中日友好医院静脉用药调配中心全肠外营养处方的合理性分析

Analyze the rationality of total parenteral nutrition (TPN) prescriptions in pharmacy intravenous admixture services

目的:对中日友好医院肠外营养处方的合理性进行调查分析,为进一步全面实施药学干预提供数据支持与参考。方法:通过HIS提取医嘱信息,依据《临床诊疗指南肠外肠内营养学分册》等相关指南对全营养混合液处方进行合理性评价,对部分不合理处方进行个体化干预。结果:2015年9―12月共审核处方2 903份,不合理处方297份(占10.2%),不合理问题345次,糖脂比不合理32.6%;其中阳离子超量29.5%;液量不适宜14.8%;热氮比不合理14.5%;缺少必要营养素9.5%。结论:中日友好医院肠外营养处方存在不合理现象,临床药师应充分发挥专业技能对肠外营养处方进行审核与干预,为提高患者用药安全做出贡献。

Objectives： In order to provide data for further and comprehensive pharmaceutical interventions, the aims of this study is to investigate the rationality of parenteral nutrition prescriptions in our hospital. Methods： Orders were extracted from the hospital information system. According to the Clinical diagnosis and treatment guidelines for parenteral and enteral nutrition, rationality of Total Nutrient Admixture（TNA） prescriptions, was evaluated. Part of the irrational prescriptions has been corrected by pharmacists. Results： 2903 prescriptions were extracted from September to December 2015. Irrational prescriptions were 297（10.2%）. 345 irrational events were identified, including the ratio of glucose to lipid unreasonable（32.6%）, cationic excess（29.5%）; the amount of liquid unsuitable（14.8%）, non-protein calorie to nitrogen unreasonable（14.5%）, lacking of necessary nutrients（9.5%）. Conclusion： There were irrational parenteral nutrition prescriptions in our hospital. More medication reviews and interventions should be conducted by skilled clinical pharmacists to contribute to drug safety.