Safety and effectiveness outcomes of an inpatient collaborative drug therapy management service for direct thrombin inhibitors
| Autor: | Carol L. White, Tanna B. Cooper, David J. Taber, Walter E. Uber, Heather Kokko, Joseph E Mazur |
|---|---|
| Rok vydání: | 2012 |
| Předmět: |
Adult
Male medicine.medical_specialty Time Factors Hemorrhage Arginine Pharmacists Antithrombins Argatroban Cohort Studies Outcome Assessment Health Care Humans Medication Errors Medicine Bivalirudin Dosing Cooperative Behavior Intensive care medicine Aged Retrospective Studies Pharmacology Inpatients Sulfonamides medicine.diagnostic_test Heparin business.industry Health Policy Retrospective cohort study Hirudins Middle Aged Thrombocytopenia Peptide Fragments Recombinant Proteins Direct thrombin inhibitor Pipecolic Acids Emergency medicine Cohort Female Partial Thromboplastin Time Drug Monitoring Pharmacy Service Hospital business Cohort study medicine.drug Partial thromboplastin time |
| Zdroj: | American Journal of Health-System Pharmacy. 69:1993-1998 |
| ISSN: | 1535-2900 1079-2082 |
| DOI: | 10.2146/ajhp120121 |
| Popis: | Purpose The impact of a collaborative drug therapy management (CDTM) agreement enabling pharmacist-managed direct thrombin inhibitor (DTI) therapy was evaluated. Methods A retrospective chart review was conducted to compare selected outcome measures between cohorts of adults who received argatroban or bivalirudin therapy for suspected heparin-induced thrombocytopenia (HIT) before ( n = 25) and after ( n = 25) the implementation of an institutional DTI protocol under which properly trained and credentialed pharmacists have a primary role in dosing and monitoring DTI infusions. The primary endpoints were the mean time to attainment of activated partial thromboplastin time (aPTT) values in a specified therapeutic range and the proportion of total inpatient treatment time during which aPTT values were in that range. Secondary endpoints included the incidence of major and minor bleeding and the incidence of medication errors. Results After implementation of the DTI protocol, therapeutic aPTT values were achieved more rapidly (a mean of 3.4 hours in the postimplementation cohort versus a mean of 7.7 hours in the preimplementation cohort, p = 0.009) and maintained more consistently. Rates of bleeding and overall mortality were similar in the two groups; the frequencies of documented medication errors were 12% and 40% in the postimplementation and preimplementation cohorts, respectively ( p = 0.05). Conclusion A pharmacist-driven DTI program resulted in improved effectiveness and safety outcomes, as demonstrated by improved attainment of target aPTT values and a decreased frequency of medication errors. Am J Health-Syst Pharm. 2012; 69:1993-8 |
| Databáze: | OpenAIRE |
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