基于体重的儿科舒格迈司标准化剂量:一项旨在提高用药指南合规性并减少浪费和成本的质量改进计划》(A Quality Improvement Initiative to Improve Compliance with Dosing Guidelines and Reduce Waste and Cost.

IF 1.6 Q2 ANESTHESIOLOGY Anesthesiology Research and Practice Pub Date : 2024-08-24 eCollection Date: 2024-01-01 DOI:10.1155/2024/6049114
Sydney E S Brown, Michael Meyer, Andrea Meyer, Ruth Cassidy, Xinyi Zhao, Deborah Wagner, Laura Wetzel, Douglas A Colquhoun
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引用次数: 0

摘要

方法:将舒格迈司小瓶分装成 25、50 或 100 毫克等分,由药房工作人员按实际体重约 2 毫克/千克的剂量(±10%)分发给麻醉工作人员。我们分析了干预前/干预后(2021 年 1 月 4 日)2019 年 1 月 1 日至 2023 年 3 月 15 日期间舒格迈司浪费和剂量操作的变化。我们使用苏麦丁给药前的最后四列火车(TOF)来衡量剂量的适当性:7,889 名 2-17 岁的患者(4,771 人有 TOF 记录),ASA 1-4 级,接受全身麻醉,使用类固醇 NMB 药物和苏麦丁逆转。干预前和干预后的平均剂量分别为 2.5 毫克/千克(标清:1.2)和 2.4 毫克/千克(标清:0.96)。接受 2 毫克/千克或 4 毫克/千克标准剂量的病例比例较低(干预前:77.6%;干预后:66.7%)。每个病例的平均浪费量从 4.2 毫克/千克(标度:4.1)降至 0.22 毫克/千克(标度:0.38)。在 TOF 测得抽搐次数为 0 或 1 次、应至少接受 4 毫克/千克治疗的病例中,接受至少 3.6 毫克/千克治疗的病例较少(治疗后:56.7% 对治疗前:66.8%),接受少于 2.2 毫克/千克治疗的病例比例较高(治疗后:27.4% 对治疗前:20.7%)。在本应接受至少 2 毫克/千克 TOF 治疗的病例中,接受 3.6 毫克/千克以上治疗的患者比例从 9.5%降至 5.2%。讨论对舒格迈司药瓶进行分装可减少浪费,但不能减少剂量,而且更有可能出现剂量严重不足的情况。虽然对药瓶进行分装可使更多人获得舒格迈德和其他昂贵的药物,但可能会带来意想不到的后果。
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Weight-Based Standardized Sugammadex Dosing in Pediatrics: A Quality Improvement Initiative to Improve Compliance with Dosing Guidelines and Reduce Waste and Cost.

Methods: Sugammadex vials were fractionated into 25, 50, or 100 mg aliquots, which would be distributed to anesthesia staff by pharmacy staff in approximate 2 mg/kg of actual body weight doses (±10%). We analyzed changes in sugammadex waste and dosing practices 1/1/2019 to 3/15/2023 pre/postintervention (4/1/2021). We gauged dose appropriateness using last train of four (TOF) prior to sugammadex administration.

Results: 7,889 patients 2-17 years (4,771 with documented TOF), ASA 1-4 receiving general anesthesia with a steroidal NMB medication and sugammadex reversal. Pre- and postintervention mean doses were 2.5 mg/kg (SD: 1.2) and 2.4 mg/kg (SD: 0.96), respectively. A smaller proportion of cases received standard 2 or 4 mg/kg doses (pre: 77.6 vs. post: 66.7%). Mean waste per case declined from 4.2 mg/kg (SD: 4.1) to 0.22 mg/kg (SD: 0.38). Among cases with 0 or 1 measured twitches on TOF that should receive at least 4 mg/kg, fewer received at least 3.6 mg/kg (post: 56.7% vs. pre: 66.8%), and a greater proportion received less than 2.2 mg/kg (post: 27.4% vs. pre: 20.7%). Among cases that should have received at least 2 mg/kg by TOF, the proportion of patients receiving more than 3.6 mg/kg declined from 9.5% to 5.2%. Discussion. Fractionating sugammadex vials was associated with decreases in waste, but not dose, and significant underdosing was more likely to occur. While vial fractionation could enable increased access to sugammadex and other costly medications, it may introduce unintended consequences.

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来源期刊
CiteScore
3.10
自引率
0.00%
发文量
29
审稿时长
18 weeks
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