A Case Study of Curriculum Change in U.S. Pharmacy Education : (미국 약학교육과 교과과정 변경의 사례)

LEE Eunkyung Euni 大韓藥學會 2010 大韓藥學會 總會 및 學術大會 Vol.2010 No.1

항균제 관리팀에서 약사의 업무 개발 및 확대 방안

김형숙,김송이,이은숙,Eunkyung Euni Lee,송경호,김의석,김홍빈 한국병원약사회 2018 병원약사회지 Vol.35 No.1

Background : Pharmacists are key members of the Antimicrobial Stewardship Program (ASP) team playing a critical role in improving antimicrobial use. A pharmacy intervention program built in the hospital electronic medical records for ASP (ASP-EMR) was developed and the sustained impact of the pharmacist-enhanced ASP was described in this study as measured by antimicrobial use and costs and the proportion of inappropriate antimicrobial prescriptions. Methods : An interrupted time series with segmented regression analysis was conducted in 3 stages; 1-preintervention; 2-pharmacists’participation in ASP without ASP-EMR and 3-pharmacists’participation in ASP with ASP-EMR. Using EMR data from a tertiary care hospital, the information on the prescribed antimicrobial agents was extracted 2009-2016. The pharmacist-enhanced ASP intervention started in March 2012. Prospective audit and feedback were triggered by ASP-EMR and the program was led by 1 clinical pharmacist and 1 pharmacy resident. Changes in the outcomes were compared before and after the pharmacist intervention with or without ASP-EMR. Results : The development of pharmacy intervention program via ASP-EMR was completed in May 2016. After the pharmacist-enhanced ASP intervention, the rate of broad spectrum antimicrobial agents decreased as measured by daily defined doses (DDDs)/1,000 inpatient days (120.1 in Stage 1 and 103.5 in stage 3). In Stage 3, inappropriate duplication of anaerobic coverage was decreased as compared to Stage 1 as measure by days of therapy (DOT)/length of therapy (LOT) (1.13 in Stage 1 and 1.01 in Stage 3). The intervention on the intravenous (IV)-to oral conversion of quinolones increased the proportion of oral ciprofloxacin prescription and the estimated cost avoidance from interventions was 4,291,797 won in Stage 2 and 5,208,979 won in Stage 3. Conclusion : The implementation of the pharmacists’participation in ASP at a tertiary care hospital in Korea was associated with a positive impact on antimicrobial use, spending, and inappropriate prescriptions

신생아에서의 Vancomycin 용량 가이드라인 적절성 평가

도현정,윤인경,최경숙,남궁형욱,Eunkyung Euni Lee,김은경,최창원 한국병원약사회 2016 病院藥師會誌 Vol.33 No.2

Vancomycin is the drug of choice for treatment of methicillin-resistant coagulase-negative Staphylococcus aureus (MRSA) infection in neonatal intensive care units (NICUs). Although the Infectious Disease Society of America (IDSA) and American Society of Hospital Pharmacists (ASHP) recommended that vancomycin trough concentrations remain above 10 mcg/ml in order to prevent resistance, the Neofax guidelines have not recommended a new dosing guideline to achieve the therapeutic dosing goal; this has consequently raised concerns in relation to reaching the therapeutic range. The purpose of this study was to evaluate the rate of achieving serum trough concentrations ranged 10~20 mcg/ml in NICU patients when initial vancomycin dosing was carried out as recommended by the Neofax guidelines. A retrospective chart review was conducted of 63 NICU patients at Seoul National University Bundang Hospital, for whom there was at least one piece of data relating to trough level serum concentrations between June 25, 2003 and July 31, 2015. The duration of therapy, total length of stay, dose adjustments to attain therapeutic range, total daily dose and adverse effects were evaluated. For the primary outcome, 3 patients were excluded because of renal dysfunction, 13 patients were excluded because the initial trough was drawn inappropriately, and 14 patients were excluded because vancomycin was not administrated according to the Neofax guidelines. Only 6 of 38 (15.8%) patients achieved the therapeutic range with empiric dosing following the Neofax guidelines. Postmenstrual age and weight at the beginning of vancomycin treatment were significantly associated with the achievement of the vancomycin therapeutic range. Two out of 60 (3.3%) patients experienced nephrotoxicity. In conclusion, the status of attaining therapeutic range by following the Neofax dosing guideline was suboptimal. Further studies are urgently needed to assist the development of appropriate dosing guidelines for the treatment of MRSA infections in neonates.

