肠外营养审方对PN医嘱合理率及费用的影响

The impact of prescription audit of parenteral nutrition on the normalization and cost of parenteral nutrition support medical orders

目的:了解药师和营养师联合开展肠外营养药物审方对肠外营养支持(PN)合理率的影响。方法:回顾性调研某院2008年5月和2011年5月出院患者的病历,对病历中PN的类型(集中配置全合一、工业化三腔袋、单瓶串输)、阳离子用量、热氮比、糖脂比、营养药费用等情况进行调研,对审方前后PN医嘱合理率的变化进行分析。结果:该院肠外营养药物审方工作开展后,集中配置的全合一PN医嘱合理率由2008年的72/156(46.15%)上升至2011年的207/218(94.95%),差异有统计学意义(P=0.0000),未经过药物审方的工业化三腔袋及串输医嘱合理率2011年分别较2008年降低39.35%(P=0.000)及8.57%(P=0.489 5)。医嘱不合理类型以热氮比及阳离子用量不合理为主。结论:开展肠外营养药物审方有利于减少不合理的PN医嘱,药师和营养师在保证PN处方的合理性和安全性方面起到了重要作用。

IECTIVE To understand the impact of prescription audit of parenteral nutrition on the normalization and cost of parenteral nutrition support medical orders. METHODS Retrospectively surveyed the medical records of our hospital inpa tients who discharged during May 20（18 and May 2011, about the type of PN compounder（All-In-One, industrialization triple- chamber bag, single-bottle infuse）, cation content, energy-nitrogen ratio, sugar-lipid supply energy ratio and TPN cost. The rate of appropriateness and TPN cost between deferent years were analyzed. RF^ULTS After carried out the routine moni- tored of TPN orders, the rational rate in All I^One PN orders increased from 72/156 （46. 15~） in May 2008 to 207/218 （94. 95 ~/00） in May 2（}1l, the increase was statistically significant （P = 0. 000 0）. The rational rate of industrialization triple- chamber-bag PN order declined from 64. 800/00 in May 2（}08 to 25.45% in May 2（}11, the decrease was statistically significant （P- 0. 0000）. The main types of inappropriate PN order were irrational energy-nitrogen ratio and the amount of cation. CONCLUSION Carrying out of routine monitored for PN order was associated with a reduction in inappropriate PN orders,in- volvement of pharmacists and dietitians played a key role on the reasonableness and safety use of PN.