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首页> 外文期刊>Integrated Pharmacy Research and Practice >Pharmacist-led implementation of a vancomycin guideline across medical and surgical units: impact on clinical behavior and therapeutic drug monitoring outcomes
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Pharmacist-led implementation of a vancomycin guideline across medical and surgical units: impact on clinical behavior and therapeutic drug monitoring outcomes

机译：由药剂师领导的医疗和外科部门实施万古霉素指南：对临床行为和治疗药物监测结果的影响

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Background: Vancomycin is the antibiotic of choice for the treatment of serious infections such as methicillin-resistant Staphylococcus aureus (MRSA). Inappropriate prescribing of vancomycin can lead to therapeutic failure, antibiotic resistance, and drug toxicity. Objective: To examine the effectiveness of pharmacist-led implementation of a clinical practice guideline for vancomycin dosing and monitoring in a teaching hospital. Methods: An observational pre–post study design was undertaken to evaluate the implementation of the vancomycin guideline. The implementation strategy principally involved education, clinical vignettes, and provision of pocket guidelines to accompany release of the guideline to the hospital Intranet. The target cohort for clinical behavioral change was junior medical officers, as they perform the majority of prescribing and monitoring of vancomycin in hospitals. Assessment measures were recorded for vancomycin prescribing, therapeutic drug monitoring, and patient outcomes. Results: Ninety-nine patients, 53 pre- and 46 post-implementation, were included in the study. Prescribing of a loading dose increased from 9% to 28% ( P =0.02), and guideline adherence to starting maintenance dosing increased from 53% to 63% ( P =0.32). Dose adjustment by doctors when blood concentrations were outside target increased from 53% to 71% ( P =0.12), and correct timing of initial concentration measurement increased from 43% to 57% ( P =0.23). Appropriately timed trough concentrations improved from 73% to 81% ( P =0.08). Pre-dose (trough) concentrations in target range rose from 33% to 44% ( P =0.10), while potentially toxic concentrations decreased from 32% to 21% ( P =0.05) post-implementation. Infection cure rates for patients increased from 85% to 96% ( P =0.11) after the guideline was implemented. Conclusion: The implementation strategy employed in this study demonstrated potential effectiveness, and should prompt additional larger studies to optimize strategies that will translate into improved clinical practice using vancomycin.
机译：背景：万古霉素是治疗严重感染（例如耐甲氧西林的金黄色葡萄球菌（MRSA））的首选抗生素。万古霉素处方不当会导致治疗失败，抗生素耐药性和药物毒性。目的：探讨由药剂师主导的在教学医院实施万古霉素剂量和监测临床实践指南的有效性。方法：进行了观察前研究后设计，以评估万古霉素指南的实施情况。实施策略主要包括教育，临床渐晕和提供袖珍指南，以将指南发布到医院内部网。临床行为改变的目标人群是初级医务人员，因为他们在医院中对万古霉素进行大多数处方和监测。记录了万古霉素处方，治疗药物监测和患者预后的评估措施。结果：这项研究包括了39名患者，实施前53名，实施后46名。开药剂量的处方从9％增加到28％（P = 0.02），开始坚持维持给药的指导原则从53％增加到63％（P = 0.32）。当血液浓度超出目标时，医生的剂量调整从53％增加到71％​​（P = 0.12），初始浓度测量的正确时机从43％增加到57％（P = 0.23）。适当的定时槽浓度从73％提高到81％（P = 0.08）。在实施后，目标范围内的剂量前（谷）浓度从33％上升至44％（P = 0.10），而潜在毒性浓度从实施后的32％下降至21％（P = 0.05）。实施指南后，患者的感染治愈率从85％增加到96％（P = 0.11）。结论：本研究中采用的实施策略显示出潜在的效果，并应促使进行其他大型研究以优化策略，这些策略将转化为使用万古霉素改善临床实践。

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