临床药师对静脉用药调配中心补充性肠外营养不合理医嘱审核的实践与分析

Practice and Analysis of Review of Irrational Medical Orders by Clinical Pharmacists for Supplemental Parenteral Nutrition in Pharmacy Intravenous Admixture Service

目的:探讨临床药师对静脉用药调配中心(pharmacy intravenous admixture service,PIVAS)补充性肠外营养不合理医嘱的审核情况,以制定改进措施,一方面促进临床合理用药,另一方面评价临床药师参与PIVAS医嘱审核的作用,从而体现药师价值。方法:收集2019年第1季度(干预前)和第2季度(干预后)航空总医院(以下简称“我院”)PIVAS审核的静脉用药医嘱中的补充性肠外营养不合理医嘱,比较两个季度的不合理医嘱率以及干预措施的有效性。结果:2019年第1季度(干预前)我院补充性肠外营养医嘱不合理率为10.50%(57/543);57份补充性肠外营养不合理医嘱中,阳离子总量超标医嘱6份(占10.53%),糖脂比不合适医嘱10份(占17.54%),热氮比不合适医嘱17份(占29.82%),有配伍禁忌医嘱2份(占3.51%),单瓶输注医嘱22份(占38.60%)。2019年第2季度(干预后)我院补充性肠外营养医嘱不合理率较第1季度明显降低,为3.36%(22/655);22份补充性肠外营养不合理医嘱中,阳离子总量超标医嘱2份(占9.09%),糖脂比不合适医嘱7份(占31.82%),热氮比不合适医嘱11份(占50.00%),有配伍禁忌医嘱0份,单瓶输注医嘱2份(占9.09%)。结论:我院补充性肠外营养医嘱存在不合理问题,主要集中在糖脂比和热氮比设计不合理方面。通过PIVAS审方药师对补充性肠外营养医嘱的审核和干预,及时纠正了不合理用药情况,节省了药品资源,为患者用药安全性提供了重要保障。审方药师仍需与临床药师协作,加强对肠外营养医嘱的干预,进一步提高肠外营养支持治疗水平。

OBJECTIVE:To probe into the review of irrational medical orders by clinical pharmacists for supplemental parenteral nutrition in pharmacy intravenous admixture service(PIVAS),so as to formulate improvement measures to promote clinical rational application of drugs,and evaluate the role of clinical pharmacists in participating in the review of medical orders in PIVAS,thereby reflecting the value of clinical pharmacists.METHODS:Irrational medical orders of supplemental parenteral nutrition for intravenous drug application reviewed by PIVAS in Aviation General Hospital(hereinafter referred to as“our hospital”)in the first quarter(before intervention)and the second quarter(after intervention)of 2019 were collected,the irrational rate and effectiveness of intervention measures were compared between two quarters.RESULTS:In the first quarter of 2019(before intervention),the irrational rate of medical orders for supplemental parenteral nutrition in our hospital was 10.50%(57/543).Among the 57 cases of irrational supplemental parenteral nutrition,6 cases(10.53%)had excessive cations,10 cases(17.54%)had inappropriate glycolipid ratio,17 cases(29.82%)had inappropriate thermal-nitrogen ratio,2 cases(3.51%)had compatibility contraindications,and 22 cases(38.60%)had single bottle infusion.In the second quarter of 2019(after intervention),the irrational rate of medical orders for supplemental parenteral nutrition in our hospital was significantly lower than that in the first quarter 3.36%(22/655).Among the 22 cases of irrational supplemental parenteral nutrition,2 cases(9.09%)had excessive cations,7 cases(31.82%)had inappropriate glycolipid ratio,11 cases(50.00%)had inappropriate thermal-nitrogen ratio,0 cases had compatibility contraindications,and 2 cases(9.09%)had single bottle infusion.CONCLUSIONS:There are some irrational issues in the medical orders for supplemental parenteral nutrition in our hospital,which mainly focus on the irrational design of glycolipid ratio and thermal-nitrogen ratio.Through the review and intervention of clinical pharmacists in PIVAS on medical orders for supplemental parenteral nutrition,the irrational drug application was corrected in a timely manner,which saved drug resources and provided important guarantee for the drug safety of patients.Reviewing pharmacists still need to cooperate with clinical pharmacists to strengthen the intervention of medical orders for parenteral nutrition and further improve the level of parenteral nutrition support treatment.