静脉用药医嘱审核与不合理用药处方干预效果
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摘要
目的考察静脉用药调配中心(PIVAS)医嘱审核结果与不合理用药干预效果,为静脉用药医嘱审核及不合理用药干预提供参考。方法查询2017年1—12月中国科学技术大学附属第一医院信息系统(HIS)静脉用药医嘱审核结果与不合理用药干预数据,采用Excel 2007版软件对数据进行统计分析。结果 2017年1—12月共审核静脉用药医嘱130688组,干预不合理用药982组,不合理用药占0.75%,干预成功525组,干预成功率53.46%。干预的不合理用药中,给药剂量不适宜构成比最高(36.96%),干预成功率最低(33.06%)。溶媒选择不适宜构成比9.67%,干预成功率最高(92.63%),溶媒用量不适宜干预成功率次之(80.00%)。不同病区不合理用药医嘱所占比例相差甚远,外科病区不合理用药干预成功率较内科病区高。结论定期对不合理用药医嘱进行分析总结,统一审方标准,实现不同药师审方同质化,对提高不合理用药干预成功率至关重要。新开展静脉药物集中调配的病区,干预不合理用药有重点的逐个突破,可有效减少不合理用药。
Objective To analyze the results of medical order review and effects of interventions for irrational use of intravenous medications in Pharmacy Intravenous Admixture Services(PIVAS),so as to provide evidence for medical order review and interventions for irrational use of intravenous medications.Methods Data on the results of medical order review and effects of interventions for irrational use of intravenous medications from January to December 2017 were searched in the hospital information system(HIS);statistical analysis was performed using Excel 2007.Results From January to December 2017,a total of130 688 medical orders regarding intravenous medications were reviewed,among which 982 involved interventions for irrational drug use,and the irrational drug use accounted for 0.75%;successful intervention was obtained in 525 of the 982 medical orders for irrational drug use,and the intervention success rate was 53.46%.Among the irrational medications,inappropriate dose was the most frequent(36.96%),and it was associated with the lowest intervention success rate(33.06%);inappropriate solvent selection accounted for 9.67% of the irrationals,and it was associated with the highest intervention success rate(92.63%),followed by that for inappropriate solvent amount(80.00%).The proportion of medical orders regarding irrational drug use varied significantly among different departments,and the intervention success rate for irrational drug use was higher in surgical departments than in medical departments.Conclusion In order to improve the success rate of interventions for irrational drug use,it is vital to regularly summarize and analyze the irrationals in drug use,and to consolidate the review criteria in an effort to harmonize the prescription review practice of different pharmacists.For the departments initially introducing PIVAS,prioritized interventions for irrational use of key medications is expected to effectively reduce irrational drug use.
Objective To analyze the results of medical order review and effects of interventions for irrational use of intravenous medications in Pharmacy Intravenous Admixture Services(PIVAS),so as to provide evidence for medical order review and interventions for irrational use of intravenous medications.Methods Data on the results of medical order review and effects of interventions for irrational use of intravenous medications from January to December 2017 were searched in the hospital information system(HIS);statistical analysis was performed using Excel 2007.Results From January to December 2017,a total of130 688 medical orders regarding intravenous medications were reviewed,among which 982 involved interventions for irrational drug use,and the irrational drug use accounted for 0.75%;successful intervention was obtained in 525 of the 982 medical orders for irrational drug use,and the intervention success rate was 53.46%.Among the irrational medications,inappropriate dose was the most frequent(36.96%),and it was associated with the lowest intervention success rate(33.06%);inappropriate solvent selection accounted for 9.67% of the irrationals,and it was associated with the highest intervention success rate(92.63%),followed by that for inappropriate solvent amount(80.00%).The proportion of medical orders regarding irrational drug use varied significantly among different departments,and the intervention success rate for irrational drug use was higher in surgical departments than in medical departments.Conclusion In order to improve the success rate of interventions for irrational drug use,it is vital to regularly summarize and analyze the irrationals in drug use,and to consolidate the review criteria in an effort to harmonize the prescription review practice of different pharmacists.For the departments initially introducing PIVAS,prioritized interventions for irrational use of key medications is expected to effectively reduce irrational drug use.
