老年患者胰岛素笔给药的有效性和安全性。

Q2 Medicine
Dylan K Montgomery, Tiffany R Shin, Bradley J Newell
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引用次数: 0

摘要

目的介绍一种成功的药剂师主导的干预方法,为未能拆除注射用胰岛素笔上的针罩的老年2型糖尿病患者提供有效、安全的教育和药物治疗管理。单位:家庭医学住院医师诊所。实践描述:该诊所是主要城市卫生系统的一部分,由27名住院医生、15名主治医生和1名门诊药剂师共同管理慢性病。它主要服务于中西部城市的低收入患者。实践创新:一名93岁的白人女性2型糖尿病患者,接受胰岛素治疗,由其内科医生转介给门诊药剂师进行糖尿病管理。患者近期因高渗性高血糖状态住院,血红蛋白A1c为15.9%。药剂师发现胰岛素笔上的针罩未能拆除,导致胰岛素给药无效,导致持续高血糖和随后的住院治疗。如果在不调整膨胀剂量的情况下恢复适当给药,这也会引起严重低血糖的安全问题。药师运用示范装置和反导方法进行教育,实施药物治疗调整,使胰岛素给药有效、安全。主要结局测量:糖尿病药物治疗方案的改变、家庭血糖读数(包括连续血糖监测数据)、血红蛋白A1c结果、低血糖发作频率、2型糖尿病住院次数。结果:在7个月的时间里,调整基础胰岛素的剂量,结合适当的给药技术和恩格列净的加入,使血红蛋白A1c低于7%,无严重低血糖或糖尿病相关住院。结论:药物错误,包括胰岛素给药错误,强调了对胰岛素治疗管理进行深入教育的必要性。教育和监测使老年患者能够按照指南安全有效地自我管理糖尿病。需要进一步的研究来确定教育老年患者胰岛素治疗自我管理T2DM的最佳策略。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Insulin Pen Administration Efficacy and Safety in an Older Patient.

Objective To describe a successful pharmacist-led intervention to effectively and safely provide education and pharmacotherapy management for an older patient with uncontrolled type 2 diabetes mellitus (T2DM) who failed to remove the needle shield on insulin pens for injection. Setting: Family medicine residency clinic. Practice Description: The clinic, part of a major urban health system, consists of 27 medical residents, 15 attending physicians, and 1 ambulatory care pharmacist managing chronic diseases collaboratively. It primarily serves low-income patients in a Midwest city. Practice Innovation: A 93-year-old White female with T2DM, receiving insulin therapy, was referred to the ambulatory care pharmacist by her physician for diabetes management. The patient had been hospitalized recently for hyperosmolar hyperglycemic state with a hemoglobin A1c of 15.9%. The pharmacist identified a failure to remove the needle shield on the insulin pen resulting in ineffective insulin administration, which caused persistent hyperglycemia and subsequent hospitalizations. This also posed a safety concern for severe hypoglycemia if proper administration resumed without adjusting the inflated dosing. The pharmacist used demonstration devices and the teach-back method to provide education and implement pharmacotherapy adjustments, resulting in effective and safe insulin administration. Main Outcome Measurements: Change in diabetes medication regimen, home blood glucose readings including continuous glucose monitor data, hemoglobin A1c results, frequency of hypoglycemic episodes, and number of hospitalizations for T2DM. Results: Over seven months, dose adjustments to basal insulin, combined with proper administration technique and the addition of empagliflozin, resulted in a hemoglobin A1c below 7%, with no severe hypoglycemia or diabetes-related hospitalizations. Conclusion: Medication errors, including insulin administration errors, highlight the need for thorough education in insulin therapy management. Education and monitoring empower older patients to self-manage diabetes safely and effectively, aligning with guidelines. Further research is required to identify optimal strategies for educating older patients on self-managing T2DM with insulin therapy.

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来源期刊
Senior Care Pharmacist
Senior Care Pharmacist PHARMACOLOGY & PHARMACY-
CiteScore
1.30
自引率
0.00%
发文量
160
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