PDCA循环在化疗药物安全管理中的应用

Application of PDCA cycle in the safety management of chemotherapy drug

目的探讨策划-实施-检查-改进（PDCA）循环在化疗药物安全管理中的效果,以实现化疗药物在肿瘤相关科室的安全应用。方法回顾性分析2014年1-12月辽宁省盘锦市中心医院肿瘤相关科室应用PDCA循环后出现的不良事件发生情况,并将其与2013年1-12月发生的174次不良事件进行对比,分析实施PDCA循环管理前后化疗药物使用过程中存在的主要问题;同时在PDCA循环实施前后,对2014年1月32名肿瘤相关科室在职护士进行化疗药物相关知识及对防护技能方面的考核,比较PDCA循环前后护士各项评分。结果实施PDCA循环管理后,不良事件发生次数由管理前的174次减少为22次,不良事件发生的主要原因为对药物的毒副作用不了解（40.92%）、配药完毕洗手不彻底（13.64%）、不正确佩戴手套和口罩（13.64%）、药物配制技术不熟练（13.64%）。实施PDCA循环管理前后,护士对化疗药物的作用、化疗药物毒性作用、化疗药物的用量、配药技能、污染物和废弃物的处理、配药和化疗操作中的防护措施、配药完毕洗手、意外暴露的处理等理论掌握及防护措施操作水平评分及总分均明显高于PDCA循环管理实施前,差异均有统计学意义（P〈0.05或P〈0.01）。结论在化疗药物安全管理中应用PDCA循环可明显降低不良事件的发生次数,提高护士对化疗药物相关知识掌握水平及防护技能,实现化疗药物在肿瘤相关科室的安全应用。

Objective To explore effect of plan-do-check-action（PDCA） cycle in the chemotherapy drug safety management, in order to realize security application of chemotherapy drugs in tumor related departments. Methods The occurrence of adverse events after the application of PDCA cycle in drug management from January to December 2014 were retrospectively analyzed, and compared with 174 adverse events occurred in tumor related department from January to December 2013 in Panjin Central Hospital of Liaoning Province. The main problems existing in the using of chemotherapy drugs before and after the management of PDCA cycle were analyzed. At the same time, chemotherapy drug related knowledge and protective skills of 32 nurses before and after PDCA cycle in January 2014 in tumor related department were examined, the scores of nurses before and after PDCA cycle were compared. Results The number of adverse event was significantly reduced after PDCA cycle management（22 cases）, the main reason were do not understand the side effects of drugs（40.92%）, not to wash hands thoroughly after dispensing（13.64%）, incorrect wearing of gloves and face mask（13.64%）, unskilled of medicine preparation（13.64%）. After PDCA cycle management, theory and protective measures operating level of the nurses such as the effect of chemotherapy drugs, toxic effects of chemotherapy drugs dispensed, dosage of chemotherapy drugs, skills of medicine preparation, disposal of pollutants and waste treatment, protective measures in the process of dispensing operation and chemotherapy, washing hands after medicine preparation, accidentally exposed processing theory and protective operation level were obviously improved compared with before, the differences were statistically significant（P〈0.05 or P〈0.01）. Conclusion Application of PDCA cycle in the chemotherapy drug safety management can significantly reduce the number of adverse events, improve the level of chemotherapy drugs related knowledge and protective ability of the nurse, realize the security application of chemotherapy drug in tumor related department.