干预前后某医院外科肠外营养使用的合理性分析

Analysis of rationality of the use of parenteral nutrition in surgical department of our hospital before and after intervention

目的探讨干预措施对降低某医院外科肠外营养不合理医嘱发生率的可行性与有效性。方法抽取西安交通大学第一附属医院外科干预前(2016年11月至2017年1月)5 487条肠外营养医嘱,干预后(2017年5—7月)5 466条肠外营养医嘱,对其合理性进行分析统计。干预措施主要有在电子病历系统中嵌入营养风险筛查表、每日对肠外营养医嘱进行合理性审核、每月进行总结点评。结果普通外科的肠外营养医嘱不合理率由19.7%(435/2 205)降至8.2%(195/2 370)(P<0.05);肝胆外科的肠外营养医嘱不合理率由63.7%(1 345/2 110)降至49.5%(1 070/2 160)(P<0.05);泌尿外科的肠外营养医嘱不合理率由87.7%(1 028/1 172)降至49.4%(462/936)(P<0.05),其中泌尿外科7月不合理率为6.2%(24/388)。结论该院所采取的干预措施对提高全院外科肠外营养合理用药水平有促进作用,但仍需持续改进。

Objective To evaluate the feasibility and effectiveness of interventions in reducing the incidence of irrational parenter⁃al nutrition advice in surgical department of our hospital.Methods A total of 5487 parenteral nutrition advices in surgical depart⁃ment before intervention(November 2016 to January 2017)and 5466 parenteral nutrition advices after intervention(May to July 2017)in the surgical department of the First Affiliated Hospital of Xi’an Jiaotong University were collected,and their rationality was analyzed.Intervention measures mainly included embedding a nutritional risk screening form in the electronic medical record system,daily review of the rationality of parenteral nutrition doctor orders,and monthly summary reviews.Results The unreason⁃able rate of parenteral nutrition advice in general surgery system decreased from 19.7%(435/2205)to 8.2%(195/2370);the unreasonable rate of parenteral nutrition advice in hepatobiliary surgery decreased from 63.7%(1345/2110)to 49.5%(1070/2160);the unreasonable rate of parenteral nutrition advice in urology surgery decreased from 87.7%(1028/1172)to 49.4%(462/936),of which the unreasonable rate in July was 6.2%(24/388).Conclusion The interventions adopted by our hospital can promote the rational use of parenteral nutrition in surgical department of our hospital,but it still needs continuous improvement.