李燕華 李仲昆 梁月琴 拔普俊 趙方允



【摘要】 目的:通過對本院靜脈用藥調配中心(pharmacy intravenous admixture services,PIVAS)不合理用藥醫囑進行分析和干預,為臨床合理用藥提供參考。方法:采用自主開發的醫囑審核軟件及人工審核相結合的方式,以2018年10月-2019年3月本院靜脈用藥調配中心長期用藥醫囑作為研究對象,對不合理用藥醫囑進行統計分析和干預。結果:選取2018年10月-2019年3月本院PIVAS長期用藥醫囑數473 530組,其中不合理醫囑數732組,占所有審核醫囑的0.15%。不合理醫囑主要類型包括:給藥濃度不當、溶媒種類選擇不當、給藥劑量不當、給藥頻次不當、重復用藥等。2019年第一季度不合理醫囑總數比2018年第四季度下降,差異有統計學意義(字2=5.885,P=0.015)。結論:該院PIVAS通過進一步加強對不合理用藥醫囑分析和干預,提高了該院靜脈用藥的安全性和合理性。
【關鍵詞】 靜脈用藥調配中心 不合理用藥醫囑 合理用藥
[Abstract] Objective: Through the analysis and intervention of unreasonable medicine prescription of pharmacy intravenous admixture services (PIVAS) in our hospital, it can provide reference for rational drug use in clinic. Method: From October 2018 to March 2019, the long-term medical treatment of PIVAS in our hospital was used as the research object. The analysis irrational medical advice and intervention on unreasonable medical orders were conducted. Result: From October 2018 to March 2019, 473 530 groups of PIVAS long-term medical orders in our hospital were selected, among which 732 were unreasonable orders, accounting for 0.15% of all examined orders. The main types of unreasonable medical advice include: improper drug concentration, improper choice of solvent type, improper dosage, improper frequency, repeated use, et al. The total number of unreasonable medical orders in the first quarter of 2019 decreased compared with the fourth quarter of 2018, with a statistically significant difference (字2=5.885, P=0.015). Conclusion: PIVAS in our hospital further strengthened the analysis and intervention of irrational medication orders to improve the safety and rationality of intravenous medication in our hospital.[Key words] Pharmacy intravenous admixture services Irrational medical advice Rational use of drugsFirst-authors address: Affiliated Yanan Hospital of Kunming Medical University, Kunming 650051, China
醫院靜脈用藥大多是經靜脈用藥調配中心(pharmacy intravenous admixture services,PIVAS)的藥師審核、調配等處理后再送至各臨床科室使用,由藥學部門統一管理。本院PIVAS主要承擔住院患者和抗腫瘤藥物門診、門急診患者的靜脈用藥調配。我國目前住院患者的給藥方式主要采用靜脈給藥,藥物直接進入血液,起效迅速、利用度高[1],但比其他給藥方式有更高的風險,使用不當可能導致更嚴重的后果[2]。這就要求PIVAS審方藥師在進行調配等環節之前應嚴格把關并遵守醫院醫囑審核制度,按照《醫療機構處方審核規范》等相關規定進行醫囑審核[3],明確藥師作為處方(包括醫囑)審核的第一責任人,發揮審方藥師的作用。……