基于TPN审核系统对全肠外营养用药医嘱分析

Analysis of medication orders for total parenteral nutrition based on TPN audit system

目的基于全肠外营养(TPN)审核系统分析TPN用药医嘱的临床应用情况,从合理性和安全性来保障临床TPN的应用。方法选择我院2016年1-12月接受营养支持治疗的13 327张TPN用药医嘱,观察TPN审核系统拦截的情况,并进行回顾性统计分析。结果 2016年有541张(占4. 06%)处方的能量供给不足,糖脂比不合理处方469张(占3. 52%),热氮比不当导致的不合理处方有633张(占4. 75%),其中,热氮比<100∶1的处方有306张(占2. 30%),> 200∶1的处方有327张(占2. 45%),电解质用量不合理总处方数180张(占1. 35%),液体量不在规定计算范围内的处方有349张(占2. 62%)。每月对各临床科室不合理的医嘱进行处方点评,将点评结果反馈临床。结论 TPN系统可以快速统计出不合理医嘱,较以往未应用TPN审核系统时,拦截的不合理率提高。临床医生应加强TPN知识的学习,临床药师收集汇总不合理医嘱,协助临床医生更合理地开立TPN用药医嘱,提高临床肠外营养用药的合理性和安全性。

Objective Based on the TPN system,the clinical application of total parenteral nutrition(TPN)medication orders was analyzed,and the application of clinical TPN was ensured for rationality and safety.Methods A retrospective statistical analysis was made on13327TPN medication orders received by our hospital from January2016to December2016by using TPN system.Results In2016,541(4.06%)prescriptions were insufficient in energy supply,469(3.52%)prescriptions were unreasonable in glycolipid ratio,633(4.75%)prescriptions were unreasonable due to improper hot nitrogen ratio.In this survey,306(2.30%)prescriptions were less than100:1in hot nitrogen ratio and327(2.45%)prescriptions more than200:1;180(1.35%)had unreasonable electrolyte dosage,and349(2.62%)prescriptions were without prescribed liquid volume.Monthly prescription reviews were made for irrational prescriptions in different clinical departments,and the results were sent back to clinical department,so as to a-chieve the goal of rational drug use,medication monitoring and management.Conclusion The unreasonable medical orders can be collected conveniently and quickly,compared with those without TPN audit system,the unreasonable rate of interception increased.Clinicians should strengthen the related learning of TPN knowledge.Clinical pharmacists collect unreasonable medical orders,so as to do integrated analysis and help clinicians to give a more reasonable TPN medication order,which is designed to provide a basis for improving the rationality and safety of medication in clinical parenteral nutrition.