단일기관에서 혈액투석 환자의 반코마이신 치료적 약물 농도 모니터링 업무 운영 실태 조사와 업무 개선 방안 (An Improvement Plan with for the Assessment of Therapeutic Drug Monitoring Services for Vancomycin in Hemodialysis Patients: A Single Institution)

서지정보

· 발행기관 : 한국병원약사회
· 수록지 정보 : 병원약사회지 / 34권 / 4호 / 380 ~ 389페이지
· 저자명 : 안희영, 정선미, 김재송, 손은선

초록

Background : Vancomycin is a commonly administered antibiotic for hemodialysis patients. However, the best dosing and monitoring algorithms for these patients remain unclear thus far. The purpose of this study is to analyze and improve therapeutic drug monitoring (TDM) services for vancomycin in hemodialysis patients.
Methods : Hemodialysis patients with TDM services between January 2015 and June 2016 were included. Sixty four cases of TDM services in 30 patients were retrospectively reviewed.
Results : Appropriacy Among the 61(95%) reports recommending serum sampling time, 33(52%) cases followed the recommended sampling time for both peak and trough concentration. There were 12 errors across the 10 reports; all of them were a result of poor awareness of the administration of vancomycin. When additional TDM was followed, the time taken to the 2nd TDM (follow-up TDM) was between 4 and 30 days.
Efficiency A total of 37(58%) cases followed the recommended dosing regimen and the total that did not follow were 20(31%). In the remaining cases(7 cases, 11%), the vancomycin administration was ceased after prior TDM. Among the 37(58%) cases, following the recommended dosing regimen, 9(24%) reports were expected to achieve the target trough level. Among the 20(31%) cases that did not follow the recommended dosing regimens, none of the reports achieved the target trough level.
Conclusion : In our institutions’TDM services, TDM reports’appropriacy is unsatisfactory because the sampling wasn’t taken at the recommended times. The awareness of the vancomycin administration was poor and the 2nd TDM was delayed. Also, the TDM reports’efficiency were not high. Providing the appropriate guide of the serum sampling time and the same guide in one patient and recommending the appropriate follow-up duration were necessary to ensure efficient TDM services. Also, full awareness of the vancomycin administration was needed to exclude errors in the reports. With the pharmacists’participation in the TDM services, these problems can be solved. By settling the guidelines of the vancomycin TDM services based on this study, we expect to improve the appropriacy and efficiency of vancomycin TDM services.

영어초록

Background : Vancomycin is a commonly administered antibiotic for hemodialysis patients. However, the best dosing and monitoring algorithms for these patients remain unclear thus far. The purpose of this study is to analyze and improve therapeutic drug monitoring (TDM) services for vancomycin in hemodialysis patients.
Methods : Hemodialysis patients with TDM services between January 2015 and June 2016 were included. Sixty four cases of TDM services in 30 patients were retrospectively reviewed.
Results : Appropriacy Among the 61(95%) reports recommending serum sampling time, 33(52%) cases followed the recommended sampling time for both peak and trough concentration. There were 12 errors across the 10 reports; all of them were a result of poor awareness of the administration of vancomycin. When additional TDM was followed, the time taken to the 2nd TDM (follow-up TDM) was between 4 and 30 days.
Efficiency A total of 37(58%) cases followed the recommended dosing regimen and the total that did not follow were 20(31%). In the remaining cases(7 cases, 11%), the vancomycin administration was ceased after prior TDM. Among the 37(58%) cases, following the recommended dosing regimen, 9(24%) reports were expected to achieve the target trough level. Among the 20(31%) cases that did not follow the recommended dosing regimens, none of the reports achieved the target trough level.
Conclusion : In our institutions’TDM services, TDM reports’appropriacy is unsatisfactory because the sampling wasn’t taken at the recommended times. The awareness of the vancomycin administration was poor and the 2nd TDM was delayed. Also, the TDM reports’efficiency were not high. Providing the appropriate guide of the serum sampling time and the same guide in one patient and recommending the appropriate follow-up duration were necessary to ensure efficient TDM services. Also, full awareness of the vancomycin administration was needed to exclude errors in the reports. With the pharmacists’participation in the TDM services, these problems can be solved. By settling the guidelines of the vancomycin TDM services based on this study, we expect to improve the appropriacy and efficiency of vancomycin TDM services.

참고자료

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