药日、给药时间、护士与患者比例和药物有关。
收集了 55 名接受抗菌药物输注的住院患者的患者和用药数据（2019 年 6 月至 8 月）。从电子用药管理系统和智能输液泵中分别提取“记录”和“实际”给药时间（n=660），并进行比较。考察了给药日（工作日/周末）、给药时间（白天/傍晚/夜间）、护士与患者比例（高 1:1/低 1:5）和药物对给药时间的影响。采用蒙特卡罗模拟法，根据观察到的给药时间差异与实际给药时间的比较，预测对万古霉素剂量调整的影响。
实际给药时间与记录的给药时间之间的中位数差异为 16 分钟（范围，2-293 分钟），有 7.7%的给药时间差异超过 60 分钟。总体而言，周末（17 [2-293] 分钟）和工作日（16 [2-188] 分钟）、高（16 [2-157] 分钟）和低（16 [2-293] 分钟）护士与患者比例病房的差异相似。夜间给药的差异最小（P<.05），半衰期较短的抗菌药物（P<.0001）的差异也较小。万古霉素给药时间的观察到的差异导致 58%的情况下（30%更高，28%更低）剂量建议不同。
总体而言，抗菌药物输注的实际给药时间与记录的给药时间之间存在差异。对于万古霉素，这些给药时间的差异预计会导致不适当的剂量建议。
