肾内科临床药师医嘱审核及典型案例

Onmedical order review of nephrology clinical pharmacist and typical case

目的分析肾内科不合理医嘱干预情况及典型案例,为实施有效医嘱审核干预提供参考。方法回顾分析海南省人民医院2019年1—12月临床药师对肾内科住院医嘱审核的情况,对医嘱干预情况、不合理医嘱类型、不合理医嘱涉及药物种类进行统计分析,并就典型不合理用药案例进行分析。结果临床药师共提出141条医嘱干预,医师采纳112条,采纳率为79.43%。不合理医嘱类型中,给药剂量、频次不适宜占比最高,达65.25%;不合理医嘱涉及药物种类中,抗感染药物占比最高,为49.66%。结论临床药师实施医嘱审核有助于促进临床安全合理用药和临床药学服务的开展。

Objective To analyze the interventions and typical cases of irrationalmedical order in the nephrology department to provide reference for the implementation of effective medical order review interventions.Methods The clinical pharmacist's reviews of inpatient medical orders in the nephrology department in Hainan General Hospital from January to December 2019 were retrospectively analyzed.The intervention of medical order,types of unreasonable medical order,and types of drug involved in unreasonable medical order were statistically analyzed,and the typical cases of irrational drug use were also analyzed.Results A total of 141 medical order interventions were proposed by the clinical pharmacist,and 112 of them were adopted by the physicians,with an adoption rate of 79.43%.The highest percentage of irrational dose and frequency was 65.25%among the types of irrational medical order,and the highest percentage of anti-infective drug was 49.66%among the types of drug involved in irrational medical order.Conclusion The implementation of medical order review by clinical pharmacist can help promote the safe and rational use of clinical drug and the development of clinical pharmacy service.