我院2017年静脉用抗肿瘤药物配置和使用分析及干预效果评价

Analysis of the admixture and use of intravenous anticancer drugs and evaluation of the intervention effect in 2017 in our hospital

目的:了解我院抗肿瘤药物静脉给药不合理医嘱的规律和特点,促进临床合理用药。方法:依据药品说明书、《新编药物学》、《中国药典·临床用药须知(2015版)》、NCCN临床实践指南、抗肿瘤药物处方点评指南等,分析我院2017年抗肿瘤药物不合理医嘱,比较干预前后抗肿瘤药物使用不合理发生率及其类型。结果:共审核医嘱6018份(干预前3160份,干预后2858份),不合理用药医嘱372份,干预前277份(74.46%),干预后95份(25.54%)。经干预后我院抗肿瘤药物不合理医嘱较前明显下降(干预前不合理率为8.77%,干预后为3.32%,P<0.01)。不合理医嘱类型主要有:需避光药物未进行避光处理(20.70%);给药顺序不正确(29.30%);溶媒选择不适宜(28.23%);未按要求预处理(21.77%)等,干预前其发生率分别为1.93%、2.75%、2.44%、1.65%;干预后分别为0.56%、0.77%、0.98%、1.01%,较干预前均显著降低(P<0.01)。结论:临床药师通过医嘱审核、反馈、干预后,可显著降低抗肿瘤药物不合理医嘱的数量,减少或避免药品不良反应及用药事故的发生。

Objective:To analyze the unreasonable prescriptions of intravenous anti-tumor drugs in our hospital,in order to promote the clinical rational use of antitumor drugs.Methods:Intravenous prescriptions for inpatients in our hospital in 2017 were checked manually according to the drug package insert,<New Materia Medica>,the guidelines of clinical medication of Chinese Pharmacopoeia,the guidelines for clinical practice of NCCN and the guidelines for the evaluation of prescriptons of antitumor drugs,etc.We analyzed the irrational medical orders and compared the unreasonable incidence rate and types before and after intervention.Results:A total of 6018 intravenous medical orders were reviewed(3160 cases were before intervention,2858 were after intervention).A total of 372 unreasonable medical orders were evaluated,there were 277 orders before intervention(74.46%),and 95 after intervention(25.54%).The unreasonable incidence rate obviously decreased through the intervention(8.77%before intervention vs 3.32%after intervention,P<0.01).The main types of irrational orders were as follows:the drugs needed to avoid light not keeping out of the sun(20.70%);the incorrect order of administration(29.30%);the unsuitable selection of solvent(28.23%);not pretreatment according to instruction(21.77%),the unreasonable rates were 1.93%,2.75%,2.44%,1.65%before intervention,and 0.56%,0.77%,0.98%,1.01%after intervention,respectively(P<0.01).Conclusion:Though review,feedback and intervene of the medical orders,the unreasonable rates were reduced significantly,which can reduce or avoid adverse drug reaction and accidents of medication.