静脉用药调配中心细胞毒药物不合理处方实际情况与干预对策分析

Analysis on the actual situation of unreasonable prescription of PIVAS cytotoxic drugs and intervention countermeasures

目的分析静脉用药调配中心(PIVAS)细胞毒药物不合理处方实际情况与干预对策。方法选取2018年1月~2020年12月PIVAS细胞毒药物不合理处方78份,统计不合理处方科室分布情况、不合理处方分类情况、溶媒选择不合理情况、溶媒用量不合理情况、给药剂量不合理情况。结果细胞毒药物不合理处方科室以肿瘤科室(32.05%)为主,其余依次为胸外科(28.21%)、血液科(25.64%)、普外科(6.41%)、泌尿外科(3.85%)、妇科(2.56%)、呼吸科(1.28%);不合理处方分类以溶媒用量不合理(51.28%)为主,其次为溶媒选择(42.31%)、用药剂量(3.85%)、配伍禁忌(2.56%);溶媒选择不合理处方药物以多柔比星脂质体、吡柔比星、伊达比星、高三尖酯碱为主;溶媒用量不合理处方药物以依托泊苷(25.00%)为主,其次多西他赛(17.50%)、吉西他滨(15.00%)、培美曲塞二钠(12.50%)、雷替曲塞(7.50%)、其他(22.50%);用药剂量不合理处方药物有紫杉醇脂质体(力扑素),注射用培美曲塞二钠(普来乐),甲氨蝶呤注射液。结论PIVAS细胞毒药物不合理处方实际情况不理想,主要发生在肿瘤科室,以溶媒用量不合理为主,其次存在溶媒选择、用药剂量不合理以及配伍禁忌。临床应结合实际情况予以针对性干预措施,以降低PIVAS细胞毒药物不合理处方发生率,提高细胞毒药物应用效果。

Objective To analyze the actual situation of irrational prescription of cytotoxic drugs in intravenous drug dispensing center(PIVAS)and the intervention countermeasures.Methods 100 unreasonable prescriptions of PIVAS cytotoxic drugs in our hospital from December 2018 to December 2020 were collected.And the distribution of unreasonable prescription departments,the classification of unreasonable prescriptions,the unreasonable selection of solvent,the unreasonable dosage of solvent,and the unreasonable dosage of drug were counted.Results Most of the departments with unreasonable prescription of cytotoxic drugs were tumor department(32.05%),followed by thoracic surgery department(28.21%),hematology department(25.64%),general surgery department(6.41%),urology department(3.85%),gynecology department(2.56%)and respiratory department(1.28%).The main classification of unreasonable prescription was the unreasonable dosage of solvent(51.28%),followed by solvent selection(42.31%),dosage(3.85%),incompatibility taboo(2.56%).The unreasonable prescription drugs were mainly doxorubicin liposome,piroxorubicin,idabicin and alkalotriglycerine.The prescription drugs with unreasonable dosage of solvent were mainly etoposide(25.00%),followed by docetaxel(17.50%),gemcitabine(15.00%),pemetrexed disodium(12.50%),ratitrexed(7.50%)and others(22.50%).The drug dosage is unreasonable prescription drugs paclitaxel liposome(leptosin),pemetrexed disodium for injection(pralol),methotrexate injection.Conclusion PIVAS the unreasonable prescription of cytotoxic drugs is not ideal,mainly in the tumor department,the dosage of solvent is unreasonable,followed by the choice of solvent and dosage of drug,clinical intervention should be taken to reduce the incidence of unreasonable prescription of PIVAS cytotoxic drugs and improve the application effect of cytotoxic drugs according to the actual situation.