Schentag J J, Ballow C H, Fritz A L, Paladino J A, Williams J D, Cumbo T J, Ali R V, Galletta V A, Gutfeld M B, Adelman M H
Center for Clinical Pharmacy Research, State University of New York (SUNY), Buffalo.
Diagn Microbiol Infect Dis. 1993 Mar-Apr;16(3):255-64. doi: 10.1016/0732-8893(93)90119-r.
Rapid reporting of culture and susceptibility data is the first of several important steps in the successful management of infected patients. As has been said many times, rapidly reported data are of little value unless the patient directly benefits. Benefit requires better overall communication and an action plan linked to timely use of these results. In 1989 the Millard Fillmore Hospital Antibiotic Review Committee developed and implemented a prototype approach to hospital wide antimicrobial management. The formulary was revised and the drug use evaluation process modified to enhance effectiveness and to lower the cost of therapy and inventory. Clinical pharmacy antimicrobial agent management specialists were then recruited to individualize patient treatments to the isolated pathogens in conjunction with the Division of Infectious Diseases. To provide the clinical pharmacy specialists with rapid and clinically useful information, a real-time computer link was created between the pharmacy (antibiotic orders) and the microbiology laboratory (culture results). Customized software was implemented to screen all patients automatically for mismatches between pathogens and drugs, or to screen for doses inappropriate to minimum inhibitory concentration or renal function. Special attention was paid to identification of opportunities to target a more appropriate narrow-spectrum regimen after culture results became available. Changes in antimicrobial regimen or dosage were made by contacting the prescribing physician. Over 90% of the recommended changes were made, and virtually all changed regimens had satisfactory clinical outcome. Real dollar expenditures for antimicrobial agents declined by > $200,000 per year. Prior to the institution of this computerized clinical management strategy, antimicrobial purchases were rising yearly at the rate of 12%-15%. The combined efforts of clinical pharmacy, microbiology, and infectious disease personnel successfully optimized antimicrobial therapy on a hospital wide basis. Antimicrobial agent optimization improved patient outcome, and the cost savings more than covered the costs of the program personnel and software.
快速报告培养和药敏数据是成功管理感染患者的几个重要步骤中的第一步。正如人们多次所说，快速报告的数据若不能使患者直接受益则毫无价值。受益需要更好的全面沟通以及与及时利用这些结果相关的行动计划。1989年，米勒德·菲尔莫尔医院抗生素审查委员会制定并实施了一种全院范围抗菌药物管理的原型方法。修订了处方集，修改了药物使用评估流程，以提高疗效并降低治疗和库存成本。随后招聘了临床药学抗菌药物管理专家，以便与传染病科合作，根据分离出的病原体为患者制定个体化治疗方案。为了向临床药学专家提供快速且具有临床实用性的信息，在药房（抗生素医嘱）和微生物实验室（培养结果）之间建立了实时计算机链接。实施了定制软件，以自动筛查所有患者，查找病原体与药物之间的不匹配情况，或筛查剂量与最低抑菌浓度或肾功能不匹配的情况。特别关注在培养结果出来后确定采用更合适的窄谱治疗方案的机会。通过联系开处方的医生来对抗菌治疗方案或剂量进行调整。超过90%的建议调整得以实施，而且几乎所有调整后的治疗方案都取得了令人满意的临床结果。抗菌药物的实际支出每年减少了超过20万美元。在实施这种计算机化临床管理策略之前，抗菌药物采购量每年以12% - 15%的速度增长。临床药学、微生物学和传染病科人员的共同努力在全院范围内成功优化了抗菌治疗。抗菌药物的优化改善了患者的治疗结果，节省的成本超过了项目人员和软件的成本。
