静脉用药调配中心前置审核与干预的不合理用药医嘱分析

Analysis of irrational medical orders after pre-review and interventions in pharmacy intravenous admixture service

目的:分析并确认静脉用药调配中心(pharmacy intravenous admixture service,PIVAS)前置审核干预不合理用药医嘱的主次因素,完善医嘱前置审核干预,规范合理用药。方法:采用分类统计和帕累托图法分析2018年9月至2019年8月福建医科大学附属漳州市医院PIVAS审核干预的6746条不合理静脉用药医嘱,根据医嘱的错误类型和所涉及的病区,均按ABC分类法分类,并对各类因素的典型案例进行分析。结果:对不合理用药医嘱的原因进行分析,A类主要因素类型有超剂量给药、配伍用药不适宜、用药频次不适宜,占比为71.4%;B类次要因素类型有溶媒品种和用量,占比为18.1%;C类一般因素类型有药品用法、规格不适宜,医嘱录入错误等,占比为10.5%。对不合理用药医嘱涉及的病区进行分析,A类主要因素所涉及病区有神经外科一、三病区,肝胆胰脾病区,胸心外科,胃小肠病区,占比为75.6%;B类次要因素所涉及病区有神经外科二病区和肿瘤放疗病区,占比为14%;C类一般因素所涉及病区有结直肠科、五官科、乳腺外科等,占比为10.4%。结论:审方药师通过对不合理静脉用药医嘱的分析与总结,提升了前置审核和干预能力,促进了合理用药。

Objective:To analyze and identify the factors of irrational medical orders after pre-review and interventions in pharmacy intravenous admixture service(PIVAS),so as to improve pre-review efficiency and standardize rational medication.Methods:The 6746 irrational medical orders in PIVAS from September 2018 to August 2019 were analyzed by classification and Pareto chart analysis.According to the error categories of medical orders and the inpatient regions involved,the medical orders were respectively divided into three categories:A,B and C,and typical cases of various categories of factors were analyzed.Results:First,the causes of irrational medical orders were analyzed.The main factors of category A included overdose medication,incompatibility of drugs and inappropriate frequency of drug use,accounting for 71.4%.The minor factors of category B included inappropriate solvent varieties or dosages,accounting for 18.1%.10.5%of irrational medical orders were classified as the factors of category C,such as application error,order entry errors and so on.Then,analyses were made concerning irrational medical orders in various inpatient regions.The main factors of category A were associated with the 1st and 3rd inpatients regions of the Neurosurgery Department,the Hepatobiliary,the Pancreatic and Splenic,the Thoracic and Cardiac Surgery and the Stomach and Small Intestine Departments,accounting for 75.6%.The minor factors of category B were associated with the Neurosurgery DepartmentⅡand the Tumor Radiotherapy Inpatient Region,accounting for 14%.The general factors of category C were associated with the Colorectal,ENT and Breast Surgery Departments,accounting for 10.4%.Conclusion:The analysis and summary of irrational medical orders in PIVAS could improve the pharmacists’ability of pre-review and interventions of medical orders and further promote rational drug use.