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신생아중환자의 안전한 약물사용을 위한 약료서비스

Pharmaceutical Care for Medication Safety in Critically Ill Neonates

  • 투고 : 2020.08.20
  • 심사 : 2020.09.15
  • 발행 : 2020.09.30

초록

Objective: This study aimed to investigate pharmaceutical care for critically ill neonates and suggest targeted strategies compatible with the Korean health-system pharmacy. Methods: Articles that reported pharmacy practices for critically ill neonates were reviewed. Pharmaceutical care practices and roles of neonatal pharmacists were identified, and criteria were developed for neonates in need of specialized care by clinical pharmacists. Results: Neonatal pharmacists play many roles in the overall medication management pathway. For clinical decision support, multidisciplinary ward rounds, clinical pharmacokinetic services, and consultation for pharmacotherapy and nutrition support were conducted. Prevention and resolution of drug-related problems through review of medication charts contributed to medication safety. Pharmaceutical optimization of intravenous medication played an important role in safe and effective therapy. Information on the use of off-label medicine, recommended dosage and dosing schedules, and stability of intravenous medicine was provided to other health professionals. Most clinical practices for neonates in Korea included therapeutic drug monitoring and nutrition support services. Reduction in medication errors and adverse drug reactions, shortening the duration of weaning medicines, decreasing the use and cost of antimicrobials, and improvement in nutrition status were reported as the outcomes of pharmacist-led interventions. The essential criteria of pharmaceutical care, including for patients with potential high-risk factors for drug-related problems, was developed. Conclusion: Pharmaceutical care for critically ill neonates varies widely. Development and provision of standardized pharmaceutical care for Korean neonates and a stepwise strategy for the expansion of clinical pharmacy services are required.

