Validation of Albumin Prescription in Vali Asr and Ayatollah Musavi Zanjan Hospitals
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Abstract
Background: Human serum albumin (HSA) is a versatile protein exclusively produced by hepatocyte cells in the liver, constantly released into the bloodstream. Substantial quantities of HSA are employed to ameliorate a variety of clinical conditions. The purpose of this study was to assess the accuracy of albumin serum administration as recorded in the patient files of Valiasr and Ayatollah Mousavi Hospitals in Zanjan, Iran. methods: This study aimed to assess the accuracy of albumin prescriptions in adult departments of Ayatollah Mousavi and Valiasr hospitals from March 2013 to March 2019. Collected data on albumin consumption and patient information were carried out through reviewing medical records of patients, resulting in a selection of 316 cases. The study developed a reference framework for assessing albumin administration accuracy. A scoring mechanism was used to categorize prescriptions into appropriate, inappropriate, questionable, and ambiguous classes. Statistical analysis was conducted using SPSS software. Results: The findings indicated that the average patient age was 62.2 years. Among 316 patients, 60.4% were male. The mean serum albumin level measured 3.14 g/dL. The collective volume of albumin administered to patients across both hospitals was 5016 units, averaging 15.77 units per patient, and this was utilized over a total of 2253 days. Among the studied patients, 197 passed away during treatment, 110 were discharged, and 9 were transferred to other wards. Based on the established reference, it was observed that 5.5% of prescriptions were accurate, 51.9% were inaccurate, 26.4% were debatable, and 0.6% were undetermined. The total cost of prescribing this quantity of albumin in both hospitals amounted to 9,274,584,000 Rials, distributed as 8,347,125,600 Rials and 927,458,400 Rials in their respective proportions. Conclusion: Ultimately, the study highlighted that physician-prescribed albumin, guided by provided instructions, contained numerous errors necessitating vigilant and ongoing oversight. After a comprehensive review of all the data presented, it is apparent that there is no conclusive evidence supporting the existence of a formalized strategy for consistent reduction in albumin consumption within the hospitals.
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[22] Wiedermann, C.J., Moderator Effect of Hypoalbuminemia in Volume Resuscitation and Plasma Expansion with Intravenous Albumin Solution. Int J Mol Sci, 2022. 23(22).
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[25] Jahangard-Rafsanjani, Z., et al., The evaluation of albumin utilization in a teaching university hospital in Iran. 2011. 10(2): p. 385.
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[28] Natsch, S., et al., Use of albumin in intensive care unit patients—is continuous quality assessment necessary? 1998. 23(3): p. 179-183.
[29] Qian, S.-Z., et al., Hypoalbuminemia, a novel prognostic factor for prediction of long-term outcomes in critically ill patients with septic shock. 2019. 12(6): p. 7401-7409.
[30] Perel, N., et al., Level of Hypoalbuminemia as a Prognostic Factor in Patients admitted to a Tertiary Care Intensive Coronary Care Unit. Cardiol Cardiovasc Med, 2022. 6(6): p. 536-541.
[31] Doweiko, J.P., D.J.J.J.o.P. Nompleggi, and E. Nutrition, Use of albumin as a volume expander. 1991. 15(4): p. 484-487.
[32] Shahram, A., S. Ebrahim, and C. Vahide, Evaluation of Albumin Use in a Teaching Hospital. Journal of Mazandaran University of Medical Sciences, 2015. 25(129): p. 137-141.
[33] Sepideh Rahiq, A.G., Abasad Gharedaghi, Evaluation of The Albumin Utilization in The Hospitalized Patients at Sina Hospital and it's Compliance with International Standard Guidelines during 6 months, in KR-TBZMED. 2017, Tabriz University of Medical Sciences: Tabriz University of Medical Sciences. p. 72.
[34] Tucker, C.J.J.o.B. and C. Pharmacy, The Impact of Criteria for Use and a Prescriber Order From on Albumin Utilization. 2017. 8(4).
[35] King, W.-S., et al., Introduction of guidelines for the use of albumin and the effect on albumin prescribing practices in British Columbia. 2012. 54(1): p. 34-8.
[36] Benefit, L. and M. Benefit, Guidelines for Intravenous Albumin Administration at Stanford Health Care.
[2] Consortium, U.H., Adapted from UHC guidelines for the use of albumin, nonprotein colloid, and crystalloid solutions. 2000-05-01.
[3] Tinawi, M., New Trends in the Utilization of Intravenous Fluids. Cureus, 2021. 13(4): p. e14619.
[4] Kim, S., et al., Hypoalbuminemia and Clinical Outcomes: What is the Mechanism behind the Relationship? Am Surg, 2017. 83(11): p. 1220-1227.
[5] Nicholson, J.P., M.R. Wolmarans, and G.R. Park, The role of albumin in critical illness. Br J Anaesth, 2000. 85(4): p. 599-610.
[6] Levitt, D.G. and M.D. Levitt, Human serum albumin homeostasis: a new look at the roles of synthesis, catabolism, renal and gastrointestinal excretion, and the clinical value of serum albumin measurements. Int J Gen Med, 2016. 9: p. 229-55.
[7] Doweiko, J.P. and D.J. Nompleggi, Role of albumin in human physiology and pathophysiology. JPEN J Parenter Enteral Nutr, 1991. 15(2): p. 207-11.
[8] Sugio, S., et al., Crystal structure of human serum albumin at 2.5 A resolution. Protein Eng, 1999. 12(6): p. 439-46.
[9] Mishra, V. and R.J. Heath, Structural and Biochemical Features of Human Serum Albumin Essential for Eukaryotic Cell Culture. Int J Mol Sci, 2021. 22(16).