체중감량 목적으로 사용되는 녹차추출물의 임상정보

윤영진,신상윤,정경혜,Eunkyung Euni Lee 한국임상약학회 2018 한국임상약학회지 Vol.28 No.4

Background: Green tea extracts are approved as nonprescription drug and available as health functional foods, health foods, andbeverages. Clinical information on the products is lacking. Methods: Information about the products on green tea nonprescriptiondrugs was obtained from the website of the Korea Pharmaceutical Information Center. The Naver, i.e., a top ranking online searchportal, was used for compiling the list of the health functional food products using key words of 'green tea catechin' on August 23,2018. The recommended daily dosages of catechins were calculated as 30% of the total dried mass of green tea and about 50% ofthe catechins were considered as epigallocatechin gallate (EGCG). Results: A total of two types of nonprescription drugscontaining green tea powder or extracts, nine health functional food products, and three types of health foods were found. Theregulatory requirements of the EGCG exceeding 800 mg were reported to be associated with adverse effects of elevated liverenzyme. If consumers take several green tea products concurrently, such as nonprescription drugs with health functional foods orhealth foods, it could exceed the recommended amount of EGCG. Conclusion: The concurrent use of green tea products asnonprescription drugs, health functional foods, and healthy foods may lead to an increased exposure to EGCG. Pharmacists shouldbe aware the availability of various types of green tea products and the potential risk of liver toxicity due to excessive consumptionof EGCG.

항생제 처방 시스템 순응도 및 사용자 평가

공현진,허은정,김형숙,정영미,이정화,Eunkyung Euni Lee,이주연,정종탁,송경호,김의석,김홍빈 한국병원약사회 2022 병원약사회지 Vol.39 No.4

Background : An antibiotic prescription system is introduced at Seoul National University Bundang Hospital to encourage appropriate antibiotic use. The system suggests a list of recommended antibiotics according to the tailored purpose of a prescription, such as empirical therapy, specific pathogen target, and surgical prophylaxis. The aim of this study is to describe the prescriber compliance and awareness regarding the system at a tertiary care hospital in Korea. Methods : We compared the purpose of a prescription chosen in the antibiotic prescription system with the actual infectious diseases confirmed via electronic health records (EHRs) to determine the prescriber’s compliance with the system. To investigate the perception, usability, and improvements of the antibiotic prescription system, we also conducted a survey of its users. Results : Regarding compliance, 52 out of 120 cases (43.3%) reviewed showed that the purpose of a prescription chosen in the system were consistent with those of the EHRs. Our survey of user awareness of the system garnered a 19.7% response rate (59 out of 300). About 45.8% of the respondents agreed with the necessity for such a system, while 28.8% disagreed and 88.2% noted that the system was inconvenient. 69.4% answered under 60% of purpose match rate and 77.9% answered under 60% of prescription rate within recommended lists. The most response to improvements was error or lack of information provided by the system. Conclusion : This study revealed a low match rate between the purpose of a prescription chosen in the antibiotic prescription system and those confirmed through EHRs. Periodic feedback on the use of the system and training on its use and purpose are hence necessary to increase user compliance with the system and encourage appropriate antibiotic usage.

다학제 팀의료에 의한 노인의료센터 입원환자의 항콜린약물부담 감소효과 분석

이주혜,박가영,서예원,이정화,이은숙,Eunkyung Euni Lee,최정연,김광일,이주연 한국임상약학회 2020 한국임상약학회지 Vol.30 No.2

Background: Reducing the total anticholinergic burden (AB) in older adults is recommended owing to the several peripheral and central adverse effects. This study aimed to identify the AB status of patients admitted to geriatric centers for assessing the influence of the pharmacist-involved multidisciplinary geriatric team care on reducing the AB. Methods: We retrospectively reviewed the medical records of 328 older patients hospitalized in geriatric centers from July 1, 2018 to June 30, 2019, who received comprehensive geriatric assessment and pharmaceutical interventions from a multidisciplinary geriatric team. We measured the total AB scores for the medications at the time of admission and upon hospital discharge using the Korean Anticholinergic Burden Scale (KABS). The pre-admission factors associated with high AB (KABS score ≥3) at the time of admission were identified. Results: The proportion of patients with high AB significantly decreased from 41.8% (136/328) at the time of admission to 25.0% (82/328) on discharge (p<0.001). The pre-admission AB of patients transferred from skilled nursing facilities (odds ratio[OR]: 2.85, 95% CI: 1.26- 3.75), taking more than 10 medications (OR: 3.70, 95% CI: 1.55-8.82), suffering from delirium (OR: 2.80, 95% CI: 1.04-7.50), or depression (OR: 2.78, 95% CI: 1.04-7.41) were significantly high. Antipsychotics were the most frequent classes of drugs that contributed to the total KABS score at the time of admission, followed by antihistamines. Conclusions: This study demonstrated that the multidisciplinary teams for geriatric care are effective at reducing AB in older adults. The factors associated with high AB should be considered when targeting pharmaceutical care in geriatric individuals.

