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Effect of Hospital-Wide Interventions to Optimize Albumin Use in a Tertiary Hospital Publisher Pubmed



Laki B1 ; Taghizadehghehi M2 ; Assarian M1 ; Heidari K2 ; Torkamandi H3 ; Javadi MR1, 2 ; Gholami K2
Authors
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Authors Affiliations
  1. 1. Clinical Pharmacy Department, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
  2. 2. Research Center for Rational Use of Drugs, Tehran University of Medical Sciences, Tehran, Iran
  3. 3. Pharmaceutical Care Department, Dr. Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran

Source: Journal of Clinical Pharmacy and Therapeutics Published:2017


Abstract

What is known and objective: Albumin has been frequently used as a therapeutic agent based on previous recommendations that are mostly controversial. Considering limited evidence-based indications, common inappropriate albumin use in many hospitals necessitates prompt educational and regulatory interventions. We performed this study to assess the effect of a hospital-wide programme to optimize albumin use in a tertiary referral university-affiliated hospital. Methods: This study was conducted in three 45-day phases, separated by two sequential interventions: guideline implementation and albumin order-sheet consideration. We evaluated albumin use and assessed its appropriateness in each phase at baseline, after guideline implementation and after order-sheet consideration. Results: We recorded 100, 93 and 71 albumin orders for 100, 84 and 66 patients during the first, second and third phases, respectively. The adjusted number of albumin orders (used albumin vials) was 94.9 (1481.7 vials), 80.8 (1037.6 vials) and 66 (1219 vials) in the first, second and third phases of the study, respectively. Albumin orders with appropriate indication increased significantly over the three phases of the study (OR=1.5, P=.008). The frequency of inappropriate orders reduced significantly from the first phase to the third phase (58%-27%, P=.007). What is new and conclusion: The pattern and amount of albumin use changed following guideline implementation and order-sheet consideration, and inappropriate albumin use was reduced in our hospital. There was still room for improvement, particularly for indications that were not included in the guideline. Hence, a more comprehensive guideline, frequent audit, feedback and interactive educational approaches might be necessary to achieve results that are of a greater magnitude. © 2017 John Wiley & Sons Ltd
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