Henry Ford Hospital, Detroit, MI, USA.
Am J Health Syst Pharm. 2022 Jul 8;79(14):1173-1179. doi: 10.1093/ajhp/zxac094.
Evidence-based guideline recommendations for vancomycin dosing recently shifted from a trough-based strategy to an area under the curve (AUC) approach. While several AUC dosing methods exist, the optimal approach has not been determined. Literature characterizing time requirements for various vancomycin dosing strategies remains limited.
A time and motion study was conducted to measure the time spent by clinical pharmacists dosing vancomycin using an AUC nomogram. Pharmacists who dosed and monitored vancomycin for adult patients on the general medical ward (GMW) or intensive care unit (ICU) of a large academic medical center consented to study participation. Vulnerable patients and vancomycin orders for surgical infection prophylaxis were excluded. The primary outcome was the median amount of time clinical pharmacists dedicated to vancomycin-related clinical activities during an 8-hour weekday shift. Secondary outcomes included the proportion of patients prescribed vancomycin at the beginning of each shift and factors contributing to greater than average time spent on vancomycin-related responsibilities.
Seven clinical pharmacists collected data on 178 vancomycin orders. The estimated amount of time a clinical pharmacist spent on daily vancomycin responsibilities averaged 10.45 minutes (interquartile range [IQR], 6.94-15.8 minutes). The overall median time requirement per vancomycin assessment was 3.45 minutes (IQR, 1.95-6.7 minutes). The only factor independently associated with prolonged dosing time was follow-up dosing from a previous day.
The study elucidated time requirements associated with an AUC nomogram-based vancomycin dosing approach. This data could be used to compare time requirements associated with other existing vancomycin dosing strategies, which may help healthcare systems determine the optimal AUC dosing method for their specific practice model.
最近，基于血药峰浓度的万古霉素剂量指南推荐策略转变为基于曲线下面积（AUC）的方法。虽然有几种 AUC 剂量方法，但尚未确定最佳方法。描述各种万古霉素剂量策略所需时间的文献仍然有限。
我们进行了一项时间和运动研究，以测量临床药师使用 AUC 药代动力学曲线下面积计算图进行万古霉素剂量调整时所花费的时间。同意参与研究的药师负责为大型学术医疗中心普通医疗病房（GMW）或重症监护病房（ICU）的成年患者进行万古霉素剂量调整和监测。排除了易发生感染的患者和用于手术感染预防的万古霉素医嘱。主要结果是临床药师在 8 小时工作日轮班期间用于与万古霉素相关的临床活动的中位数时间。次要结果包括每个班次开始时开万古霉素医嘱的患者比例以及导致与万古霉素相关职责花费时间超过平均时间的因素。
7 名临床药师收集了 178 例万古霉素医嘱的数据。临床药师每天用于万古霉素相关职责的估计时间平均为 10.45 分钟（四分位间距[IQR]，6.94-15.8 分钟）。每次万古霉素评估的总体中位数时间需求为 3.45 分钟（IQR，1.95-6.7 分钟）。唯一与延长剂量时间独立相关的因素是前一天的后续剂量。
该研究阐明了基于 AUC 药代动力学曲线下面积计算图的万古霉素剂量方法的时间要求。这些数据可用于比较与其他现有的万古霉素剂量策略相关的时间要求，这可能有助于医疗保健系统为其特定的实践模式确定最佳的 AUC 剂量方法。