키워드

참고문헌

  1. Ohlinger J, Brown MS, Laudert S, Swanson S, Fofah O; CARE Group. Development of potentially better practices for the neonatal intensive care unit as a culture of collaboration: communication, accountability, respect, and empowerment. Pediatrics 2003;111:e471-81.
  2. Kaushal R, Bates DW, Landrigan C, et al. Medication errors and adverse drug events in pediatric inpatients. JAMA 2001;285(16):2114-20. https://doi.org/10.1001/jama.285.16.2114
  3. Dabliz R, Levine S. Medication safety in neonates. Am J Perinatol 2012;29(1):49-56. https://doi.org/10.1055/s-0031-1285831
  4. Jain S, Basu S, Parmar VR. Medication errors in neonates admitted in intensive care unit and emergency department. Indian J Med Sci 2009;63(4):145-51. https://doi.org/10.4103/0019-5359.50763
  5. Chappell K, Newman C. Potential tenfold drug overdoses on a neonatal unit. Arch Dis Child Fetal Neonatal Ed 2004;89(6):F483-4. https://doi.org/10.1136/adc.2003.041608
  6. Chedoe I, Molendijk HA, Dittrich ST, et al. Incidence and nature of medication errors in neonatal intensive care with strategies to improve safety: a review of the current literature. Drug Saf 2007;30(6):503-13. https://doi.org/10.2165/00002018-200730060-00004
  7. Gray JE, Goldmann DA. Medication errors in the neonatal intensive care unit: special patients, unique issues. Arch Dis Child Fetal Neonatal Ed 2004;89(6):F472-3. https://doi.org/10.1136/adc.2003.046060
  8. Campino A, Lopez-Herrera MC, Lopez-de-Heredia I, Valls-i-Soler A. Educational strategy to reduce medication errors in a neonatal intensive care unit. Acta Paediatr 2009;98(5):782-5. https://doi.org/10.1111/j.1651-2227.2009.01234.x
  9. Cordero L, Kuehn L, Kumar RR, Mekhjian HS. Impact of computerized physician order entry on clinical practice in a newborn intensive care unit. J Perinatol 2004;24(2):88-93. https://doi.org/10.1038/sj.jp.7211000
  10. Johnson FL, Winship HW, Trinca CE. Neonatal medication surveillance by the pharmacist. Am J Hosp Pharm 1977;34(6):609-12.
  11. Johnson CJ, Lobas NH, Ivey MF. Development of a pharmaceutical care system in a neonatal intensive care satellite pharmacy. Am J Hosp Pharm 1993;50(6):1158-63.
  12. Dice JE, Burckart GJ, Woo JT, Helms RA. Standardized versus pharmacist-monitored individualized parenteral nutrition in lowbirth-weight infants. Am J Hosp Pharm 1981;38(10):1487-9.
  13. Bryant BG. Clinical pharmacist emerging member of the NICU team. Neonatal Netw 1985;3(6):40-4.
  14. Lobas NH, Armitstead JA, Ivey MF. Expanding staff pharmacists' responsibilities to maintain pharmacy services in a neonatal intensive-care unit. Am J Hosp Pharm 1991;48(8):1708-11.
  15. Mills B, Fensterheim L, Taitel M, Cannon A. Pharmacist-led Tdap vaccination of close contacts of neonates in a women's hospital. Vaccine 2014;32(4):521-5. https://doi.org/10.1016/j.vaccine.2013.11.035
  16. Simpson JH, Lynch R, Grant J, Alroomi L. Reducing medication errors in the neonatal intensive care unit. Arch Dis Child Fetal Neonatal Ed 2004;89(6):F480-2. https://doi.org/10.1136/adc.2003.044438
  17. Schellack N, Gous AGS. An overview of the time needed to render critical ward services in a neonatal intensive care unit: documenting the activities of a clinical pharmacist: original research. S Afr Pharm J 2011;78(7):1-3.
  18. Mulholland PJ. Pharmacists as non-medical prescribers: what role can they play? The experience in a neonatal intensive care unit. Eur J Hosp Pharm 2014;21:335-8. https://doi.org/10.1136/ejhpharm-2013-000401
  19. de Jager Z, Schellack N, Gous A. What role does the clinical pharmacist play in the neonatal intensive care unit? S Afr Pharm J 2014;81(7):22-3.
  20. Ragab MH, Al-Hindi MY, Alrayees MM. Neonatal parenteral nutrition: Review of the pharmacist role as a prescriber. Saudi Pharm J 2016;24(4):429-40. https://doi.org/10.1016/j.jsps.2014.06.009
  21. Dunkley MK. Neonatal intensive care - an Australian survey of the pharmacist's role. Aust J Hosp Pharm 1991;21:104-8.
  22. Krzyzaniak N, Bajorek B. A global perspective of the roles of the pharmacist in the NICU. Int J Pharm Pract 2017:25(2):107-20. https://doi.org/10.1111/ijpp.12284
  23. Kim SL, Lee JY, Ro SY, et al. Growth curves and factors associated with growth of premature infants during initial hospitalization. J Kor Soc Health-Syst Pharm 2002;19(3):243-8.