원내 폐렴 진료 지침 수립 후 경험 항생제 선택의 적절성 평가

강지영,김형숙,정영미,남궁형욱,이은숙,Eunkyung Euni Lee,황주희,송경호,김의석,김홍빈 한국병원약사회 2018 병원약사회지 Vol.35 No.4

Background : The Antimicrobial Stewardship Program promotes interdisciplinary interventions and targeted recommendations for the proper utilization of antibiotics. In particular, the aim of the program is to avoid indiscriminate use of broad-spectrum antibiotics based on the documented literature on the significant impact of unsystematic usage of antibiotics on the distribution of antibiotic-resistant microorganisms. To improve the care process for pneumonia treatment using antimicrobial agents, institution-level guidelines were established and disseminated at the Seoul National University Bundang Hospital in April 2016. In this study, we evaluated changes in the physicians’antibiotic prescribing patterns both before-and after-the implementation of the guidelines. Methods : The electronic medical records of inpatients who were prescribed with one or more antibiotics in May 2014 (Group A) and May 2016 (Group B) were reviewed. Data on demographic characteristics, clinical outcomes, and antibiotic prescriptions were collected and the prescription records were compared both before- and after- the implementation of the guidelines. Results : A total of 180 patients were included in the study: 77 patients in group A and 103 patients in group B. The baseline characteristics of the patients were not significantly different between the two groups. Community-acquired pneumonia was the most common diagnosis in both the groups and the difference was not significant (68.8% vs. 67.9%; p=0.67). The type of antibiotic prescriptions used for empirical treatment was not different between the two groups. The most commonly prescribed empirical antibiotics were cephalosporins, with no significant difference (p=0.31). One of the most inappropriately used antibiotics was piperacillin/tazobactam and the rate of prescription was similar in both the groups (p=0.68). The rates of appropriate empirical selection of antibiotics remained unaltered between the two groups (67.5% vs. 71.8%; p=0.53). Conclusions : Implementation of the guidelines only exhibited no significant effect on the antibiotic prescribing patterns of physicians for the treatment of pneumonia. To improve the adequate use of empiric antibiotics, more active interventions and closer monitoring of the feedbacks should be additionally considered and evaluated in future studies.

외과계 중환자실 전담약사 유무에 따른 중재활동 변화 및 회피비용 분석

신상미,허은정,김윤희,최경숙,이은숙,Eunkyung Euni Lee,송인애 한국병원약사회 2017 병원약사회지 Vol.34 No.4

Background : The prevention of adverse drug events had been documented by pharmacists in critically ill patients. The purpose of this study was to evaluate the effect of the designated pharmacists’interventions, acceptance rate and cost avoidance in the surgical intensive care unit (SICU) at a tertiary hospital in Korea. Methods : A retrospective observational study was conducted using electronic medical records. The frequencies of the interventions, acceptance rate, and type of interventions were observed. Cost avoidance was calculated from the potential benefit or harm of the pharmacists’recommendations and the expected extension of hospitalization without a pharmacist intervention. Results : The frequencies of the intervention increased from 0.16% to 0.56%(p 0.001) and the acceptance rate of the pharmacist intervention increased from 69% to 89%(p 0.05). Since the introduction of the designated pharmacist, pharmacists’interventions have expanded into the clinical field, such as total parenteral nutrition (TPN), drug recommendations and sharing treatment plans, possible adverse drug reactions, and therapeutic drug monitoring (TDM). The calculated avoidance cost per month associated with a designated pharmacists’intervention was 9,335,382 won/month. Conclusion : With the designated pharmacist, the frequencies of the pharmacists’intervention and the acceptance rate of interventions among the medical team increased. The cost avoidance from the pharmacists’interventions imply a potential economic advantage; therefore, it is necessary to evaluate the further economic effects of the pharmacists’intervention.

