Yoshikawa Naoki, Miyata Chiaki, Koreeda Hidehiko, Nakahara Shuichi, Matsusaki Yuki, Yamada Yusei, Nagano Takehiko, Ochiai Hidenobu, Ikeda Ryuji
Department of Pharmacy, University of Miyazaki Hospital, 5200 Kihara, Kiyotake-Cho, Miyazaki 889-1692, Japan.
Department of Pharmacy, University of Miyazaki Hospital, Miyazaki, Japan.
Ther Adv Drug Saf. 2025 May 24;16:20420986251339580. doi: 10.1177/20420986251339580. eCollection 2025.
Task shifting and sharing have been proposed as strategies to address healthcare staffing shortages and improve patient outcomes. In emergency and intensive care medicine, pharmacist interventions have shown potential to reduce medication errors and improve care quality. However, the precise benefits of pharmacist support in therapeutic drug monitoring (TDM) for emergency center inpatients require further verification.
To determine the contribution of pharmacist support in entering blood drug concentration test orders to patient safety during anti-methicillin-resistant (MRSA) drug administration in the emergency and critical care center, and investigate the association between this support and the frequency of vancomycin-induced kidney injury.
Single-center retrospective cohort study comparing outcomes 2 years before and 2 years after implementing pharmacist support for blood concentration test order entry.
Patients receiving intravenous vancomycin with blood concentrations measured at the emergency center were included. Propensity score matching was used to minimize confounding. The primary outcome was the change in frequency of vancomycin-induced kidney injury before and after pharmacist support implementation.
Pharmacist support significantly reduced the frequency of vancomycin-induced kidney injury (from 6.5% to 0.0%, = 0.043) and shortened time to first TDM implementation ( = 0.019) in the overall cohort. Similar significant reductions were observed in the propensity score matched cohort (from 11.9% to 0.0%, = 0.013).
Pharmacist support in entering blood drug concentration test orders significantly reduced vancomycin-induced kidney injury frequency and shortened time to first TDM, enhancing patient safety during anti-MRSA medication administration in the emergency and critical care center. This task-shifting approach demonstrates clear benefits for patient care and physician workload.
任务转移和共享已被提议作为解决医疗人员短缺问题并改善患者治疗效果的策略。在急诊和重症医学中，药师干预已显示出减少用药错误和提高护理质量的潜力。然而，药师在急诊中心住院患者的治疗药物监测（TDM）中提供支持的确切益处尚需进一步验证。
确定在急诊和重症监护中心使用抗耐甲氧西林金黄色葡萄球菌（MRSA）药物期间，药师在录入血药浓度检测医嘱方面提供的支持对患者安全的贡献，并调查这种支持与万古霉素所致肾损伤发生频率之间的关联。
单中心回顾性队列研究，比较实施药师支持录入血药浓度检测医嘱前2年和后2年的结果。
纳入在急诊中心接受静脉注射万古霉素并进行血药浓度检测的患者。采用倾向评分匹配法以尽量减少混杂因素。主要结局是实施药师支持前后万古霉素所致肾损伤发生频率的变化。
在整个队列中，药师的支持显著降低了万古霉素所致肾损伤的发生频率（从6.5%降至0.0%，P = 0.043），并缩短了首次进行TDM的时间（P = 0.019）。在倾向评分匹配队列中也观察到了类似的显著降低（从11.9%降至0.0%，P = 0.013）。
在录入血药浓度检测医嘱方面，药师的支持显著降低了万古霉素所致肾损伤的发生频率，并缩短了首次进行TDM的时间，在急诊和重症监护中心使用抗MRSA药物期间提高了患者安全性。这种任务转移方法对患者护理和医生工作量显示出明显益处。
