Department of Clinical and Administrative Pharmacy, University of Georgia College of Pharmacy, Albany, GA, USA.
Department of Pharmacology and Toxicology, Medical College of Georgia at Augusta University, Albany, GA, USA.
Am J Health Syst Pharm. 2022 Jun 7;79(12):984-992. doi: 10.1093/ajhp/zxab453.
Intravenous fluids are the most commonly prescribed medication in the intensive care unit (ICU) and can have a negative impact on patient outcomes if not utilized properly. Fluid stewardship aims to heighten awareness and improve practice in fluid therapy. This report describes a practical construct for implementation of fluid stewardship services and characterizes the pharmacist's role in fluid stewardship practice.
Fluid stewardship services were integrated into an adult medical ICU at a large community hospital. Data characterizing these services over a 2-year span are reported and categorized based on the 4 rights (right patient, right drug, right route, right dose) and the ROSE (rescue, optimization, stabilization, evacuation) model of fluid administration. The review encompassed 305 patients totaling 905 patient days for whom 2,597 pharmacist recommendations were made, 19% of which were related to fluid stewardship. This corresponded to an average of 1.52 fluid stewardship recommendations per patient. Within the construct of the 4 rights, 39% of recommendations were related to the right patient, 33% were related to the right route, 17% were related to the right drug, and 11% were related to the right dose. By the ROSE model, 1% of recommendations were related to the rescue phase, 3% were related to optimization, 79% were related to stabilization, and 17% were related to evacuation.
Implementation of fluid stewardship pharmacy services in a community hospital medical ICU is feasible. Integration of this practice contributed to 19% of pharmacy recommendations. The most common recommendations involved evaluation of the patient for the appropriateness of fluid therapy during the stabilization phase. The impact of fluid stewardship on patient outcomes needs to be explored.
静脉输液是重症监护病房（ICU）中最常用的药物治疗方法，如果使用不当，可能会对患者的预后产生负面影响。液体管理旨在提高意识并改善液体治疗实践。本报告描述了实施液体管理服务的实用结构，并描述了药师在液体管理实践中的作用。
液体管理服务被整合到一家大型社区医院的成人内科 ICU 中。报告了在 2 年期间这些服务的数据，并根据液体给药的 4 个正确（正确的患者、正确的药物、正确的途径、正确的剂量）和 ROSE（抢救、优化、稳定、撤离）模型对其进行了分类。该审查涵盖了 305 名患者，总计 905 个患者日，共提出了 2597 项药师建议，其中 19%与液体管理有关。这相当于每位患者平均提出 1.52 项液体管理建议。在 4 个正确的结构中，39%的建议与正确的患者有关，33%的建议与正确的途径有关，17%的建议与正确的药物有关，11%的建议与正确的剂量有关。根据 ROSE 模型，1%的建议与抢救阶段有关，3%的建议与优化阶段有关，79%的建议与稳定阶段有关，17%的建议与撤离阶段有关。
在社区医院内科 ICU 实施液体管理药学服务是可行的。该实践的整合贡献了 19%的药学建议。最常见的建议涉及在稳定阶段评估患者接受液体治疗的适宜性。需要探讨液体管理对患者结局的影响。
