某三甲医院急诊内科地塞米松磷酸钠注射液使用分析

Usage analysis of Dexamethasone Sodium Phosphate Injection in a department of emergency medicine of A top three hospital

目的通过对某三甲医院急诊内科地塞米松磷酸钠注射液处方进行点评,发现临床使用地塞米松磷酸钠存在的问题,提出改进措施。方法利用某三甲医院临床药学管理系统(PASS),抽取急诊内科2012年9月至2013年2月全部处方数及使用地塞米松磷酸钠注射液处方数,记录抽取结果。同时,利用医院药品微机管理系统(HIS)和PASS随机抽取2012年9月至2013年2月急诊内科含地塞米松磷酸钠注射液处方每月100张,共600张,药学人员对每张处方进行初评,处方点评专家组进行终评,得出点评结果。通过医院管理部门,与临床科室有效沟通,反馈处方点评结果、存在的问题及改进措施。结果 2012年9月至2013年2月每月地塞米松磷酸钠注射液处方数分别为432、327、233、185、271、264张,合计总处方数1 448张,占急诊内科总处方数的11.97%,总体呈下降趋势。期间急诊内科地塞米松磷酸钠注射液处方合理率分别为28%、43%、36%、48%、73%、70%,总体上合理率由28%上升到70%。不合理处方类型主要表现在适应证不适宜、遴选的药品不适宜、有配伍禁忌等。抽取的处方中部分处方医师不合理处方比例在下降,合理率不断提高。结论通过实施处方点评及与临床医生的有效沟通等干预措施,地塞米松磷酸钠处方开具的合理率在不断提高,使用率呈下降趋势,处方点评取得一定效果。但仍需完善HIS功能设置,加强医务人员对相关法律法规和诊疗规范的学习,提高药学人员与临床医生的沟通能力,从而提高处方质量,促进合理用药。

Objective To find out problems of dexamethasone sodium phosphate injection used in clinic,and then to put forward improvement measures. Methods We extracted all prescriptions and the prescriptions containing all of dexamethasone sodium phosphate injection between September 2012 to February 2013 in a department of emergency medicine by setting extraction conditions in PASS PharmAssist（ PASS） of A top three hospital. At the same time,in Hospital Information System（ HIS） and PASS PharmAssist（ PASS）, we randomly selected 100 prescriptions of dexamethasone sodium phosphate injection per month from September 2012 to February 2013,total 600. Firstly,pharmacy staff reviewed preliminarily each prescription,and then the reviewing prescription panel finally commented on each prescription and worked out results. In addition,the hospital management departments communicated effectively with clinical departments to feedback the results of prescription review,problems and improvement measures. Results In this study,monthly prescription numbers of dexamethasone sodium phosphate injection were 432,327,233,185,271,264 copies respectively between September 2012 and February 2012,with a overall downward trend. The total number of prescriptions dexamethasone Sodium Phosphate is 1448,accounting for 11. 97% of total number of prescriptions. During this period,reasonable rates of Dexamethasone Sodium Phosphate Injection prescription were 28% in September 2012,in October 43% 2012,36% in November 2012,48% December 2012,73% in January 2013,in 70% February 2013. In general,a reasonable rate increased from 28% up to 70%. The types of irrational prescription were mainly manifested in that indication was not appropriate,selection of drugs was not suitable,a compatibility taboo,etc. Of the extracted prescriptions,the proportion of unreasonable prescriptions for some prescribers was inclining,and reasonable rate continued to increase. Conclusions Through the implementation of prescription comment and effective communication with clinicians and other interventions,the reasonable rate of prescriptions of dexamethasone sodium phosphate injection is increasing,and the utilization rate decreases,which indicates prescription comment achieves certain results. But we still need to improve the function of hospital information system settings,strengthen medical personnel to learn the relevant laws and regulations and the diagnostic standard,and improve the communication skills of the pharmaceutical researchers and clinicians so as to improve the quality of prescription and promote rational use of medicines.