临床药师参与的抗菌药物医嘱用药干预情况分析

Analysis of Intervention of Antibacterial Drugs Prescribed by Doctors Participated by Clinical Pharmacists

目的:分析由临床药师主导的抗菌药物医嘱用药干预情况,为临床抗菌药物的合理使用提供参考。方法:利用医院信息系统,收集2019年6月—2020年9月有临床药师实施用药干预的1 226条抗菌药物医嘱,分析所涉及抗菌药物医嘱的不合理原因和干预结果,以及干预成功医嘱的科室分布、药物品种分布和抗菌药物使用变化情况。结果:实施用药干预的1 226条抗菌药物医嘱中有1 140条干预成功,其中医嘱的不合理原因主要为用药疗程过长(369条,占32.37%)、药品选择不适宜(190条,占16.67%)、单次用药剂量过大(172条,占15.09%)、联合用药不适宜(148条,占12.98%)和给药频次过高(130条,占11.40%);1 140条干预成功的抗菌药物医嘱涉及的科室主要为骨科(212条,占18.60%)、口腔科(152条,占13.33%)、肝胆外科(107条,占9.39%)和手外科(103条,占9.04%),骨科、口腔科、手外科的医嘱不合理原因主要为用药疗程过长,而肝胆外科的医嘱不合理原因主要为药品选择不适宜;1 140条干预成功的抗菌药物医嘱涉及的药物主要为五水头孢唑林(252条,占22.11%)、头孢唑肟(190条,占16.67%)和左氧氟沙星(118条,占10.35%),五水头孢唑林和头孢唑肟的医嘱不合理原因主要为用药疗程过长,而左氧氟沙星的医嘱不合理原因主要为给药频次过高;2019年6月—2020年9月,各临床科室的抗菌药物销售金额均有不同程度下降,其中骨科和口腔科的降幅最大,此外骨科、泌尿外科和消化内科的抗菌药物用药频度也显著下降。结论:临床药师的用药干预在临床上有着较好的接受度,可有效促进临床抗菌药物的合理使用,确保患者用药的安全性和有效性。

Objective: To analyze the intervention of antibacterial drugs prescribed by doctors led by clinical pharmacists, and provide reference for the rational use of clinical antibacterial drugs. Methods: With the hospital information system, 1 226 orders of antibacterial drugs that were intervened by clinical pharmacists from June 2019 to September 2020 were collected, and the irrational reasons and intervention results of the orders of antibacterial drugs involved were analyzed, as well as the distribution of departments, distribution of drug varieties and changes in the use of antibacterial drugs where the orders were successfully intervened. Results: A total of 1 140 of the 1 226 orders of antimicrobial drugs were successfully intervened. The irrational reasons for the orders were mainly the long course of medication(369 orders, accounting for 32.37%), inappropriate drug selection(190 orders, accounting for 16.67%),excessive single dosage(172 orders, accounting for 15.09%), inappropriate combination medication(148 orders,accounting for 12.98%) and excessive frequency of administration(130 orders, accounting for 11.40%). The departments involved in the 1 140 orders of antibacterial drugs successfully intervened were mainly orthopedics(212 orders, accounting for 18.60%), stomatology(152 orders, accounting for 13.33%), hepatobiliary surgery(107 orders, accounting for9.39%) and hand surgery(103 orders, accounting for 9.04%). The irrational reason of the orders of orthopedics,stomatology and hand surgery was mainly the long course of medication, while the irrational reason of the orders of hepatobiliary surgery was mainly the inappropriate drug selection. The 1 140 orders of antibacterial drugs that were successfully intervened mainly involved cefazolin pentahydrate(252 orders, accounting for 22.11%), cefazoxime(190orders, accounting for 16.67%) and levofloxacin(118 orders, accounting for 10.35%). The irrational reason of the orders of cefazolin pentahydrate and cefazoxime was mainly the long course of medication, while the irrational reason of the orders of levofloxacin was mainly the high frequency of administration. From June 2019 to September 2020, the sales amount of antibacterial drugs in all clinical departments decreased to varying degrees, with the largest decline in orthopedics and stomatology. In addition, the use frequency of antibacterial drugs in orthopedics, urology and digestive medicine also decreased significantly. Conclusion: The medication intervention of clinical pharmacists is acceptable in clinical practice, which can effectively promote the rational use of clinical antibacterial drugs and ensure the safety and effectiveness of patient medication.