静脉用药调配中心对化疗药医嘱审核及PDCA循环干预效果分析

Analysis of the effect of intravenous drug dispensing center on the examination of doctor′s orders for chemotherapeutics and PDCA circulation intervention

目的静脉用药集中调配对化疗药物的安全及合理应用有重要意义,集中调配工作中发现有很多超说明书用药现象。本研究旨在为促进化疗药物合理使用提供参考。方法选取2017-11-01-2018-02-28泰安市中心医院静脉用药调配中心审核的128条化疗药物超说明书用药医嘱进行分析,采用针对性措施进行计划-实施-检查-措施(plan-docheck-action,PDCA)循环干预,并与2018-03-01-2018-06-30记录的48条化疗药物超说明书用药医嘱进行对比,对化疗药物使用的溶媒、剂量、浓度、给药途径和用药顺序等合理性进行分析,评价干预效果。结果经PDCA循环干预后,化疗药物处方合格率由干预前98.82%提高到99.56%。溶媒选择超说明书(χ^2=21.001,P<0.001)、输液浓度与给药速度超说明书(χ^2=6.284,P=0.012)和剂量超说明书(χ^2=5.235,P=0.022)干预前后差异有统计学意义;给药途径(χ^2=3.078,P=0.079)和用药顺序(χ^2=1.048,P=0.305)差异无统计学意义。结论静脉用药调配中心可通过对化疗药物超说明书用药医嘱的审核及PDCA循环干预,有效规范化疗药物的应用,保证患者用药安全、合理、有效。

OBJECTIVE The centralized deployment of intravenous drugs is of great significance to the safety and rational use of chemotherapeutic drugs.Many superinstructions have been found in the centralized dispensing work.The purpose of this study is to promote the rational use of chemotherapeutic drugs to provide reference.METHODS 128 prescriptions for over-specification use of chemotherapeutic drugs examined by the intravenous drug dispensing center of Taian Central Hospital from November 1,2017 to February 28,2018 were analyzed.The plan-do-check-action(PDCA)cyclic intervention was carried out with targeted measures,and 48 chemotherapeutic drugs were recorded from March 1,2018 to June 30,2018.The rationality of the solvent,dose,concentration,route and sequence of administration of chemotherapeutic drugs were analyzed,and the intervention effect was evaluated.RESULTS After PDCA cycle intervention,the qualified rate of chemotherapeutic prescription increased from 98.82% to 99.56%.There was significant difference between before and after intervention in the choice of solvent(χ^2=21.001,P<0.001),concentration of infusion and speed of administration(χ^2=6.284,P=0.012),and dosage over instruction(χ^2=5.235,P=0.022).There was no significant difference in the route of administration(χ^2=3.078,P=0.079)and sequence of administration(χ^2=1.048,P=0.305).CONCLUSION Through the review and PDCA circle intervention on chemotherapeutic prescriptions of off-label drug using,pharmacy intravenous admixture service can standardize the application of chemotherapeutic drugs and guarantee the safe,reasonable and effective use of drugs.