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药物治疗实现患者术后良好结局:一项包括围手术期专科药师访谈的叙述性综述

Positive Patient Postoperative Outcomes with Pharmacotherapy: A Narrative Review including Perioperative-Specialty Pharmacist Interviews.

作者信息

Parrish Richard H, Bodenstab Heather Monk, Carneal Dustin, Cassity Ryan M, Dager William E, Hyland Sara J, Lovely Jenna K, Pollock Alyssa, Sparkes Tracy M, Wong Siu-Fun

机构信息

Department of Biomedical Sciences, Mercer University School of Medicine, Columbus, GA 31902, USA.

Department of Medical Science, Sobi Pharma, Waltham, MA 02451, USA.

出版信息

J Clin Med. 2022 Sep 24;11(19):5628. doi: 10.3390/jcm11195628.

Abstract

The influence of pharmacotherapy regimens on surgical patient outcomes is increasingly appreciated in the era of enhanced recovery protocols and institutional focus on reducing postoperative complications. Specifics related to medication selection, dosing, frequency of administration, and duration of therapy are evolving to optimize pharmacotherapeutic regimens for many enhanced recovery protocolized elements. This review provides a summary of recent pharmacotherapeutic strategies, including those configured within electronic health record (EHR) applications and functionalities, that are associated with the minimization of the frequency and severity of postoperative complications (POCs), shortened hospital length of stay (LOS), reduced readmission rates, and cost or revenue impacts. Further, it will highlight preventive pharmacotherapy regimens that are correlated with improved patient preparation, especially those related to surgical site infection (SSI), venous thromboembolism (VTE), nausea and vomiting (PONV), postoperative ileus (POI), and emergence delirium (PoD) as well as less commonly encountered POCs such as acute kidney injury (AKI) and atrial fibrillation (AF). The importance of interprofessional collaboration in all periprocedural phases, focusing on medication management through shared responsibilities for drug therapy outcomes, will be emphasized. Finally, examples of collaborative care through shared mental models of drug stewardship and non-medical practice agreements to improve operative throughput, reduce operative stress, and increase patient satisfaction are illustrated.

摘要

在加强康复方案以及医疗机构注重减少术后并发症的时代,药物治疗方案对外科手术患者预后的影响日益受到重视。与药物选择、剂量、给药频率和治疗持续时间相关的具体情况正在不断演变,以优化许多加强康复方案要素的药物治疗方案。本综述总结了近期的药物治疗策略,包括那些配置在电子健康记录(EHR)应用程序和功能中的策略,这些策略与术后并发症(POC)的频率和严重程度降至最低、缩短住院时间(LOS)、降低再入院率以及成本或收入影响相关。此外,它将重点介绍与改善患者准备情况相关的预防性药物治疗方案,特别是那些与手术部位感染(SSI)、静脉血栓栓塞(VTE)、恶心和呕吐(PONV)、术后肠梗阻(POI)以及苏醒谵妄(PoD)相关的方案,以及较少见的POC,如急性肾损伤(AKI)和心房颤动(AF)。将强调跨专业协作在所有围手术期阶段的重要性,重点是通过对药物治疗结果分担责任来进行药物管理。最后,举例说明了通过药物管理的共享思维模式和非医疗实践协议进行协作护理,以提高手术效率、减轻手术压力并提高患者满意度。

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