항암화학요법을 받은 혈액질환자에서 발생한 호중구감소성 균혈증에서 경험적 항생제 내성의 위험인자분석

우택,홍소연,정영미,최경숙,이은숙,Eunkyung Euni Lee,송경호,방수미 한국병원약사회 2021 병원약사회지 Vol.38 No.3

Background : Broad-spectrum antibiotics including those with anti-pseudomonal activity are recommended based on regional and institutional epidemiologic antimicrobial-resistance profiles when selecting empirical antibiotics for febrile neutropenia. We have used ceftizoxime with amikacin as empirical antibiotics for patients with neutropenic fever. To prescribe the appropriate empirical antibiotics, periodic analysis of the current status of febrile neutropenia and the causative microorganisms is required. We analyzed the risk factors for infection resistance to ceftizoxime with amikacin in bacteremic febrile neutropenia among patients undergoing chemotherapy. Methods : We retrospectively reviewed bloodstream infections in patients undergoing treatment for acute leukemia or hematopoietic stem cell transplantation from July 1, 2014, to June 30, 2019. Early treatment response was assessed 7 days after the onset of bacteremia by the negative conversion of follow-up blood cultures, improved C-reactive protein (CRP) levels, and defervescence. Multivariate logistic regression was used to evaluate the risk factors associated with antibiotic-resistant infection. Results : A total of 190 bacteremia episodes were identified. The majority of the bacteria [142 (74.7%)] were gram-negative, and 11 (5.7%) were Pseudomonas aeruginosa. Ceftizoxime with amikacin (43.6%) and piperacillin with tobramycin (23.2%) was mainly used as the empirical antibiotics. The 30-day mortality was found to be 3.1%. Among 174 patients assessed for early treatment response, most of them (98.2%) showed favorable responses including the negative conversion of blood cultures, improved CRP levels (85.0%), and defervescence (81.6%). Multivariate logistic regression analysis showed that exposure to third-generation antibiotics, cephalosporin (p=0.012) or piperacillin/tazobactam (p=0.048) within 30 days prior to the onset of bacteremia were independent risk factors for infections resistant to treatment with ceftizoxime with amikacin. Conclusion : When considering ceftizoxime with amikacin as the empirical antibiotics of choice, it should be noted that exposure to antibiotics such as third-generation cephalosporin or piperacillin/ tazobactam is limited to within 30 days prior to the onset of bacteremia.

신생아중환자실 전담약사의 임상적 중재에 의한 회피비용 및 절감비용 분석

김윤희,노주현,서예원,최경숙,이은숙,Eunkyung Euni Lee,최창원 한국병원약사회 2018 병원약사회지 Vol.35 No.3

Background : In neonates, frequent changes in dosing intervals and dosage can increase the risk of medication errors. In addition, patients in Neonatal Intensive Care Unit (NICU) are highly dependent on total parenteral nutrition (TPN) which is one of the most important interventions made by pharmacists. Although the role of ICU pharmacists in improving clinical outcomes has been documented, there is little report on economic impact of such interventions in Korea. The purpose of this study was to evaluate interventions made by NICU pharmacists and describe cost avoidance and cost savings. Methods : From March 1 to August 31, 2016, a retrospective evaluation was conducted by analyzing clinical intervention records from prescription review, TPN consults, and Clinical Pharmacokinetic Consultation Service (CPCS) reports delivered by pharmacist at Seoul National University Bundang Hospital. The level of intervention outcome severity was graded by three independent pharmacist evaluators and the economic impact was determined by calculating cost avoidance and cost saving. Results : During the study period, a total of 608 clinical interventions were performed, TPN was involved in 482 (79.3%) interventions and the number of intervention activities related to prescription review was 81 (13.3%). The most frequent interventions related to prescription review were‘ incorrect dose and interval (46.1%)’, followed by ‘incorrect administration schedule’and ‘consult for medication information and treatment plan’. Antibiotics were the most frequently associated with medication errors (52%). The prescriber’s acceptance rate of pharmacist recommendations was 95.2%. Total cost avoidance for 6 months was 175,863,624 won and total cost saving for 6 months was 75,033 won. Conclusions : This study showed reduction of medication errors and medical expenses in a Korean hospital. However, further study is needed to demonstrate the contribution of clinical pharmacists to improvement of clinical and economic outcomes more comprehensively.