Literature DB >> 32508358

Impact of Clinical, Unit-Specific Guidelines on Dornase Alfa Use in Critically Ill Pediatric Patients Without Cystic Fibrosis.

Carson Tester1, Doug Raiff1, Travis Heath1.   

Abstract

Purpose: The purpose of this study was to evaluate the impact of the implementation of pharmacist-guided, unit-specific dornase alfa utilization guidelines for patients without cystic fibrosis in an academic medical institution. The study reviewed the prescribing patterns in the institution's pediatric intensive care unit (PICU) and pediatric cardiac intensive care unit (PCICU) before and after the implementation of these guidelines. The primary objective of this study was to determine the effects of the guidelines on the number of dornase alfa doses prescribed in critically ill pediatric patients without cystic fibrosis. We also evaluated the pharmacoeconomic effect of the guidelines and the impact on clinical outcomes in these critically ill patients.
Methods: This study was a single-center, retrospective evaluation of the implementation of pharmacist-guided, unit-specific dornase alfa guidelines. The guidelines were piloted on November 1, 2015. Pre-guideline implementation data were collected from February 1, 2015 to October 31, 2015. Post-guideline implementation data were collected from December 1, 2016 to August 31, 2016. We included patients admitted to the PICU and PCICU who had received at least 1 dose of dornase alfa and did not have a medical history or suspicion of cystic fibrosis.
Results: During the pre-guideline data collection period, 1067 doses of dornase alfa were administered, and following guideline implementation, 239 doses were administered. The average total admission length of stay for patients admitted to the PICU or PCICU before guideline implementation and after implementation was 16.22 and 13.14 days, respectively (P = .042). Conclusions: The implementation of pharmacist-guided, unit-specific dornase alfa guidelines within the PICU and PCICU resulted in a 77.6% reduction in the use of dornase alfa among these units. The implementation of these guidelines led to a cost reduction of approximately US $87 707.76 over a 9-month period for the health system. During the study, the length of stay for patients admitted to the PICU and PCICU did not increase, indicating that the reduction in use of dornase alfa did not negatively affect the overall hospital length of stay for patients.
© The Author(s) 2019.

Entities:  

Keywords:  cost-effectiveness; critical care; drug/medical use evaluation; pediatrics

Year:  2019        PMID: 32508358      PMCID: PMC7243607          DOI: 10.1177/0018578719836644

Source DB:  PubMed          Journal:  Hosp Pharm        ISSN: 0018-5787


  11 in total

1.  Evaluation of Inhaled Dornase Alfa Administration in Non-Cystic Fibrosis Patients at a Tertiary Academic Medical Center.

Authors:  Heather Torbic; Gaspar Hacobian
Journal:  J Pharm Pract       Date:  2015-02-09

2.  Effects of 12-week administration of dornase alfa in patients with advanced cystic fibrosis lung disease. Pulmozyme Study Group.

Authors:  K McCoy; S Hamilton; C Johnson
Journal:  Chest       Date:  1996-10       Impact factor: 9.410

3.  Dornase alpha compared to hypertonic saline for lung atelectasis in critically ill patients.

Authors:  Houssein A Youness; Kathryn Mathews; Marwan K Elya; Gary T Kinasewitz; Jean I Keddissi
Journal:  J Aerosol Med Pulm Drug Deliv       Date:  2012-03-13       Impact factor: 2.849

4.  AARC Clinical Practice Guideline: Effectiveness of Pharmacologic Airway Clearance Therapies in Hospitalized Patients.

Authors:  Shawna L Strickland; Bruce K Rubin; Carl F Haas; Teresa A Volsko; Gail S Drescher; Catherine A O'Malley
Journal:  Respir Care       Date:  2015-07       Impact factor: 2.258

5.  Pilot study of dornase alfa (Pulmozyme) therapy for acquired ventilator-associated infection in preterm infants.

Authors:  Melissa Scala; Deborah Hoy; Maria Bautista; Judith Jones Palafoutas; Kabir Abubakar
Journal:  Pediatr Pulmonol       Date:  2017-01-03

6.  Recombinant human deoxyribonuclease shortens ventilation time in young, mechanically ventilated children.

Authors:  Joachim Riethmueller; Thomas Borth-Bruhns; Matthias Kumpf; Reinhard Vonthein; Jakub Wiskirchen; Martin Stern; Michael Hofbeck; Winfried Baden
Journal:  Pediatr Pulmonol       Date:  2006-01

Review 7.  Dornase Alfa for Non-Cystic Fibrosis Pediatric Pulmonary Atelectasis.

Authors:  Krisy-Ann Thornby; Ashley Johnson; Samantha Axtell
Journal:  Ann Pharmacother       Date:  2014-05-08       Impact factor: 3.154

8.  Inhaled Dornase alfa (Pulmozyme) as a noninvasive treatment of atelectasis in mechanically ventilated patients.

Authors:  Jessica Nutik Zitter; Pierre Maldjian; Michael Brimacombe; Kevin P Fennelly
Journal:  J Crit Care       Date:  2012-12-21       Impact factor: 3.425

9.  Clinical and in vitro effect of dornase alfa in mechanically ventilated pediatric non-cystic fibrosis patients with atelectases.

Authors:  Joachim Riethmueller; Matthias Kumpf; Thomas Borth-Bruhns; Wolfgang Brehm; Jakub Wiskirchen; Ludger Sieverding; Cosima Ankele; Michael Hofbeck; Winfried Baden
Journal:  Cell Physiol Biochem       Date:  2009-02-18

Review 10.  Nebulised dornase alfa versus placebo or hypertonic saline in adult critically ill patients: a systematic review of randomised clinical trials with meta-analysis and trial sequential analysis.

Authors:  Casper Claudius; Anders Perner; Morten Hylander Møller
Journal:  Syst Rev       Date:  2015-11-08
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  2 in total

Review 1.  Use of dornase alfa in the paediatric intensive care unit: current literature and a national cross-sectional survey.

Authors:  Bibiche den Hollander; Rosalie S N Linssen; Bart Cortjens; Fardi S van Etten-Jamaludin; Job B M van Woensel; Reinout A Bem
Journal:  Eur J Hosp Pharm       Date:  2020-10-29

2.  A Quality Improvement Approach to Influence Value-based Mucolytic Use in the PICU.

Authors:  Holly Catherine Gillis; Kevin Dolan; Cheryl L Sargel; R Zachary Thompson; Jeffrey E Lutmer
Journal:  Pediatr Qual Saf       Date:  2021-07-28
  2 in total

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