我院儿童使用水合氯醛溶液的采样分析及风险防范与管理

Risk Analysis and Management of Use of Chloral Hydrate Solution in Pediatric Patients in Our Hospital

目的采样分析我院儿童使用水合氯醛溶液的实际用量,探讨防止过量或累计用药的管理策略。方法抽取我院2015年7~12月所有18岁(含)以下儿童使用水合氯醛溶液的所有处方,对其使用科别、患者年龄、使用剂量等情况进行统计,根据儿童生长发育体重指标,计算患儿使用水合氯醛的使用剂量范围,从而判断处方中用量是否合理,是否存在过量使用和重复用药的风险。结果 2015年7~12月所有18岁(含)以下儿童使用水合氯醛溶液的处方是1 086张,我院水合氯醛溶液多用于神经科、儿科、耳鼻喉科等科室的检查前镇静用;10 m L水合氯醛溶液多用于12岁(含)以下儿童,30 m L水合氯醛溶液多用于13岁以上儿童;12.80%的处方存在用药过量的风险;处方中存在实际使用量过小,药品有浪费的现象和剩余药品在患者手中,有误服和过量使用的潜在风险;有12人次存在同一天中重复取药的情况,存在重复用药的风险。结论严格执行高危药品管理制度,完善医院HIS系统,规范医生处方开具,完善水合氯醛规格,发挥药师作用,避免药物过量和累计使用的风险。

OBJECTIVE To analyze the actual dosages of chloral hydrate solution used in pediatric patients in our hospital and discuss how to prevent excessive dosing or accumulated overdose. METHODS The prescriptions of chloral hydrate solution for outpa- tients under or equal to 18 years old during the period of July 2015 to December 2015 in our hospital were extracted. The information a- bout departments, patient age, and dosages were collected. The dose ranges of chloral hydrate according to the height and weight stand- ardized growth charts for children were calculated in order to determine whether the prescribed dosage was too high and whether there was risk of overuse and cumulative overdose. RESULTS A total of 1 086 chloral hydrate prescriptions were extracted, mostly pre- scribed by the departments of neurology, pediatrics, ENT and other departments for sedation before examinations. The children under or equal to 12 years old were mostly prescribed 10 mL of chloral hydrate solution, while those over 13 years old were prescribed 30 mL. The risk of overdose was 12. 8%. The actual dosages were too small for some children. There existed drug waste phenomenon and po- tential risks of accidental medication and overuse. There were 12 patients with repeated prescriptionson the same day, resulting in a re- peated medication risk. CONCLUSION In order to avoid the risk of overdose and repeated use of chloral hydrate solution in pediatric children, it is necessary to comply with the high-risk drug management system, improve the hospital information system, write prescrip- tions correctly, and change the preparation package of chloral hydrate solution. Pharmacists need to play a more active role.