ICU/HCU退室後の睡眠薬の継続に関する実態調査と病棟薬剤師の介入効果の検討

Material type: 文書・図像類

Author: 佐々木, 駿一

Publisher: 慶應義塾大学

Publication date: 2022

Material Format: Digital

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Note (General)：: type:text【目的】ICU/HCU病棟では患者の病態に応じて新規に治療薬が開始されることが多い一方、退室後も漫然と投与を継続される症例が一定数存在する。新規作用機序の睡眠薬であるメラトニン受容体作動薬、オレキシン受容体拮抗薬（以下MT/OX系薬）は、せん妄予防効果が期待され集中治療室で使用され...

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Material Type: 文書・図像類
Title: ICU/HCU退室後の睡眠薬の継続に関する実態調査と病棟薬剤師の介入効果の検討
Author/Editor: 佐々木, 駿一
Author Heading: 佐々木, 駿一
Publication, Distribution, etc.: 慶應義塾大学
Publication Date: 2022
Publication Date (W3CDTF): 2022
Alternative Title: ICU/HCU タイシツゴノスイミンヤクノケイゾクニカンスルジッタイチョウサトビョウトウヤクザイシノカイニュウコウカノケントウ
ICU/HCU taishitsugo no suimin'yaku no keizoku ni kansuru jittai chōsa to byōtō yakuzaishi no kainyū kōka no kentō
Survey on the actual situation of sleeping pills continuation after ICU/HCU discharge and the effectiveness of intervention by ward pharmacists
Periodical title: 学事振興資金研究成果実績報告書
Text Language Code: jpn
eng
Target Audience: 一般
Note (General): type:text
【目的】ICU/HCU病棟では患者の病態に応じて新規に治療薬が開始されることが多い一方、退室後も漫然と投与を継続される症例が一定数存在する。新規作用機序の睡眠薬であるメラトニン受容体作動薬、オレキシン受容体拮抗薬（以下MT/OX系薬）は、せん妄予防効果が期待され集中治療室で使用されることが多い。本研究ではMT/OX系薬の処方動向を後ろ向きに調査し、当院における処方実態と、病棟薬剤師が処方継続の検討を積極的に行った場合の効果を明らかにする。【方法】ICU/HCUの担当薬剤師は、新規開始薬剤と入室前の使用薬剤を整理し一般床の薬剤師に情報提供を行い、一般床の薬剤師は退院までに薬剤の妥当性を検討し医師と協議する取り組みを2022年9月より実施した。MT/OX系薬は処方継続要検討薬剤とし、積極的に検討を行った。薬剤師の介入が可能な2泊以上ICU/HCUに在室した患者を対象として、退室時にMT/OX系薬を使用していた患者の退院時の処方継続の有無について2022年6-8月を介入前、9-11月を介入後としてカルテ調査を行った。（倫理委員会受付番号：2022-1161）【結果】組み入れ患者は介入前、介入後でそれぞれ106名、98名であり、退院までにICU/HCUに再度2泊以上在室した患者、死亡退院となった患者、2023年3月時点で入院中の患者を除外した88名、87名を解析対象とした。退院時にMT/OX系薬が定時処方されていた患者はそれぞれ33名（37.5%）、36名(41.4%)であり病棟薬剤師の介入前後で変化は見られなかった。【考察/結論】ICU/HCU退室時にMT/OX系薬を定時内服していた患者の約40%で、退院時も継続して処方されていた。病棟薬剤師の取り組み前後で退院時の処方継続率に変化は見られなかった。当院では入院中の睡眠薬としてOX系薬を推奨していることも一因と考えられる。今後も薬剤師による介入を進めるほか、介入内容、継続妥当性を評価した内容について更に検討を行い、変化が見られなかった理由について解析を行う予定である。 Purpose: In intensive care unit (ICU)/High care unit (HCU) wards, new therapeutic medicines are often started according to the patient's condition, while a certain number of patients continue to receive these medicines after leaving the ICU/HCU wards. Melatonin receptor agonists and orexin receptor antagonists (MT/OX medicines), which are sleeping pills with novel mechanisms of action, are often used in ICU for their potential efficacy in preventing delirium. In this study, we retrospectively surveyed prescribing trends of MT/OX medicines to clarify the actual prescribing situation in Keio university hospital and the effect of actively considering the continuation of prescribing by ward pharmacists. Methods: The pharmacist in charge of the ICU/HCU organized newly started medicines and medicines used before admission and provided information to the general bed pharmacist. General bed pharmacist reviewed the appropriateness of the medicines and discussed them with the doctors before discharge. Patients who had been in the ICU/HCU wards for 2 nights or more, where pharmacist intervention was possible, were surveyed to determine whether or not they continued prescribing MT/OX medicines at discharge, with June-August 2022 as the pre-intervention period and September-November as the post-intervention period. (Ethics Committee receipt number: 2022-1161) Results: There were 106 and 98 patients before and after the intervention, respectively. 88 and 87 patients were included in the analysis after excluding patients who stayed in the ICU/HCU wards for more than 2 nights again before discharge, patients who were discharged due to death, and hospitalized as of March 2023. The number of patients who were regularly prescribed MT/OX medicines at the time of discharge was 33 (37.5%) and 36 (41.4%), respectively, and there was no change before and after the intervention of the ward pharmacist. Discussion/Conclusion: Approximately 40% of patients who were taking MT/OX drugs on a regular basis at the time of ICU/HCU discharge continued to receive them at the time of discharge. There was no change in the prescription continuation rate at discharge before and after the ward pharmacist's intervention. This may be due in part to the fact that the hospital recommends OX medicines as inpatient sleeping pills. In addition to continuing the pharmacist intervention, we plan to further examine the content of the intervention and the evaluation of its continued appropriateness, and to analyze the reasons for the lack of change.
Access Restrictions: 限定公開
Data Provider (Database): 国立情報学研究所 : 学術機関リポジトリデータベース（IRDB）（機関リポジトリ）
https://irdb.nii.ac.jp
Original Data Provider (Database): 慶應義塾大学 : 慶應義塾大学学術情報リポジトリ