医药护一体化监管模式对我院TDM全过程实施的影响

Effects of Integrated Supervision Mode by Doctors,Pharmacists and Nurses on the Whole-process Implementation of TDM in Our Hospital

目的:探讨医药护一体化监管模式对治疗药物监测(TDM)全过程实施的影响。方法:将我院2018年1-12月期间实施TDM的患者作为对照组,采用传统监管模式(即医师、药师、护士三方的工作相对独立);将2019年1-12月期间TDM监测患者作为观察组,采用医药护一体化监管模式(即医师、药师、护士三方相互合作,以患者和样本为中心,药师作为关键衔接,制订各环节的执行标准,明确各自职责)。比较两组患者药物浓度总体达标率、问题样本发生率、危急值通报率、临床满意度、用药建议反馈与采纳情况以及6种监测药物(丙戊酸钠、地高辛、他克莫司、环孢霉素、甲氨蝶呤、万古霉素)的药物浓度达标率。结果:观察组的药物浓度总体达标率、危急值通报率、临床满意度合格率分别为64.57%、99.39%、97.22%,均显著高于对照组的57.86%、96.80%、92.22%(P<0.05);而观察组的问题样本发生率为0.72%,显著低于对照组的3.09%(P<0.001)。观察组的个体化药师发出反馈率(89.19%)、医师反馈交流率(80.50%)、用药建议采纳率(69.98%),均显著高于对照组的50.34%、71.46%、55.36%(P<0.001)。观察组患者除他克莫司的药物浓度达标率略低于对照组外(73.40%vs.75.77%,P>0.05),其余5种监测药物的药物浓度达标率均高于对照组,其中丙戊酸钠、地高辛、万古霉素的药物浓度达标率差异有统计学意义(P<0.05)。结论:对TDM全过程实施医药护一体化监管模式,可有效提高药物浓度达标率,并实现个体化用药的全程动态监督和反馈,有利于保障临床用药安全。

OBJECTIVE:To investigate the effects of integrated supervision mode by doctors,pharmacists and nurses on the whole-process implementation of therapeutic drug monitoring(TDM).METHODS:The patients monitored with TDM in our hospital admitted from Jan.to Dec.2018 were selected as control group,treated with the traditional drug supervision mode(i.e.the work of doctors,nurses and pharmacists was relatively independent).Treatment group was composed of inpatients monitored with TDM from Jan.to Dec.2019,treated with the integrated supervision mode of doctors,nurses and pharmacists(i.e.doctors,nurses and pharmacists cooperated with each other,taking the patients and sample as the center,pharmacists as the key link formulated the implementation standards of each link,and clarified their respective responsibilities).The concentration compliance rate,the incidence of incorrect samples,critical value notification rate,clinical satisfaction,drug recommendation feedback and adoption,compliance rates of 6 kinds of monitored drugs(sodium valproate,digoxin,tacrolimus,cyclosporin,methotrexate,vancomycin)were compared between two groups.RESULTS:The overall compliance rate,critical value notification rate and clinical satisfaction rate of the observation group were respectively 64.57%,99.39%and 97.22%,which were significantly higher than 57.86%,96.80%and 92.22%of control group(P<0.05).The incidence of incorrect samples in observation group was 0.72%,which was significantly lower than 3.09%of control group(P<0.001).The feedback rate of individual pharmacists(89.19%),the feedback rate of doctors(80.50%)and the adoption rate of medication suggestions(69.98%)in the observation group were significantly higher than control group(50.34%,71.46%and 55.36%,P<0.001).The compliance rate of tacrolimus concentration in observation group was slightly lower than control group(73.40%vs 75.77%,P>0.05).The concentration compliance rate of other 5 varieties was higher than control group,and the differences of valproate sodium,digoxin and vancomycin concentrations between two groups were statistically significant(P<0.05).CONCLUSIONS:The implementation of integrated doctors,nurses and pharmacists supervision mode in TDM can effectively improve the drug concentration compliance rate,realize the dynamic supervision and feedback of individualized drug use,which is conducive to ensure the safety of clinical medication.