IV Vancomycin 적시투약 현황 분석

Abstract

As interest in patients’safety has been increasing, the timely administration ofscheduled medication is being more and more emphasized. In 2013, the research hospital establishedthe guideline for‘ time-critical medications (TCM)’based on the‘30-minute rule’from theInstitute for Safe Medication Practices (ISMP) and the ‘medication management and use (MMU)standard’of the Joint Commission International. According to this guideline, if the maintenancedoses of these medications are administrated early or delayed for more than 30 minutes before orafter the scheduled dose, such effect may cause harm or result in substantial sub-optimal therapyor pharmacological effect. The research hospital has a total 125 TCMs, including those medications that need therapeutic drug monitoring. At the pharmacy, before prepared TCMs aredelivered to each ward, warning labels are attached to each TCM during the inspection procedureby charging pharmacists. If delayed or early administration of TCM occurs, it should be reportedas a near miss to the internal patient safety management program. Among these time-criticalmedications, this research was conducted on vancomycin of which dosing time could significantlyaffect the maintenance of therapeutic plasma concentration. From April to August 2013, vancomycinadministration status (administration time adherence, and the reason of early or delayedadministration, where applicable) was inspected at the wards of pulmonary medicine, internalmedicine intensive care unit, and emergency center. Overall, vancomycin was administrated a total 1,638 times in 167 patients in 3 investigateddepartments. Except for the 563 first doses, the administration time of 997 cases was adhered(administration time adherence rate = 92.74%, 997/1,075). The reason for early or delayed administrationwas omitted in most cases (61.54%, 48/78). The most frequently marked reason for suchaction was the‘ change of the administration time based on the TDM result or change the ward’(26.92%, 21/78) and‘ other medical care procedures(operation, lab test , etc)’(11.54%, 9/78). The adherence rate of vancomycin timely administration was high and well maintained in theresearch hospital. Pharmacists also played an important role in this favorable result. Furthersustained education of healthcare professionals will be needed for a more detail management ofsome early of delayed administration.