Effectiveness of pharmacist dosing adjustment for critically ill patients receiving continuous renal replacement therapy: a comparative study

被引：26
作者：
Jiang, Sai-Ping [1 ]
Zhu, Zheng-Yi [2 ]
Wu, Xiao-Liang [3 ]
Lu, Xiao-Yang [1 ]
Zhang, Xing-Guo [1 ]
Wu, Bao-Hua [1 ]
机构：
[1] Zhejiang Univ, Coll Med, Affiliated Hosp 1, Dept Pharm, Hangzhou 310003, Zhejiang, Peoples R China
[2] Zhejiang Univ, Coll Med, Childrens Hosp, Dept Pharm, Hangzhou 310003, Zhejiang, Peoples R China
[3] Zhejiang Univ, Coll Med, Affiliated Hosp 1, Intens Care Unit, Hangzhou 310003, Zhejiang, Peoples R China
来源：
THERAPEUTICS AND CLINICAL RISK MANAGEMENT | 2014年 / 10卷
关键词：
pharmacist interventions; drug dosing adjustment; adverse drug event; cost saving; CRRT; ADVERSE DRUG EVENTS; INTENSIVE-CARE-UNIT; IMPACT; OUTCOMES;
D O I：
10.2147/TCRM.S59187
中图分类号：
R19 [保健组织与事业（卫生事业管理）];
学科分类号：
摘要：
Background: The impact of continuous renal replacement therapy (CRRT) on drug removal is complicated; pharmacist dosing adjustment for these patients may be advantageous. This study aims to describe the development and implementation of pharmacist dosing adjustment for critically ill patients receiving CRRT and to examine the effectiveness of pharmacist interventions. Methods: A comparative study was conducted in an intensive care unit (ICU) of a university-affiliated hospital. Patients receiving CRRT in the intervention group received specialized pharmacy dosing service from pharmacists, whereas patients in the no-intervention group received routine medical care without pharmacist involvement. The two phases were compared to evaluate the outcome of pharmacist dosing adjustment. Results: The pharmacist carried out 233 dosing adjustment recommendations for patients receiving CRRT, and 212 (90.98%) of the recommendations were well accepted by the physicians. Changes in CRRT-related variables (n=144, 61.81%) were the most common risk factors for dosing errors, whereas antibiotics (n=168, 72.10%) were the medications most commonly associated with dosing errors. Pharmacist dosing adjustment resulted in a US$2,345.98 ICU cost savings per critically ill patient receiving CRRT. Suspected adverse drug events in the intervention group were significantly lower than those in the preintervention group (35 in 27 patients versus [vs] 18 in eleven patients, P<0.001). However, there was no significant difference between length of ICU stay and mortality after pharmacist dosing adjustment, which was 8.93 days vs 7.68 days (P=0.26) and 30.10% vs 27.36% (P=0.39), respectively. Conclusion: Pharmacist dosing adjustment for patients receiving CRRT was well accepted by physicians, and was related with lower adverse drug event rates and ICU cost savings. These results may support the development of strategies to include a pharmacist in the multidisciplinary ICU team.
引用
收藏
页码：405 / 412
页数：8
相关论文
共 24 条
[1]   Pharmacokinetics and drug dosing adjustments during continuous venovenous hemofiltration or hemodiafiltration in critically ill patients [J].
Bugge, JF .
ACTA ANAESTHESIOLOGICA SCANDINAVICA, 2001, 45 (08) :929-934
[2]   Principles of Antibacterial Dosing in Continuous Renal Replacement Therapy [J].
Choi, Gordon ;
Gomersall, Charles D. ;
Tian, Qi ;
Joynt, Gavin M. ;
Li, Alexander M. M. Y. ;
Lipman, Jeffrey .
BLOOD PURIFICATION, 2010, 30 (03) :195-212
[3]   Drug Dosing During Continuous Renal Replacement Therapy [J].
Churchwell, Mariann D. ;
Mueller, Bruce A. .
SEMINARS IN DIALYSIS, 2009, 22 (02) :185-188
[4]   Pharmacist reporting of serious adverse drug events to the Food and Drug Administration [J].
Gavaza, Paul ;
Brown, Carolyn M. ;
Lawson, Kenneth A. ;
Rascati, Karen L. ;
Steinhardt, Mary ;
Wilson, James P. .
JOURNAL OF THE AMERICAN PHARMACISTS ASSOCIATION, 2012, 52 (05) :E109-E112
[5]  
Glossop A, 2008, J INTENSIVE CARE SOC, V9, P160
[6]   Appropriate antibiotic dosing in severe sepsis and acute renal failure: factors to consider [J].
Javier Gonzalez de Molina, Francisco ;
Ferrer, Ricard .
CRITICAL CARE, 2011, 15 (04)
[7]   A primer on continuous renal replacement therapy for critically ill patients [J].
Joy, MS ;
Matzke, GR ;
Armstrong, DK ;
Marx, MA ;
Zarowitz, BJ .
ANNALS OF PHARMACOTHERAPY, 1998, 32 (03) :362-375
[8]   The impact of critical care pharmacists on enhancing patient outcomes [J].
Kane, SL ;
Weber, RJ ;
Dasta, JF .
INTENSIVE CARE MEDICINE, 2003, 29 (05) :691-698
[9]   Analysis of risk factors for adverse drug events in critically ill patients [J].
Kane-Gill, Sandra L. ;
Kirisci, Levent ;
Verrico, Margaret M. ;
Rothschild, Jeffrey M. .
CRITICAL CARE MEDICINE, 2012, 40 (03) :823-828
[10]   On-ward participation of a hospital pharmacist in a Dutch intensive care unit reduces prescribing errors and related patient harm: an intervention study [J].
Klopotowska, Joanna E. ;
Kuiper, Rob ;
van Kan, Hendrikus J. ;
de Pont, Anne-Cornelie ;
Dijkgraaf, Marcel G. ;
Lie-A-Huen, Loraine ;
Vroom, Margreeth B. ;
Smorenburg, Susanne M. .
CRITICAL CARE, 2010, 14 (05)
123