[10] Jalilehvand, F., et al., Binding of histidine and human serum albumin to dirhodium(II) tetraacetate. J Inorg Biochem, 2021. 224: p. 111556.
[11] Garcovich, M., M.A. Zocco, and A. Gasbarrini, Clinical use of albumin in hepatology. Blood Transfus, 2009. 7(4): p. 268-77.
[12] Bernardi, M., et al., Albumin in decompensated cirrhosis: new concepts and perspectives. Gut, 2020. 69(6): p. 1127-1138.
[13] Tufoni, M., et al., Hemodynamic and Systemic Effects of Albumin in Patients with Advanced Liver Disease. Curr Hepatol Rep, 2020. 19(3): p. 147-158.
[14] Liumbruno, G.M., et al., Recommendations for the use of albumin and immunoglobulins. Blood Transfus, 2009. 7(3): p. 216-34.
[15] Tanzi, M., et al., Evaluation of the appropriate use of albumin in adult and pediatric patients. Am J Health Syst Pharm, 2003. 60(13): p. 1330-5.
[16] Ala, S., E. Salehifar, and V.J.J.o.M.U.o.M.S. Chalaki, Evaluation of albumin use in a teaching hospital. 2015. 25(129): p. 137-141.
[17] HAJHOSSEIN, T.A., et al., Evaluation of the pattern of human albumin utilization at a university affiliated hospital. 2012.
[18] Vargas, E., et al., Use of albumin in two Spanish university hospitals. 1997. 52(6): p. 465-470.
[19] Ishida, T.S., M.C. Sakai, and D.O.d. Melo, The appropriate use of human albumin in a Brazilian University Hospital: therapeutic indication and dosage regimen %J Brazilian Journal of Pharmaceutical Sciences. 2018. 54.
[20] Allison, G. and A. Coulson, NHS Tayside Phenytoin Prescribing and Monitoring Guideline.
[21] Phillips, M., J. Gayman, and M.J.A.j.o.h.-s.p.A.o.j.o.t.A.S.o.H.-S.P. Todd, ASHP guidelines on medication-use evaluation. American Society of Health-system Pharmacists. 1996. 53(16): p. 1953-1955.
[22] Wiedermann, C.J., Moderator Effect of Hypoalbuminemia in Volume Resuscitation and Plasma Expansion with Intravenous Albumin Solution. Int J Mol Sci, 2022. 23(22).
[23] Bernardi, M., C.S. Ricci, and G. Zaccherini, Role of human albumin in the management of complications of liver cirrhosis. J Clin Exp Hepatol, 2014. 4(4): p. 302-11.
[24] Hryciw, N., et al., Intravenous Albumin for Mitigating Hypotension and Augmenting Ultrafiltration during Kidney Replacement Therapy. Clin J Am Soc Nephrol, 2021. 16(5): p. 820-828.
[25] Jahangard-Rafsanjani, Z., et al., The evaluation of albumin utilization in a teaching university hospital in Iran. 2011. 10(2): p. 385.
[26] Kazemi, Y., et al., Albumin utilization in a teaching hospital in Tehran: time to revise the prescribing strategies. 2013: p. 127-132.
[27] Debrix, I., et al., Clinical practice guidelines for the use of albumin: result of a drug use evaluation in a Paris Hospital. 1999. 21: p. 11-16.
[28] Natsch, S., et al., Use of albumin in intensive care unit patients—is continuous quality assessment necessary? 1998. 23(3): p. 179-183.
[29] Qian, S.-Z., et al., Hypoalbuminemia, a novel prognostic factor for prediction of long-term outcomes in critically ill patients with septic shock. 2019. 12(6): p. 7401-7409.
[30] Perel, N., et al., Level of Hypoalbuminemia as a Prognostic Factor in Patients admitted to a Tertiary Care Intensive Coronary Care Unit. Cardiol Cardiovasc Med, 2022. 6(6): p. 536-541.
[31] Doweiko, J.P., D.J.J.J.o.P. Nompleggi, and E. Nutrition, Use of albumin as a volume expander. 1991. 15(4): p. 484-487.
[32] Shahram, A., S. Ebrahim, and C. Vahide, Evaluation of Albumin Use in a Teaching Hospital. Journal of Mazandaran University of Medical Sciences, 2015. 25(129): p. 137-141.
[33] Sepideh Rahiq, A.G., Abasad Gharedaghi, Evaluation of The Albumin Utilization in The Hospitalized Patients at Sina Hospital and it's Compliance with International Standard Guidelines during 6 months, in KR-TBZMED. 2017, Tabriz University of Medical Sciences: Tabriz University of Medical Sciences. p. 72.
[34] Tucker, C.J.J.o.B. and C. Pharmacy, The Impact of Criteria for Use and a Prescriber Order From on Albumin Utilization. 2017. 8(4).
[35] King, W.-S., et al., Introduction of guidelines for the use of albumin and the effect on albumin prescribing practices in British Columbia. 2012. 54(1): p. 34-8.
[36] Benefit, L. and M. Benefit, Guidelines for Intravenous Albumin Administration at Stanford Health Care.
| Files | ||
| Issue | Vol 10 No 2 (2024) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/jppm.v10i2.16835 | |
| Keywords | ||
| Albumin - Prescription - Consumption - Human Serum | ||
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How to Cite
1.
Markazi R, Pezeshkian A, Ahmadi F, Asadi-Khiavi M, Noubarani M. Validation of Albumin Prescription in Vali Asr and Ayatollah Musavi Zanjan Hospitals. JPPM. 2024;10(2):49-57.
