Matsumoto Takanori, Matsumoto Taichi, Tsutsumi Chiyo, Hadano Yoshiro
Department of Pharmacy, St. Mary's Hospital, 422 Tsubuku-Honmachi, Kurume, Fukuoka, 830-8543, Japan.
Basic Medical Research Unit, St. Mary's Research Center, 422 Tsubuku-Honmachi, Kurume, Fukuoka, 830-8543, Japan.
J Pharm Health Care Sci. 2024 Sep 27;10(1):59. doi: 10.1186/s40780-024-00377-3.
Antimicrobial agents (AMAs) are essential for treating infections. A part of AMAs chelate with metal cations (MCs), reducing their blood concentrations. That drug-drug interaction could lead to a reduction of therapeutic efficacy and the emergence of drug-resistant bacteria. However, prescriptions ordering concomitant intake (co-intake) of AMAs and MCs are frequently seen in clinical settings. A method for preventing such prescriptions is urgently needed.
We implemented pop-up alerts in the hospital's ordering and pharmacy dispensation support system to notify the prescriptions ordering co-intake of AMAs and MCs for physicians and pharmacists, respectively. To assess the effectiveness of the pop-up alerts, we investigated the number of prescriptions ordering co-intake of AMAs and MCs and the number of pharmacist inquiries to prevent co-intake of AMAs and MCs before and after the implementation of pop-up alerts.
Before the implementation of pop-up alerts, 84.5% of prescriptions containing AMA and MCs ordered co-intake of AMAs and MCs. Implementing pop-up alerts time-dependently reduced the proportion of prescriptions ordering co-intake of AMAs and MCs to 43.8% and 29.5% one year and two years later, respectively. The reduction of tetracycline-containing prescriptions was mainly significant. Before the implementation of pop-up alerts, the proportion of prescriptions in which pharmacists prevented co-intake of AMAs and MCs was 3.4%. Implementing pop-up alerts time-dependently increased proportions of such prescriptions to 20.9% and 28.2% one year and two years later.
Implementing pop-up alerts reduced prescriptions ordering co-intake of AMAs and MCs and accelerated pharmacists to prevent co-intake of AMAs and MCs. The implementation of dual pop-up alerts in the hospital's ordering and pharmacy dispensation support system could help prevent co-intake of AMAs and MCs.
抗菌药物（AMAs）对于治疗感染至关重要。一部分抗菌药物会与金属阳离子（MCs）螯合，降低其血药浓度。这种药物相互作用可能导致治疗效果降低以及耐药菌的出现。然而，临床环境中经常出现同时开具抗菌药物和金属阳离子的处方。迫切需要一种防止此类处方的方法。
我们在医院的医嘱和药房配药支持系统中设置了弹出式提醒，分别向医生和药剂师通知同时开具抗菌药物和金属阳离子的处方。为了评估弹出式提醒的有效性，我们调查了弹出式提醒实施前后同时开具抗菌药物和金属阳离子的处方数量以及药剂师为防止同时开具抗菌药物和金属阳离子而进行询问的次数。
在实施弹出式提醒之前，84.5%含有抗菌药物和金属阳离子的处方开具了抗菌药物和金属阳离子的同时服用。实施弹出式提醒后，同时开具抗菌药物和金属阳离子的处方比例随时间下降，一年后和两年后分别降至43.8%和29.5%。含四环素处方的减少尤为显著。在实施弹出式提醒之前，药剂师阻止抗菌药物和金属阳离子同时服用的处方比例为3.4%。实施弹出式提醒后，此类处方比例随时间增加，一年后和两年后分别升至20.9%和28.2%。
实施弹出式提醒减少了同时开具抗菌药物和金属阳离子的处方，并促使药剂师阻止抗菌药物和金属阳离子同时服用。在医院的医嘱和药房配药支持系统中实施双重弹出式提醒有助于防止抗菌药物和金属阳离子同时服用。
