临床药师审查医嘱的结果分析

Analysis of the Result of Clinical Pharmacists' Investigation of Medical Advice

目的：探索临床药师在医嘱审核中的方法和作用。方法：设计调查表，对2011年11月～2012年10月临床药师参与审查的医嘱结果进行分析。结果：14675名患者的178724务医嘱中，应用抗菌药物的患者有3232人，占审查医嘱总人数的22．0％，使用抗菌药物患者的医嘱中抗菌药物医嘱5387条，占审查医嘱数的3．0％。发现并干预差错医嘱597条，干预成功率为100％。差错医嘱占审查医嘱总数的0．33％，主要为剂量差错、用法差错和重复用药差错。临床药师监护的重症患者，适应证差错和相互作用差错较普通病区患者多。结论：临床药师与病房药师共同参与医嘱审查工作，可提高医院药师队伍的整体素质，使合理用药工作持续发展，减少用药风险。

Objective： To explore the methods and the role of clinical pharmacists in the medical advice audit. Methods： The questionnaire was designed to analyze the results of the medical advice investigated by the clinical pharmacists from November 2011 to October 2012. Results： Totally 3 232 patients were in the use of antimierobial drugs in a investigation of 14 675 patients in 178 724 medical advices, accoufiting for 22.0% of the total number of the investigation; the use of antimicrobial agents in patients with medical advices of antimicrobial were 5 387, accounting for 3.0% of the total number of the investigation ; 597 errors were detected and intervened, accounting for 0.33% of the total number of the investigation; the main errors were dose errors, usage errors and repeated medication errors. Indication error and interaction error were more in the critically ill patients monitored by the clinical pharmacists than that in the general ward patients. Conclusion： Clinical pharmacists and ward pharmacists to participate medical advice review, particularly to concern about the patients with medical advices of antimicrobial drugs, and to intervene reasonably in the dose errors, usage errors and repeated medication errors can improve the overall quality of the hospital pharmacist team, make sustainable development of rational use of drugs and reduce the risk of medication.