The Impact Of Albumin Use Guidelines & Pharmacist Participation In General Surgery Ward

Background:Human serum albumin has been used in clinical practice for over 60 years. It is applied in a wide disease range, but always lack of guidelines to standardize its use. Albumin is extracted from healthy human plasma. Because of the limitation of raw material, its supply is limited. The increasing albumin consumption brings about a contradiction situation that its supply can not meet clinical demand. In addition, albumin is pretty much expensive, and its cost has become severe medical burden. So, the extent of albumin rational administration not only influences patients'medical costs, but also affects the allocation rationality of the limited resource.Objective:To access the impact of the albumin guidelines recommended by the American University Hospital Consortium and clinical pharmacist participation on albumin clinical use in general surgery ward.Method:Retrospectively survey albumin use without any influence from albumin guidelines and clinical pharmacist participation in general surgery inpatients that were on admission during from May to Aug.2008. Then an educational program on albumin use guidelines was organized toward all general surgery doctors to guarantee that every doctor is familiar with the guidelines. Collect the data of albumin use in general surgery inpatients that were on admission during from May to Aug.2009 with restriction of the guidelines and clinical pharmacist intervention. Compare the two sets of data on albumin use and evaluating indicators of diseases development to access the impact of the guidelines and clinical pharmacist participation.Results:1 Compare the baseline of patients:A total of 1242 patients (male 695, female 547) were retrospectively surveyed, and their mean age is (56.2±15.8) years. A total of 1256 patients (male 693, female 563) involved in the intervention period, and their mean age is (57.1±15.8) years. There is no statistical difference between the two sets of patients on sex (P=0.6938), age (P=0.1730) and the proportion of diseases (P=0.1345).2 Compare the data of albumin use:228 patients accepted albumin treatment in the retrospective survey period. The total weight of albumin used is 25690 g, and the mean weight of albumin used per patient is (112.7±124.6) g.191 patients accepted albumin treatment in the intervention period. The total weight of albumin used is 17020 g, and the mean weight of albumin used per patient is (89.1±70.9) g. There is statistical decrease in the intervention patients comparing with retrospective survey patients on the proportion of patients accepting albumin treatment (P=0.0350) and mean weight of albumin used (P=0.0158). The concentration of serum albumin before accepting albumin treatment between the two sets patients is familiar (P=0.24).39 (17.1%) patients in the retrospective survey period and 38 (19.9%) patients in the intervention period were treated by albumin according the guidelines indications (P=0.4630). The albumin use beyond the guidelines mainly focused on large intestine cancer, gastric cancer, benign or malignant pancreas diseases, benign gastrointestinal diseases. In the intervention period, clinical pharmacist checked 304 prescriptions in all.38 (12.5%) prescriptions belong to the guidelines indications, 113 (37.2%) prescriptions were canceled because of pharmacist's advice,49 (16.1%) prescriptions were changed because of pharmacist's advice, but 104 (34.2%) prescriptions beyond the guidelines indications were not changed at all because doctors refused pharmacist's advice.3 Compare the evaluating indicators of diseases development:the mean length of hospitalization in retrospective survey period and intervention period is (10.4±8.9) days and (10.3±8.5) days respectively (P=0.8497).9(0.7%) patients and 10(0.8%) patients died respectively (P=0.8383).113 (9.1%) patients and 100 (8.0%) patients respectively accepted treatment in ICU (P=0.3063).The mean length of ICU stay is (112.8±76.5) h and (94.1±61.1) h respectively (P=0.0519).7 (0.6%) patients and 5 (0.4%) patients respectively accepted mechanical ventilation (P=0.5488). The mean duration of mechanical ventilation is (83.1±58.6) h and (83.4±86) h respectively (P=0.9951). Organ failure happened in 16 (1.3%) patients and 5 (0.4%) patients respectively (P=0.0148). No one needed renal replacement therapy in both sets of periods. There is no statistical difference on evaluating indicators such as mortality, ICU or hospital length of stay, ICU proportion, and mean duration of mechanical ventilation or renal replacement therapy and so on.Conclusion:This study confirms that the implementation of albumin use guidelines and clinical pharmacist participation can realize improved albumin rational administration, reduced its consumption, significant cost savings and no negative influence in general surgery inpatients.