422条住院患者不合理用药医嘱的帕累托图分析

Analysis of Pareto Diagram on Irrational Medical Orders of 422 Inpatients

目的:基于帕累托图分析,了解沈阳医学院附属中心医院(以下简称"我院")医嘱不合理用药情况及原因,为临床合理用药提供参考。方法:汇总分析2018年1—6月我院住院患者58 560条用药医嘱点评结果,应用帕累托图,分析导致医嘱不合理用药的主要因素、次要因素及一般因素。结果:58 560条医嘱中,422条医嘱(占0.72%)存在1种或1种以上不合理用药现象,不合理用药合计471例次。12项不合理用药类型中,溶剂及配制浓度不适宜、围术期用药不合理、给药剂量不当、疗程不适宜和药品剂型或给药途径不适宜为主要因素;超说明书用药、适应证不适宜为次要因素;联合用药不适宜、重复用药、选药不适宜、配伍不当和无指征用药为一般因素。结论:采用帕累托图分析住院患者不合理用药情况,可直接发现主次要因素,便于有针对性地进行干预,提高合理用药水平。

OBJECTIVE: Based on the analysis of pareto diagram, to investigate the the situation and causes of irrational medical orders in Shenyang Medical College Affiliated Central Hospital(hereinafter referred to as "our hospital"), so as to provide reference for the clinical rational medication. METHODS: The review results of 58 560 pieces of medical orders of inpatients in our hospital from Jan. to Jun. 2018 were summarized and analyzed, and the main, secondary and general factors leading to irrational medication of medical orders were analyzed by using pareto diagram. RESULTS: Of the 58 560 medical orders, 422(0.72%) were found to have one or more kinds of irrational drug use, with a total of 471 case-times of irrational drug use. Among the 12 types of irrational drug use, inappropriate solvent and preparation concentration, unreasonable perioperative drug use, inappropriate dosage, inappropriate course of treatment and improper dosage form or route of drug administration were the main factors. Off-label drug use and inappropriate indications were secondary factors.The general factors were improper combination of drugs, repeated dosing, inappropriate drug selection, improper compatibility and drug requisition without indications. CONCLUSIONS: Pareto diagram analysis of irrational drug use in inpatients can directly identify the main and secondary factors. It is beneficial to carry out targeted intervention and improve the levels of rational medication.