  24. Yang HR, Choi CW, Kim BI, Seo JK, Choi SA, Kim SY. Clinical significance of the nutritional support team for preterm infants in a neonatal intensive care unit. Korean J Pediatr Gastroenterol Nutr 2009;12(1):39-45. https://doi.org/10.5223/kjpgn.2009.12.1.39
  25. An SH, Kim JY, Gwak HS. Outcomes of a new dosage regimen of amikacin based on pharmacokinetic parameters of Korean neonates. Am J Health Syst Pharm 2014;71(2):122-7. https://doi.org/10.2146/ajhp130308
  26. Park TY, Kim YH, Jung YM, Lee JW, Lee ES. The comparison analysis of the prevention of adverse drug events through order interventions by designated-pharmacists. J Kor Soc Health-Syst Pharm 2014;31(1):638-43. https://doi.org/10.32429/JKSHP.2014.31.1.005
  27. Jung JW, Kang YJ, Moon MY, et al. Preliminary study for economic evaluation of clinical pharmacist intervention. J Kor Soc Health-Syst Pharm 2011;28(4):327-36.
  28. Kim YH, Rho JH, Suh YW, et al. Pharmacist interventions in neonatal intensive care unit associated cost avoidance and cost savings. J Kor Soc Health-syst Pharm 2018;35(3):281-91.
  29. Oh YK, Lee GS, Rhie S. Neonatal total nutritional pharmacy service at intensive care unit at a university hospital in Korea. Korean J Clin Pharm 2013;23(2):167-74.
  30. Doh HJ, Yoon IK, Choi KS, et al. Evaluation of empiric vancomycin dosing regimens among neonates in a Korean tertiary care hospital. J Kor Soc Health-syst Pharm 2016;33(2):130-40.
  31. Choi DW, Ye KN, Kim JT, An SH. Phenobarbital dosing and therapeutic drug monitoring in the neonatal intensive care unit. Yakhak Hoeji 2018;62(1):49-53. https://doi.org/10.17480/psk.2018.62.1.49
  32. Kim SL, Kim JY, An SH, Kang MK, Shin HY. Impact of clinical decision support system and clinical pharmacist in pediatrics. J Kor Soc Health-Syst Pharm 2006;23(2):95-103.
  33. Taketomo CK, Hodding JH, Kraus DM. Pediatric & Neonatal Dosage Handbook, 19th ed. Hudson, OH: Lexi-Comp, 2012; 787-90, 1715-19.
  34. An SH, Kim JY, Song YC. Prevention of medication errors by clinical pharmacist and the computerized decision support system (CDSS) in neonatal intensive care unit. Pharmacotherapy 2009;29(3):128e
  35. Pandolfini C, Bonati M. A literature review on off-label drug use in children. Eur J Pediatr 2005;164(9):522-8.
  36. Bae HJ, Shin YJ, Shin HJ, et al. Off-label drug use in neonatal intensive care unit: a tertiary center experience. J Kor Soc Healthsyst Pharm 2019;36(3):325-34.
  37. Al-Turkait A, Szatkowski L, Choonara I, Ojha S. Review of drug utilization studies in neonatal units: a global perspective. Int J Environ Res Public Health 2020;17(16):E5669
  38. Krzyzaniak N, Pawlowska I, Bajorek B. Review of drug utilization patterns in NICUs worldwide. J Clin Pharm Ther 2016;41(6):612-20. https://doi.org/10.1111/jcpt.12440
  39. Johnson MR, Nash DR, Laird MR, Kiley RC, Martinez MA. Development and implementation of a pharmacist-managed, neonatal and pediatric, opioid-weaning protocol. J Pediatr Pharmacol Ther 2014;19(3):165-73.
  40. Willis ZI, Gillon J, Xu M, Slaughter JC, Di Pentima MC. Reducing antimicrobial use in an academic pediatric institution: Evaluation of the effectiveness of a prospective audit with real-time feedback. J Pediatric Infect Dis Soc 2017;6(4):339-345
  41. Hamdy RF, Bhattarai S, Basu SK, et al. Vancomycin use in a level IV NICU. Pediatrics 2020;146(2):e20192963. https://doi.org/10.1542/peds.2019-2963
  42. Krzyzaniak N, Pawlowska I, Bajorek B. The role of the clinical pharmacist in the NICU: a cross-sectional survey of Australian and Polish pharmacy practice. Eur J Hosp Pharm 2018;25(e1):e7-e16. https://doi.org/10.1136/ejhpharm-2017-001432
  43. An SH. Contributing factors on pharmacokinetic variability in critically ill neonates. Korean J Clin Pharm 2017;27(2):63-8. https://doi.org/10.24304/kjcp.2017.27.2.63
  44. Leopoldino RD, Santos MT, Costa TX, Martins RR, Oliveira AG. Drug related problems in the neonatal intensive care unit: incidence, characterization and clinical relevance. BMC Pediatr 2019;19(1):134. https://doi.org/10.1186/s12887-019-1499-2
  45. Nascimento ARFD, Leopoldino RWD, Santos METD, Costa TXD, Martins RR. Drug-related problems in cardiac neonates under intensive care. Rev Paul Pediatr 2020;38:e2018134. https://doi.org/10.1590/1984-0462/2020/38/2018134
  46. Loureiro CV, Fonteles MM, Mascarenhas MB, Chaves EF, Firmino PY. Medication follow-up in newborns with extremely low birthweight. Pharm Pract (Granada) 2019;17:1584. https://doi.org/10.18549/PharmPract.2019.4.1584