静脉药物配置中心审核的不合...嘱原因及干预效果回顾性分析_孟祥君.pdf

中国病案2023 年第 24 卷第 4 期 109distal tibial fractures:a comparison of medial and lateral plating J.J Orthop Sci,2012,17(5):562-566.11 Lee YS,Chen SH,Lin JC,et al.Surgical treatment of distal tibia fractures:a comparison of medial and lateral plating J.Orthopedics,2009,32(3):163.12 Lau TW,Leung F,Chan CF,et al.Wound complication of minimally invasive plate osteosynthesis in distal tibia fracturesJ.Int Orthop,2008,32(5):697-703.13 李健伟,陈能,栗志辉,等.L 型解剖板踝前横切口微创治疗胫骨远端骨折的疗效分析J.中华创伤骨科杂志,2014,16(5):457-459.14 戚浩天,李卫康,赵永杰,等.两种方法治疗胫骨远端关节外骨折疗效比较J.中国修复重建外科杂志,2013,27(11):1286-1290.15 An L,Zhang JW,Ma WH,et al.Clinical comparison of single-incision and dual-incision approaches for the treatment of distal tibial and fibular fractures:A randomized controlled trialJ.J Orthop Surg(Hong Kong),2020,28(2):1-8.16 吴溢峰,李朝福,钟姣红,等.三种钢板内固定技术治疗胫骨远端骨折的比较J.中国矫形外科杂志,2018,26(16):1452-1456.17 Zelle BA,Bhandari M,Espiritu M,et al.Treatment of distal tibia fractures without articular involvement:a systematic review of 1125 fracturesJ.J Orthop Trauma,2006,20(1):76-79.18 肖志林,周明昌,冯经旺,等.微创经皮钢板接骨术结合锁定加压钢板与切开复位解剖型钢板内固定治疗胫骨远端骨折的疗效比较J.中华创伤骨科杂志,2014,16(1):91-92.19 Pitkowski K,Piekarczyk P,Kwiatkowski K,et al.Comparison of different locking plate fixation methods in distaltibia fracturesJ.Int Orthop,2015,39(11):2245-2251.(2022-06-11 收稿)静脉药物配置中心审核的不合理医嘱原因及干预效果回顾性分析 孟祥君 摘要 目的 回顾性分析某三甲医院静脉药物配置中心医嘱用药不合理的原因及干预现状，为药师合理审方提供参考，促进临床合理用药。方法 调取2021年1月1日-2021年12月31日PIVAS医嘱用药428735组，应用 Excel 2013 统计审方药师所记录的不合理医嘱，对不合理医嘱的审核与干预、科室分布、医嘱类型等情况进行分析、总结不合理医嘱发生原因，提出合理性意见。结果 审核的 428735 组 PIVAS 医嘱中，不合理医嘱 438 组，不合格率为 0.10%。不合理用药涉及的主要病区有心血管内科二病区、血液科一病区、心血管内科三病区、呼吸内科三病区，构成比分别为 8.45%、7.08%、6.62%、6.39%。不合理用药主要类型有溶媒量不适宜、溶媒选择不适宜，营养剂开具不合规范、给药浓度不适宜、给药剂量不适宜、溶液配置问题、TPN 中加入非营养类药物、有配伍禁忌、给药频次不适宜、能量物质单独输注。占比较高的类型为溶媒量不适宜、溶媒选择不适宜，构成比分别为 43.60%、31.51%。不合理医嘱成功干预 406 组，干预成功率为 92.69%，结论 溶媒量不适宜和溶媒选择不适宜是不合理医嘱的主要问题，应采取相应措施，能及时预防和减少不合理用药情况的发生，为患者安全用药提供保障，提高临床合理用药水平。关键词 静脉药物配置中心；不合理医嘱；合理用药1 Retrospective Analysis of Reasons and Intervention Effects of Unreasonable Medical Orders Audited by Intravenous Retrospective Analysis of Reasons and Intervention Effects of Unreasonable Medical Orders Audited by Intravenous Drug Allocation Center Drug Allocation Center Meng Xiangjun Abstract ObjectivesAbstract Objectives To retrospectively analyze the causes and intervention status of irrational drug use ordered by the intravenous drug allocation center of a Three A and Tertiary Hospital,so as to provide reference for pharmacists to rationally evaluate prescriptions and promote rational drug use in clinical practice.MethodsMethods 428735 groups of PIVAS prescribed medications were recruited from January 1st,2021 to December 31st,2021.The unreasonable medical orders recorded by prescription examiners were counted by Excel 2013.The review and intervention of unreasonable medical orders,distribution of departments and types of medical orders were analyzed and the causes of unreasonable medical orders were summarized.Put forward reasonable opinions.ResultsResults Among 428735 groups of PIVAS medical orders audited,438 groups of unreasonable medical orders,the unqualified rate was 0.10%.The main wards involved in irrational drug use were the second ward of cardiovascular department,the first ward of hematology department,the third ward of cardiovascular department and the third ward of respiratory department,with the composition ratio of 8.45%,7.08%,6.62%and 6.39%,respectively.The main types of irrational drug use include inappropriate solvent quantity,inappropriate solvent selection,non-standard nutrient formulation,inappropriate drug concentration,inappropriate drug dosage,solution configuration problems,adding non-nutritional drugs into TPN,incompatibility,inappropriate drug administration frequency,and single infusion of energy substances.The most important types were unsuitable solvent quantity and unsuitable solvent selection,with composition ratios of 43.60%and 31.51%,respectively.406 groups were successfully intervened with unreasonable medical orders,and the success rate of intervention was 92.69%.ConclusionsConclusions Inappropriate solvent quantity and inappropriate solvent selection were the main problems of unreasonable medical orders.Corresponding measures should be taken to prevent and reduce irrational drug use in time,provide guarantee for safe drug use of patients,and improve clinical rational drug use level.Key wordsKey words Intravenous drug dispensing center；Unreasonable medical advice；Rational drug use 解放军总医院医疗保障中心药剂科，北京市，100853 中国病案2023 年第 24 卷第 4 期 110FirstFirst-authorauthors address s address Department of Pharmacy,Medical Supplies Center of Chinese PLA General Hospital,Beijing 100853,China 静脉药物配置中心(Pharmacy Intravenous Ad-mixture Service,PIVAS)是集中调配静脉药物的场所，由药学专业人员根据医师处方或用药医嘱的适宜性审核，并按照无菌操作要求在洁净环境下对静脉用药进行集中调配，以供临床直接静脉输注使用1，静脉输液是当前临床上常见的治疗手段，对于患者的治疗具有积极意义2-3。某院药房自成立 PIVAS 以来，承担病区的静脉输液配置工作，为了提高药物配制质量，加强临床合理用药，为此专门设立 PIVAS 审方药师岗位，旨在拦截不合理医嘱并协助医师制定有效的用药方案，降低药品不良反应的发生率，促进药房与临床的沟通以推动临床药学的发展。分析 PIVAS 不合理医嘱的用药