全面触发工具在呼吸科药品不良事件实时监测中的应用

Application of global trigger tool in real-time measurement of adverse drug events in respiratory department

目的验证全面触发(GTT)工具在呼吸科药品不良事件(ADE)实时监测中应用的可行性。方法首先由初级专业技术资格的临床医师和药师每日应用设计的触发器对呼吸科的住院患者进行日常监测并确定触发器阳性病例,再由中级专业技术资格的临床医师和药师进行ADE的判定和分析,并将最终确定的ADE进行危害程度分级、汇总和上报。结果设计的触发器20项中有17项为阳性,触发器阳性率为85.00%。触发器阳性共计260例次,检出ADE 24例次,触发器阳性预测值为9.23%。纳入登记的病例205份,ADE检出率为11.71%(24/205),与呼吸科ADE自愿上报率(1.12%)比较差异有统计学意义(χ~2=98.01,P<0.01)。ADE主要集中在60岁以上的老年患者(构成比79.17%)。患者原发疾病以慢性阻塞性肺疾病急性加重期、社区获得性肺炎和支气管哮喘等呼吸科常见病为主。涉及药品主要为抗菌药物、抗结核药、糖皮质激素和支气管扩张剂等20个常见品种。ADE的危害程度以轻中度为主,其中E级22例次,F级2例次。结论触发器设计合理,能够实时监测呼吸科ADE并检测到更多的ADE,可作为临床药师开展专科临床药学工作的内容与切入点。

Objective To verify the feasibility of using Global Trigger Tool (GTT) in real- time measurement of adverse drug events (ADE) in respiratory department. Methods First,clinicians and pharmacists with primary professional and technical qualifications applied the designed trigger daily to monitor patients in the respiratory department and determine the positive trigger cases.Then,clinicians and pharmacists with secondary professional and technical qualifications conducted the judgment and analysis of adverse drug events and classified, summarized and reported the final determined ADE. Results17 cases were positive in 20 triggers designed in this study,and the positive rate of triggers was 85.00%.There were 260 positive triggers and 24 ADE detections,and the Trigger′s PPV was 9.23%.Among 205 registered cases,ADE detection rate was11.71%(24/205),showing a significant statistical difference (χ^2 =98.01, P <0.01) with the voluntary reporting rate of ADE in respiratory department (1.12%).ADE was mainly concentrated in elderly patients over 60 years of age (79.17%).The main primary diseases of the patients were acute exacerbation of chronic obstructive pulmonary disease,community- acquired pneumonia,bronchial asthma and other common respiratory diseases.The drugs involved were mainly antibacterial agents,anti- tuberculosis drugs,glucocorticoids,bronchiectasis agent and so on, totally 20 common varieties.The ADE harmful degree was mainly mild and moderate,including grade E (22 cases) and grade F (2 cases). Conclusion The trigger designed in this study can monitor the adverse drug events in respiratory department in real time,which can be used as the content and entry point for clinical pharmacists to carry out specialized pharmaceutical services and is beneficial to the improvement of patients′ medication safety management level.