全面触发工具在心理卫生疾病患者药品不良事件监测中的探索与运用

Exploration and Application of Global Trigger Tool in Monitoring Adverse Drug Events in People with Mental Health Problems

目的:本研究旨在运用全面触发工具(global trigger tool,GTT)监测心理卫生疾病住院患者的药品不良事件(adverse drug event,ADE),统计ADE发生率并分析影响因素。方法:随机抽取600例四川大学华西医院心理卫生中心出院日期在2015年以内的成年住院患者病历信息。使用针对心理卫生疾病患者ADE监测的31项触发器对病历进行查阅,确定ADE并分析影响因素。结果:600例患者共发现281个ADE,ADE发生率为40. 50%。常见的ADE包括消化系统反应、神经系统反应以及锥体外系反应等。影响ADE发生率的相关因素分析结果:①不同性别、年龄段以及出入院护理级别患者ADE发生率无明显差异;②发生过ADE的心理卫生疾病患者,其治疗药物品种数明显多于未发生过ADE的患者,且使用同类药物联合治疗的患者ADE发生率分别较换药治疗和单药治疗的患者更高;③发生过ADE的患者其平均住院日明显较未发生ADE的患者长,且随着ADE发生数增加,平均住院日亦增加。结论:GTT可有效监测心理卫生疾病患者ADE发生情况,以便相关机构对ADE发生情况进行统计分析,为防范ADE发生提供参考依据,在我国心理卫生疾病医疗机构有推广价值。但GTT还需经过进一步修订,以适用于本区域内的心理卫生疾病患者ADE监测。

Objective:To apply the global trigger tool(GTT)in monitoring adverse drug events(ADEs)in inpatients with mental health problems,and count the incidence of ADEs and analyze the influencing factors.Methods:The study was conducted in the mental health center of West China Hospital of Sichuan University.The medical records of 600 adult inpatients with discharge date within2015 were randomly selected.Totally 31 triggers for monitoring ADEs in people with mental health problems were used to review the medical records,and ADEs were defined and the influencing factors were analyzed.Results:A total of 281 ADEs were detectedout in the 600 reviewed medical records with the incidence rate of 40.50%.The common ADEs included digestive system reactions,nervous system reactions and extrapyramidal reactions.The analysis results of influencing factors for ADEs showed that age,gender and nursing level had no apparent effects on the occurrence rate of ADEs,the number of therapeutic drugs used in the patients with ADEs was more than that used in the patients without ADEs,and the incidence of ADEs in the patients with combination therapy with the same kind was higher than that in the patients with changing prescription or monotherapy.The patients with ADEs stayed longer in hospital,and with the incidence increase of ADEs,the length of stay gradually increased.Conclusion:ADEs in patients with mental health problems can be effectively monitored by GTT,which is beneficial to statistical analysis of ADEs by related institutions and provides reference for the prevention of ADEs.It is worthy of promotion in Chinese mental health centers.However,GTT should be revised further in order to be applicable to ADE monitoring for local patients with mental health problems.