Hospital Pharmacy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Department of General, Abdominal, Thoracic and Vascular Surgery, Katholisches Marienkrankenhaus, Hamburg, Germany.
PLoS One. 2024 Jun 6;19(6):e0305047. doi: 10.1371/journal.pone.0305047. eCollection 2024.
Ostomy surgery is a common procedure that poses various challenges for patients and healthcare professionals. There are numerous guidelines addressing different ostomy-related problems (ORPs) and supporting an interdisciplinary approach for ostomy care, but evidence-based literature for optimizing drug therapy after ostomy surgery is lacking.
To investigate and characterize typical ORPs in relation to drug therapy and provide best practice recommendations from a pharmaceutical point of view.
Patients with an ileo- or colostomy were consecutively enrolled in a prospective, interventional monocentric cohort study during hospitalization, with particular attention to medication. A clinical pharmacist assessed DRPs by performing level 3 medication reviews and patient interviews. Pharmacists' interventions (PIs) were evaluated by two senior clinical pharmacists and documented in DokuPIK (Documentation of Pharmacists' Interventions in the Hospital). Following interdisciplinary discussions, physicians either accepted or rejected the proposed changes in drug therapy. Comparisons were made between ileostomy and colostomy patients regarding type and extent of PIs.
Out of the 80 patients included in the cohort, 54 (67.5%) had an ileostomy and 26 (32.5%) a colostomy. In this study, 288 PIs were documented (234 ileostomy vs. 54 colostomy), of wich 94.0% were accepted and implemented by the physicians. The most common reason for PIs in both subgroups (29.6% ileostomy vs. 26.1% colostomy) was a missing drug although indicated (e.g. no loperamide, but high stoma output). The proportion of PIs associated with the ostomy was higher in ileostomy patients (48.3% ileostomy vs. 31.5% colostomy; p = 0.025). Typical ORPs were extracted and analyzed as case studies including recommendations for their respective management and prevention.
This study highlights the importance of clinical pharmacists being a part of interdisciplinary teams to collaboratively improve ostomy care and patient safety. Especially ileostomy patients are more vulnerable for ORPs in the context of drug therapy and need to be monitored carefully.
造口手术是一种常见的手术，给患者和医护人员带来了各种挑战。有许多指南针对不同的造口相关问题（ORP）并支持造口护理的跨学科方法，但缺乏关于造口手术后优化药物治疗的循证文献。
调查和描述与药物治疗相关的典型 ORP，并从药学角度提供最佳实践建议。
在住院期间，连续纳入患有回肠或结肠造口术的患者进行前瞻性、干预性单中心队列研究，特别关注药物治疗。临床药师通过进行三级药物审查和患者访谈来评估用药不当（DRP）。药剂师的干预措施（PI）由两名资深临床药师进行评估，并记录在 DokuPIK（医院药剂师干预记录）中。在进行跨学科讨论后，医生要么接受，要么拒绝药物治疗的建议改变。比较回肠造口术和结肠造口术患者的 PI 类型和程度。
在纳入的 80 名患者队列中，54 名（67.5%）患有回肠造口术，26 名（32.5%）患有结肠造口术。在这项研究中，共记录了 288 项 PI（234 项回肠造口术与 54 项结肠造口术），其中 94.0%被医生接受并实施。在两个亚组中，PI 最常见的原因是尽管有指征（例如，没有洛哌丁胺，但造口输出量高）但仍缺少药物。与造口相关的 PI 在回肠造口术患者中更为常见（48.3%回肠造口术与 31.5%结肠造口术；p=0.025）。提取并分析了典型的 ORP，并作为案例研究进行分析，包括对各自管理和预防的建议。
这项研究强调了临床药师作为跨学科团队的一部分的重要性，以共同改善造口护理和患者安全。特别是回肠造口术患者在药物治疗方面更容易出现 ORP，需要密切监测。
