药学干预在规范静脉用抗肿瘤药物使用及预防差错中的作用研究

Study on the Role of Pharmaceutical Intervention in Regulating the Use of Intravenous Antitumor Drugs and Preventing Errors

目的:探讨药师对静脉用抗肿瘤药不合理情况实施药学干预的效果,以及在静脉用抗肿瘤药调配前处方审核中的作用。方法:选取2018年7-12月采用基于PIVAS智能信息系统进行自动识别+常规干预的静脉使用抗肿瘤药物住院医嘱作为对照组。将2019年1-6月采用基于PIVAS智能信息系统自动识别+用药宣教与规范化培训+药师前置个体化审核评价及药学干预的静脉使用抗肿瘤药物住院医嘱作为干预组。比较两组潜在用药差错发生率、潜在用药差错的干预成功率、潜在用药差错对应的不良反应发生率、不良反应处理所需的中位人均费用等情况。结果:干预组潜在用药差错发生率低于对照组,差异有统计学意义(P<0.01)。干预组用药剂量、浓度、溶媒、配伍禁忌、超适应证、医嘱权限潜在用药差错数均低于对照组,差异均有统计学意义(P<0.05)。干预组潜在用药差错的干预成功率高于对照组,差异有统计学意义(P<0.01)。干预组潜在用药差错对应的不良反应发生率为9.68%低于对照组的35.09%,差异有统计学意义(P<0.01)。干预组对应不良反应处理所需的中位人均费用819.57(752.41,891.70)元低于对照组的1506.30(1136.50,1867.19)元,差异有统计学意义(P<0.01)。结论:合理有效的药学干预可以有效降低用药差错事件发生,规范静脉用抗肿瘤药医嘱并降低用药差错发生率,降低不良反应发生率,节省了医疗费用与医疗资源,在一定程度上保障了患者的用药安全。

Objective:To investigate the effects of pharmaceutical interventions on unreasonable prescriptions in antitumor drugs and the role in the pre-prescription review of intravenous antitumor drugs.Method:Inpatient orders of intravenous antitumor drugs using automatic recognition based on PIVAS intelligent information system and routine intervention from July 2018 to December 2018 were selected as the control group.Inpatient orders of intravenous antitumor drugs using automatic identification based on automatic PIVAS intelligent information system,medication education and standardized training,pre-individualized audit and evaluation by pharmacists and pharmaceutical intervention from January 2019 to June 2019 were selected as the intervention group.The incidence of potential medication errors,intervention success rate of potential medication errors,the incidence of adverse reactions corresponding to potential medication errors and the median per capita cost of adverse reaction management were compared between two groups.Result:The incidence of potential medication errors in the intervention group was lower than that in the control group,the difference was statistically significant(P<0.01).The potential medication errors number of drug dose,concentration,solvent,incompatibility,super-indication and doctor’s advice permissions error in the intervention group were lower than those in the control group,the differences were statistically significant(P<0.05).The intervention success rate of potential medication errors in the intervention group was higher than that in the control group,the difference was statistically significant(P<0.01).The incidence of adverse reactions corresponding to potential medication errors in the intervention group was 9.68%,which was lower than 35.09% in the control group, the difference was statistically significant (P<0.01). The median per capita cost of adverse reaction management in the intervention group was 819.57 (752.41, 891.70) yuan, which was lower than 1 506.30 (1 136.50, 1 867.19) yuan in the control group, the difference was statistically significant (P<0.01). Conclusion: Reasonable and effective pharmaceutical intervention can effectively reduce the occurrence of medication errors, standardize the medical orders of intravenous antitumor drugs and reduce the incidence of medication errors, reduce the incidence of adverse reactions, save medical costs and medical resources, and ensure the medication safety of patients to a certain extent.