引文
[1]谢牧牧,任浩洋,张淼,等.我院老年病区PIVAS不合理医嘱及药师干预情况调查[J].中国药物应用与监测,2013,10(4):215-217.
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[11]王海鹏,孟庆跃.2000-2009年我国成年人诊断糖尿病流行趋势分析[J].中国预防医学杂志,2013,14(2):132-135.
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[13]欧阳丹薇,邵燕,孔德云,等.注射用洛铂与0.9%氯化钠注射液及5%葡萄糖注射液的配伍稳定性[J].中国医药工业杂志,2015,46(2):199-203.
[14]陈佰义,何礼贤,胡必杰.中国鲍曼不动杆菌感染诊治与防控专家共识[J].中华医学杂志,2012,92(2):76-85.
[15]孙尧,胡静,罗璨.EPOCH方案中依托泊苷、盐酸多柔比星和硫酸长春新碱的配伍稳定性[J].中国医院药学杂志,2016,36(21):1923-1927.
[16]刘维,张萌萌,陈恳,等.表柔比星、长春新碱和依托泊苷3种化疗药物混合配制的配伍稳定性考察[J].中国医院药学杂志,2016,36(16):1382-1385.
[17]BETTY L,GAHART,ADRIENE R,et al.Intravenous medications[M].St Louis Mo:Mosby,2016:1033.
[18]王秀丽,赵岩,刘萍.审方药师对静脉用药调配中心抗肿瘤药物不合理医嘱干预效果[J].医药导报,2017,36(增):109-110.
[2]高立栋,王秀梅,石俊霞.静脉用药集中调配中心药师干预不合理用药医嘱情况点评分析[J].中国药物经济学,2017,12(4):24-29.
[3]中国药师协会,中国执业药业协会.中国医师药师临床用药指南[M].重庆:重庆出版社,2009:419.
[4]刘圣,傅先明.静脉用药物调配技术[M].合肥:安徽科学技术出版社,2015:205.
[5]GERALD K,MCEVO Y,PHARM D.Hand Book on injectable drugs[M].Betherda:American Society of Health-System Pharmacists,2015:286-287.
[6]范倩倩,张波,李大魁,等.注射用盐酸氨溴索的临床应用现状与思考[J].中国药学杂志,2015,50(9):816-820.
[7]陈渊,马彬,杨克虎,等.围手术期使用盐酸氨溴索对肺保护作用的系统评价[J].中国循证医学杂志,2009,9(5):558-564.
[8]赵志刚,费宇彤.药品超说明书使用循证评价[M].北京:中国协和医科大学出版社,2017:97.
[9]张春铜,刘杰,陈秀英.不合理用药致药物不良反应典型案例分析[J].实用药物与临床,2014,17(11):1469-1472.
[10]吴永佩,焦雅辉.临床静脉用药调配与使用指南[M].北京:人民卫生出版社,2010:76-389.
[11]王海鹏,孟庆跃.2000-2009年我国成年人诊断糖尿病流行趋势分析[J].中国预防医学杂志,2013,14(2):132-135.
[12]米文杰,陈迹.静脉用药集中调配基础知识问答[M].北京:人民卫生出版社,2016:128.
[13]欧阳丹薇,邵燕,孔德云,等.注射用洛铂与0.9%氯化钠注射液及5%葡萄糖注射液的配伍稳定性[J].中国医药工业杂志,2015,46(2):199-203.
[14]陈佰义,何礼贤,胡必杰.中国鲍曼不动杆菌感染诊治与防控专家共识[J].中华医学杂志,2012,92(2):76-85.
[15]孙尧,胡静,罗璨.EPOCH方案中依托泊苷、盐酸多柔比星和硫酸长春新碱的配伍稳定性[J].中国医院药学杂志,2016,36(21):1923-1927.
[16]刘维,张萌萌,陈恳,等.表柔比星、长春新碱和依托泊苷3种化疗药物混合配制的配伍稳定性考察[J].中国医院药学杂志,2016,36(16):1382-1385.
[17]BETTY L,GAHART,ADRIENE R,et al.Intravenous medications[M].St Louis Mo:Mosby,2016:1033.
[18]王秀丽,赵岩,刘萍.审方药师对静脉用药调配中心抗肿瘤药物不合理医嘱干预效果[J].医药导报,2017,36(增):109-110.