114份肿瘤患者医嘱中抗肿瘤药物临床使用的合理性分析与评价

Analysis and Evaluation of Rationality on Clinical Medication of Anti-tumor Drugs in 114 Medical Orders of Tumor Patients

目的:分析和评价医院抗肿瘤药物临床使用的合理性,为抗肿瘤药物的合理使用提供参考。方法:抽取2018年7月—12月间妇科收治的肿瘤患者使用含抗肿瘤药物医嘱114份,统计抗肿瘤药物医嘱临床使用情况,按照"点评标准"评价抗肿瘤药物的临床使用(如溶媒品种、溶媒量、给药顺序、静脉滴注速度等)的合理性以及不合理使用原因及其对策。结果:114份使用抗肿瘤药物医嘱中,其用药合理医嘱103份(合理率为90.35%),不合理医嘱11份(占9.65%);不合理用药原因为医师超权限使用2例(占18.18%)、给药滴注速度不适宜2例(占18.18%)、给药顺序不适宜4例(占36.36%)、未充分水化1例(占9.09%)、不合理的输液保管与使用2例(占18.18%)。结论:医院临床抗肿瘤药物使用总体较合理,但仍需要进一步改进,必要时开展治疗药物监测(TDM);同时应关注不良反应和疗效,最大限度地减少药物不良反应的发生,确保药物使用的安全、有效、合理和个体化。

Objective:To analyze and evaluate the rationality of clinical medication of anti-tumor drugs,and to provide reference for rational use of antitumor drugs.Methods:114 prescriptions containing anti-tumor drugs were taken from tumor patients admitted to gynecology department from July to December 2018.The clinical use of anti-tumor drugs prescribed by doctors was analyzed,and the rationality,reasons and countermeasures of the clinical use of anti-tumor drugs(such as solvent variety,solvent quantity,drug delivery order,intravenous infusion rate,etc.)were evaluated according to the"comment standard".Results:Among the 114 medical orders for the medication of anti-tumor drugs,103 medical orders were reasonable(the reasonable rate was 90.35%),and 11 medical orders were unreasonable(9.65%).The reasons for unreasonable drug use were:2 cases(18.18%)were used beyond the authority of doctors,2 cases(18.18%)were used at inappropriate infusion rate,4 cases(36.36%)were given at inappropriate infusion sequence,1 case(9.09%)was not fully hydrated,and 2 cases(18.18%)were improperly kept and used for infusion.Conclusion:The clinical medication of anti-tumor drugs is generally reasonable,but it still needs to be further improved.When necessary,therapeutic drug monitoring(TDM)should be carried out.At the same time,the attention should be paid to adverse drug reactions and efficacy,and as well as minimizing the occurrence of adverse drug reactions,so as to ensure the safety,effectiveness,rationality and individualization of drug use.