中枢神经系统、泌尿系统及麻醉药物护士处方权内容与形式探讨

Study of contents and forms of nurse's prescription right for drugs in central nervous system,urinary system and anesthetics

[目的]探讨我国三级甲等医院有资质的专业护士可开具的关于中枢神经系统、泌尿系统及麻醉药物的具体处方内容和处方形式。[方法]通过文献调研结合我国临床实际情况,选取神经内科、精神科、肾内科以及麻醉科各5名专家进行半结构访谈确定咨询问卷研究内容。采用德尔菲法,对中枢神经系统神经内科专家25名、精神科专家15名、肾内科专家23名和麻醉专家16名关于神经内科药物9个类别(69种药物)、精神科药物4个类别(34种药物)、肾内科药物6个类别(18种药物)、麻醉药物5个类别(27种药物)进行两轮专家咨询。[结果]经两轮专家咨询,神经内科药物两轮专家咨询积极系数分别是96.43%和100.00%,权威系数分别是0.78和0.86;精神科药物两轮专家咨询积极系数分别是88.24%和100.00%,权威系数分别是0.81和0.87;泌尿系统药物两轮专家咨询积极系数分别是92.59%和100.00%,权威系数分别是0.78和0.85;麻醉药物在第1轮已全部删除。由此确定三级甲等医院神经内科护士可为中枢神经系统8个类别共19个药物开具处方,肾内科护士可为泌尿系统3个类别共13种药物开具处方,不建议精神科/麻醉科的护士开具相关药物处方。[结论]建议神经内科护士可为19种中枢神经系统药物开具药物处方,肾内科护士可为13种泌尿系统药物开具处方,不建议精神科和麻醉科护士开具相关药物处方。

Objective:To explore the contents and forms of prescriptions of qualified professional nurses in departments of neurology,psychiatry,nephrology and anesthesiology in teritery grade A hospitals in China.Methods:Based on literature research and the actual clinical situation in China,five experts in neurology,psychiatry,nephrology and anesthesiology were selected to conduct semi-structured interviews,to determine the contents of the questionnaire.Using Delphi method,two rounds of expert consultation were conducted,and nine categories of neurology drugs(69 drugs),four categories of psychiatric drugs(34 drugs),six categories of renal medicine drugs(18 drugs),five categories of the anesthetic drugs(27 drugs)were conducted with 25 neurology experts,15 psychiatrist,23 renal internal medicine experts and 16 anesthesia experts.Results:After two rounds of expert consultation,the positive coefficient of neurology drugs were 96.43%and 100.00%,and the authoritative coefficient were 0.78 and 0.86,respectively.The positive coefficient of psychiatric drugs were 88.24%and 100.00%respectively,and the authoritative coefficient were 0.81 and 0.87 respectively.The positive coefficient of urological drugs were 92.59%and 100.00%,respectively,and the authoritative coefficient were 0.78 and 0.85,respectively.All anesthetic drugs were deleted in the first round.Thus,it was determined that the neurology nurses in teritery grade A hospitals could prescribe 19 drugs in 8 categories for the central nervous system.And the nephrology nurses could prescribe 13 drugs in 3 categories for the urinary system.It was not recommended that the nurses in the department of psychiatry and anesthesiology prescribe relevant drugs.Conclusions:It was adviced that neurology nurses could prescribe 19 drugs in the central nervous system,and nephrology nurses could prescribe 13 drugs in the urinary system.Psychiatric and anesthesiology nurses are not recommended to prescribe drugs.