临床药师参与胫腓骨干骨折临床路径的实施效果探讨

Implementation Effect of Clinical Pharmacists Participating in the Clinical Pathway of Tibiofibular Stem Fractures

目的:探讨临床药师参与胫腓骨干骨折临床路径的实施效果,为促进临床合理用药及优化临床路径管理提供参考。方法:收集某院进入并完成临床路径的胫腓骨干骨折患者作为研究对象,2016年的49例患者设为干预前组,未进行任何干预;2017年6月至2018年5月的42例患者设为干预后组,临床药师作为治疗团队成员全程参与患者的治疗,对用药方案进行技术和行政双重干预。观察并记录两组患者的治疗和用药情况。结果:两组患者的住院时间、住院费用、手术时间、术中出血量和不良反应发生率的差异均无统计学意义(P>0.05)。干预后组患者的药品支出费用明显低于干预前组;干预后组患者镇痛药使用率、镇痛药用药品种数和药品费用、预防用抗菌药物使用合理率均明显优于干预前组;干预后组患者质子泵抑制剂、抗骨质疏松药和辅助用药的使用率均明显低于干预前组,抗凝血药、辅助用药和预防用抗菌药物的费用均明显低于干预前组,辅助用药品种数少于干预前组,预防用抗菌药物的用药时间明显短于干预前组,上述差异均有统计学意义(P<0.05)。结论:临床药师参与胫腓骨干骨折临床路径的实施,可以提高药物使用的合理性,降低药品费用。

OBJECTIVE:To probe into he implementation effect of clinical pharmacists participating in the clinical pathway of tibiofibular stem fractures,so as to provide references for promoting clinical rational medication and optimizing clinical pathway management.METHODS:Patients with tibiofibular stem fractures who entered and completed the clinical pathway at a certain hospital were collected for the study,49 patients in 2016 were set as pre-intervention group without any intervention;42 patients from Jun.2017 to May 2018 were set as post-intervention group,clinical pharmacist were involved as a member of treatment team throughout the patient’s treatment,provided both technical and administrative interventions on medication regimen.The treatment and medication process of the two groups were observed and recorded.RESULTS:There were no statistical significance in differences in hospital stays,hospital costs,duration of surgery,intraoperative blood loss and incidences of adverse drug reactions between two groups(P>0.05).The medicine cost of post-intervention group was significantly lower than that of pre-intervention group;the use rate of analgesics,varieties and cost of analgesics and rationality rate of prophylactic antibiotics of post-intervention group were significantly better than those of pre-intervention group;the use rates of proton pump inhibitors,anti-osteoporosis medicine and adjuvant drugs of post-intervention group were significantly lower than those of pre-intervention group,the costs of anticoagulants,adjuvant drugs and prophylactic antibiotics were significantly lower than those of pre-intervention group,with less varieties of adjuvant drugs and longer medication time of prophylactic antibiotics,with statistically significant differences(P<0.05).CONCLUSIONS:The implementation of clinical pharmacists participating in the clinical pathway of tibiofibular stem fractures can imprve the rationality of medication and reduce drug cost.