质控图联合Westgard多规则法在他克莫司治疗药物监测质量控制及药学服务中的应用

Application of quality control chart combined with Westgard multi-rule method in quality control of tacrolimus therapeutic drug monitoring and pharmaceutical care

目的:探讨质控图和Westgard多规则法在他克莫司治疗药物监测(therapeutic drug monitoring,TDM)室内质量控制中的作用,以及在TDM相关药学服务中的应用。方法:收集2018年6-8月海军军医大学长海医院他克莫司TDM的室内质控结果,分别绘制Levey-Jennings质控图和Z分数质控图,运用Westgard多规则法对质控图进行评价,并应用质控图对特殊案例的TDM结果进行解读。结果:基于绘制Levey-Jennings和Z分数质控图,以及应用Westgard多规则法,发现本院2018年6-8月他克莫司TDM室内质控合格,他克莫司TDM结果准确、可靠。结论:合理应用室内质控图及Westgard多规则法有利于减少他克莫司TDM的误差,保证结果的准确性和可靠性,提高医师和患者对TDM结果的信任度,为临床合理用药提供依据。

Objective:To explore the role of quality control chart and Westgard multi-rule method in the interior quality control of tacrolimus therapeutic drug monitoring(TDM)and their application in TDM-related pharmaceutical care.Methods:The quality control results of tacrolimus were collected from June to August,2018,in Changhai Hospital,Naval Medical University.The quality control charts of Levey jennings and Z score were drawn respectively.Then,they were evaluated by Westgard multi-rule method and were used to interpret a particular case of tacrolimus TDM.Results:Based on Levey Jennings and Z score quality control charts as well as the application of Westgard multi-rule method,it was found that the interior quality control of tacrolimus TDM in the hospital from June to August,2018 met the required qualification,and the tacrolimus TDM results were accurate and reliable.Conclusion:Rational use of interior quality control charts and Westgard multi-rule method helps to reduce errors of tacrolimus TDM,ensure accuracy and reliability,enhance trust of doctors and patients in TDM results,and furthermore could provide solid evidence for more rational use of drugs.