靜脈用藥調(diào)配中心不合理醫(yī)囑分析及干預(yù)

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(diào)配中心（pharmacy intravenous admixture services，PIVAS）不合理用藥醫(yī)囑進(jìn)行分析和干預(yù)，為臨床合理用藥提供參考。方法：采用自主開發(fā)的醫(yī)囑審核軟件及人工審核相結(jié)合的方式，以2018年10月-2019年3月本院靜脈用藥調(diào)配中心長期用藥醫(yī)囑作為研究對象，對不合理用藥醫(yī)囑進(jìn)行統(tǒng)計(jì)分析和干預(yù)。結(jié)果：選取2018年10月-2019年3月本院PIVAS長期用藥醫(yī)囑數(shù)473 530組，其中不合理醫(yī)囑數(shù)732組，占所有審核醫(yī)囑的0.15%。不合理醫(yī)囑主要類型包括：給藥濃度不當(dāng)、溶媒種類選擇不當(dāng)、給藥劑量不當(dāng)、給藥頻次不當(dāng)、重復(fù)用藥等。2019年第一季度不合理醫(yī)囑總數(shù)比2018年第四季度下降，差異有統(tǒng)計(jì)學(xué)意義（字2=5.885，P=0.015）。結(jié)論：該院PIVAS通過進(jìn)一步加強(qiáng)對不合理用藥醫(yī)囑分析和干預(yù)，提高了該院靜脈用藥的安全性和合理性。

【關(guān)鍵詞】 靜脈用藥調(diào)配中心 不合理用藥醫(yī)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(yī)院靜脈用藥大多是經(jīng)靜脈用藥調(diào)配中心（pharmacy intravenous admixture services，PIVAS）的藥師審核、調(diào)配等處理后再送至各臨床科室使用，由藥學(xué)部門統(tǒng)一管理。本院PIVAS主要承擔(dān)住院患者和抗腫瘤藥物門診、門急診患者的靜脈用藥調(diào)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(jìn)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(fēng)險(xiǎn)，使用不當(dāng)可能導(dǎo)致更嚴(yán)重的后果[2]。這就要求PIVAS審方藥師在進(jìn)行調(diào)配等環(huán)節(jié)之前應(yīng)嚴(yán)格把關(guān)并遵守醫(yī)院醫(yī)囑審核制度，按照《醫(yī)療機(jī)構(gòu)處方審核規(guī)范》等相關(guān)規(guī)定進(jìn)行醫(yī)囑審核[3]，明確藥師作為處方（包括醫(yī)囑）審核的第一責(zé)任人，發(fā)揮審方藥師的作用。……