Background A previous albumin use study had shown that consumption was continually increasing.
Purpose To evaluate the effect of an update in albumin use guidelines and recommendations in our hospital.
Materials and methods We conducted a literature review to update our albumin use protocol and to establish alternative treatment options and doses for each approved indication.
After Pharmacy and Therapeutics Committee approval of the update and dissemination of the recommendations an observational, descriptive, retrospective study was conducted to evaluate intervention effectiveness. We compared albumin consumption 6 months prior to implementation with consumption 4 months later, and extrapolated to 6 months so that results could be compared.
The following variables were analysed: prescribing service, date, number of vials prescribed, treatment costs 6 months before implementation of new protocol and 4 months later.
Results A total of 397 treatment lines were included, corresponding to 1090 prescribed albumin vials (732 vials prescribed during the 6 months prior to implementation of the new protocol and 358 vials prescribed during the following 4 months).
After data extrapolation, a reduction of 26.43% albumin can be concluded. The General Surgery Department maintained consumption (pre-review consumption: 250 vials, post-review consumption: 250.5 vials). Services where consumption increased were Geriatrics (pre-review consumption: 24 vials, post-review consumption: 58.5 vials), Anaesthesia and Resuscitation (pre-review consumption: 9 vials, post-review consumption: 13.5 vials). Services where consumption decreased were Internal Medicine (pre-review consumption: 160 vials, post-review consumption: 148.5 vials), Intensive Care Unit (pre-review consumption: 70 vials, post-review consumption: 0 vials), Gynaecology (pre-review consumption: 61 vials, post-review consumption: 54 vials), Emergency (pre-review consumption: 45 vials, post-review consumption: 0 vials), Traumatology (pre-review consumption: 81 vials, post-review consumption: 10.5 vials). Consumption reduction was due to alternative recommendations diffusion and dose adjustments.
Albumin consumption increased in the Anaesthesia and Resuscitation Service due to the new treatment indication for spontaneous bacterial peritonitis. The reduction in consumption in other services occurred due to, for example, the recommendation to use vasoconstrictors as first-line treatment for hepatorenal syndrome, to use crystalloids as first-line treatment for liver resection >40% and to use 6–8 g/l albumin in paracentesis evacuations >5 litres (by reducing albumin dose per litre evacuated and raising the threshold treatment indication to 5 litres).
Conclusions The review, updating and distributing Therapeutic Protocols among physicians, improved prescription rates thus improving the use of drugs. This directly improved treatment, with positive clinical and financial outcomes.
No conflict of interest.
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