《中国万古霉素治疗药物监测指南》推荐意见的外审调查

Chinese Practice Guideline for Therapeutic Drug Monitoring of Vancomycin:Recommendations External Review

目的中国万古霉素治疗药物监测指南是我国首部基于GRADE系统制定的治疗药物监测指南。指南专家组于2014年12月21日举行推荐意见共识会,形成了14条推荐意见。本研究旨在了解中国万古霉素治疗药物监测指南推荐意见的科学性和可行性,以进一步修订推荐意见。方法对指南推荐意见进行独立外审,通过纸质问卷调查中级职称以上临床医师、临床药师和护师对14条推荐意见的赞同度,评价推荐意见的表述清楚程度和可行程度并收集其他方面的建议。基于外审结果,指南专家组开会讨论并修订推荐意见。结果共有来自4家医院、11个科室的40名临床医师、临床药师和护师参与外审工作。对推荐意见的总体赞成程度为70%,总体表述清楚程度为88%,总体可行程度为70%。其中,4条推荐意见赞成程度未超过50%,5条推荐意见可行程度未超过50%。此外,共收到165条主观建议。经指南专家组讨论,最终修订了8条推荐意见,其中删除4条推荐意见,合并2条推荐意见,局部修改2条推荐意见。结论本次外审工作在中国循证指南制定领域是一次有意义的探索与尝试,保证了更多利益相关方的参与,促进了推荐意见的明晰性和可行性。

Objective Chinese practice guideline for therapeutic drug monitoring of vancomycin is the first therapeutic drug monitoring guideline in the framework of GRADE in China. The guideline panels met a recommendation consensus in December 21 th, 2014 and finalized 14 recommendations. The aim of the current study was to assess the property of recommendations and revise them. Methods We commissioned an external review of recommendations by questionnaire. Physicians, clinical pharmacists and nurses above or equal to intermediate certificate were investigated for appreciations, clarity and feasibility of 14 recommendations as well as other suggestions about guideline. The guideline panels discussed the results and revised recommendations based on the result of external review. Results A total of 40 physicians, clinical pharmacist and nurses from 11 departments of 4 hospitals participated in the external review. The overall appreciation degree of recommendations was 70%, the overall clarity degree of recommendations was 88%, and the overall feasibility degree of recommendations was 70%. Among them, appreciation degree of 4 recommendations and feasibility degree of 5 recommendations were fewer than 50%. 165 subjective suggestions were received. After review of the results, the guideline panels reserved 6 recommendations while revised 8（Deleted 4, combined 2 and improved 2）. Conclusion Our external review is an exploration and attempt in the region of development of Chinese evidence-based practice guideline. More interest-related individuals are involved in the development of guideline. Clarity and feasibility of recommendations are ensured.