Original Article

Evaluation of Albumin Utilization in a Major Teaching Hospital in Iran Before and After Guideline Implementation

Abstract

Background: Inappropriate use of drugs is one of the major issues in health care system. Rational drug utilization based on the appropriate guidelines has an important role in management of use of expensive medications. We aimed to evaluate albumin usage's appropriateness based on evidence-based indications before and after implementing albumin prescription guideline in a teaching hospital.Methods: This study was performed in two phases. During two-month periods, all the patients who were ordered to receive albumin were evaluated. The first phase was done in November and December of 2017, during which, based on physicians' comments, the guideline was finalized and then implemented. Phase two was performed in May and June 2018.Results: Albumin was prescribed appropriately in 33 patients (55%) in the first phase and 43 (70%) patients in the second phase. 299 vials in the first phase and 456 vials in the second phase were prescribed which 198 vials (66%) and 394 (86%) vials were used with appropriate indications, respectively. The number of vials consumed with inappropriate indication decreased significantly from 101 vials (34%) in the first phase to 62 vials (14%) in the second phase (P-value=0.01). The average cost of the inappropriate indication per patient decreased from $197.3 ± 131.6 in the first phase to $183.5 ± 126.8 in the second phase (P-value=0.52).Conclusion: This study showed implementing a DUE program and designing a guideline for rational prescribing of albumin and interventional methods can optimize treatment duration, significantly decrease inappropriate usage, and avoid unnecessary hospital costs.

1. Sköldunger A, Fastbom J, Wimo A, Fratiglioni L, Johnell K. Impact of inappropriate drug use on hospitalizations, mortality, and costs in older persons and persons with dementia: findings from the SNAC study. Drugs Aging 2015;32(8):671-8.
2. Moore T, Bykov A, Savelli T, Zagorski A. Guidelines for implementing drug utilization review programs in hospitals. Management Sciences for Health, Arlington. 1997.
3. Bachhav SS, Kshirsagar NA. Systematic review of drug utilization studies & the use of the drug classification system in the WHO-SEARO Region. Indian J Med Res 2015;142(2):120-9.
4. Sacristén JA, Soto J. Drug utilisation studies as tools in health economics. Pharmacoeconomics 1994;5(4):299-312.
5. Mendez CM, McClain CJ, Marsano LS. Albumin therapy in clinical practice. Nutr Clin Pract 2005;20(3):314-20.
6. Laki B, Taghizadeh‐Ghehi M, Assarian M, et al. Effect of hospital‐wide interventions to optimize albumin use in a tertiary hospital. J Clin Pharm Ther 2017;42(6):704-9.
7. Zolfagharian F, Ghazanfari S, Elyasi S, et al. Drug utilization evaluation of albumin in a teaching hospital of Mashhad, Iran: an interventional pre–post design study. Int J Clin Pharm 2017;39(4):704-11.
8. Kazemi Y, Hadavand N, Hayatshahi A, et al. Albumin utilization in a teaching hospital in Tehran: time to revise the prescribing strategies. J Pharm Care 2013:127-32.
9. Foroughinia F, Mazraie S. Investigating the use of human albumin in a non-teaching Hospital in Iran. Iran J Pharm Res 2017;16(2):817-822.
10. Jahangard-Rafsanjani Z, Javadi MR, Torkamandi H, Alahyari S, Talasaz AH, Gholami K. The evaluation of albumin utilization in a teaching university hospital in Iran. Iran J Pharm Res 2011;10(2):385-90.
11. Finfer S, Bellomo R, Boyce N, French J, Myburgh J, Norton R; SAFE Study Investigators. A comparison of albumin and saline for fluid resuscitation in the intensive care unit. New Engl J Med 2004;350(22):2247-56.
12. Caraceni P, Domenicali M, Tovoli A, et al. Clinical indications for the albumin use: still a controversial issue. Europ J Intern Med 2013;24(8):721-8.
13. Liumbruno G, Bennardello F, Lattanzio A, Piccoli P, Rossettias G. Recommendations for the use of albumin and immunoglobulins. Blood Transfus 2009;7(3):216-34.
14. Phillips M, Gayman J, Todd M. ASHP guidelines on medication-use evaluation. American Society of Health-system Pharmacists. Am J Health Syst Pharm 1996;53(16):1953-5.
15. Talasaz AH, Jahangard-Rafsanjani Z, Ziaie S. Evaluation of the pattern of human albumin utilization at a university affiliated hospital. Arch Iran Med 2012;15(2):85-7.
16. Offringa M. Excess mortality after human albumin administration in critically ill patients. BMJ 1998 ; 317(7161): 786.
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IssueVol 9, No 2 (Spring 2021) QRcode
SectionOriginal Article(s)
DOI https://doi.org/10.18502/jpc.v9i2.6609
Keywords
Albumin; Drug Utilization Evaluation; Implementation

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How to Cite
1.
Shahbazi Khamas S, Mirbagheri I, Dehnadi Moghadam A, Jafari A, Ashouri A. Evaluation of Albumin Utilization in a Major Teaching Hospital in Iran Before and After Guideline Implementation. J Pharm Care. 2021;9(2):67-73.