本院重症医学科超说明书用药合理性分析

Analysis of Rationality of Off-label Drug Use in the Department of Intensive Care Unit in Our Hospital

目的:调查分析本院ICU超说明书用药情况,以提高其合理用药水平,保障患者用药安全。方法:分析ICU 2019年住院患者医嘱,统计其中超说明书用药品种及类型,探析超说明书用药的合理性并提出相应的药学干预措施。结果:共纳入患者219例,用药医嘱9962条,其中超说明书用药215例(98.17%);超说明书用药医嘱1031条(10.35%),其中以盐酸氨溴索粉针(19.79%)、注射用还原型谷胱甘肽(19.30%)、注射用胸腺法新(14.65%)占比最高。在超说明书用药类型中,以溶媒选择不适宜(42.29%)及超剂量使用(25.51%)占比最高。分析认为,有循证医学证据的超说明书用药占比为62.17%,需结合临床动态干预的超说明书用药占比为27.84%,无循证医学证据或可能导致严重后果的超说明书用药占比为9.99%。结论:ICU超说明书用药现象普遍,应加强相关用药教育,并积极推动超说明书用药管理制度的建设,保障患者的用药安全。

Objective:To analyze the off-label use of drugs in the department of ICU in our hospital,promote rational drug use and ensure drug safety.Methods:We retrospectively analyzed the off-label use of drugs during 2019 in ICU of our hospital,rationality of off-label use were analyzed and related pharmaceutical intervention measures were proposed based on confirmed evidence.Results:A total of 219 patients and 9962 medical orders were studied.There were 215 patients with off-label uses(98.17%);and 1031 orders with off-label medication(10.35%),among which Ambroxol Hydrochloride for Injection(19.79%),Reduced Glutathione for Injection(19.30%)and Thymalfasin for Injection(14.65%)accounted for the highest proportions,the types of off-label uses were mainly inappropriate solvent selection(42.29%)and overdose(25.51%).Detailed analysis showed that 62.17%off-label uses were evidence based,27.84%needed pharmaceutical intervention in combination with clinical condition,and 9.99%were without confirmed evidence or could lead to serious consequences.Conclusion:Off-label use of drugs is common in ICU,pharmacists should strengthen drug education,and specify the off-label use procedures to reduce risks for patients.