药师干预全营养混合液医嘱的效果

Intervention effect of pharmacists on total nutrition admixture medical records

目的评价药师干预全营养混合液(TNA)医嘱的效果。方法 2018年4月,药师对昆明医科大学第二附属医院胃肠外科二病区的TNA医嘱进行干预。选取该科室2018年1月至3月的TNA医嘱作为对照组,5月至7月的TNA医嘱作为干预组,评估药师干预TNA医嘱的效果。评估的内容包括不合理医嘱发生率(包括适应证、糖脂比、热氮比、氨基酸遴选不适宜等)、患者出院前生化指标、经济学指标变化情况。结果药师参与医嘱干预后,TNA医嘱在氨基酸遴选、糖脂比、热氮比方面的合理率显著上升(P<0. 05),不合理医嘱发生率由84. 89%下降至23. 89%(P<0. 001)。干预组前白蛋白、丙氨酸氨基转移酶、血糖与对照组相比,差异具有统计学意义(P<0. 05)。对照组TNA日均费用为(532. 59±93. 02)元,干预组TNA日均费用为(480. 50±106. 06)元,差异具有统计学意义(P<0. 001)。结论药师参与TNA医嘱干预后提高了医嘱的合理性,保障了患者用药安全,同时降低了TNA日均费用,减轻了患者经济负担。

Objective To evaluate the effect of pharmacists’ intervention on medical records of total nutrition admixture(TNA). Methods Pharmacists intervened the TNA medical records of Department of Gastrointestinal Surgery,Second Affiliated Hospital of Kunming Medical University in April,2018. Medical records of this department from January to March were selected as control group,and those from May to July were set as intervention group. The rationalities of the indications,ratio of glucose/lipid,ratio of non-protein/nitrogen energy,selection of amino acid were analyzed. The incidence of irrational medical records,changes of biochemical and economic indicators were analyzed to evaluate of intervention effect. Results Through comparative analysis,the rationality of TNA in terms of selection of amino acid,ratio of glucose/lipid and ratio of non-protein/nitrogen energy increased significantly(P<0. 05)after the participation of pharmacists. The incidence of unreasonable medical orders decreased from 84. 89% to 23. 89%(P<0. 001). The differences in prealbumin,alanine aminotransferase,and blood glucose between control and intervention group were statistically significant(P<0. 05). The average daily cost of TNA was(532. 59±93. 02)yuan in the control group and(480. 50±106. 06)yuan in the intervention group,the difference was statistically significant(P<0. 001). Conclusion Pharmacists audit for TNA can improve the rationality of TNA medical records,and the safety of patients’ medication is guaranteed. The reduced daily average cost of TNA can relieve the economic burden of patients.