Belliveau P P, Rothman A L, Maday C E
Department of Pharmacy, University of Massachusetts Medical Center, Worcester 01655-0251, USA.
Am J Health Syst Pharm. 1996 Jul 1;53(13):1570-5. doi: 10.1093/ajhp/53.13.1570.
The implementation, monitoring, and impact of a program to restrict vancomycin use are described. A vancomycin restriction program was implemented in February 1995 at an acute care teaching hospital after guidelines for vancomycin use were established by a multidisciplinary group. Pharmacists reviewed each vancomycin order, suggested alternative treatments when vancomycin use did not comply with the guidelines, and set duration limits for all orders. Orders requiring greater clinical experience for review were referred to a pharmacist or a physician in the division of infectious diseases. The program was monitored by an infectious diseases pharmacist. Data collected after the program was established showed that the volume of vancomycin use decreased substantially. Problems in enforcing the restriction program included administration of vancomycin for surgical prophylaxis before the order reached the pharmacy, continuing use of vancomycin for initial empirical treatment of febrile neutropenic and immunocompromised patients, inadequate tracking of the evaluations, and deficiencies in the evaluations related to a need for continuing education of the pharmacists about the program. Use of vancomycin decreased after a pharmacy-enforced restriction program was implemented.
本文描述了一项限制万古霉素使用计划的实施、监测及影响。1995年2月，在一个多学科小组制定了万古霉素使用指南后，一家急症护理教学医院实施了万古霉素限制计划。药剂师会审查每一份万古霉素医嘱，当万古霉素的使用不符合指南时，建议采用替代治疗方法，并为所有医嘱设定使用期限。需要更多临床经验来审查的医嘱会提交给传染病科的药剂师或医生。该计划由一名传染病药剂师进行监测。计划实施后收集的数据表明，万古霉素的使用量大幅下降。实施限制计划存在的问题包括：在医嘱送达药房之前就进行万古霉素的外科预防性给药；继续将万古霉素用于发热性中性粒细胞减少和免疫功能低下患者的初始经验性治疗；对评估的跟踪不足；以及评估存在缺陷，原因是药剂师需要接受有关该计划的继续教育。在实施了由药房强制执行的限制计划后，万古霉素的使用量有所下降。
