蔗糖铁合理使用评价体系的构建与实践

Construction and practice of evaluation system for rational use of iron sucrose

目的利用PDCA循环模式找出蔗糖铁在临床使用过程中存在的问题和高危风险点,以此构建蔗糖铁合理使用评价体系并进行实例验证。方法选取该院2017年1月至2020年12月收治的使用蔗糖铁注射液(ISI)且发生不良反应的排名前5的科室中的120例患者作为研究对象。参照既往相关文献和指南,从用药指征、用药过程和用药结果3个方面进行药学和临床专家讨论与修订、制定ISI的药物利用评价(DUR)标准体系,最后将其纳入该文所选病例中进行验证。结果ISI的DUR标准体系在第1轮函询时,函询条目重要性、可操作性的变异系数(CV)值分别为4.58~24.56和9.52~35.76,W值分别为0.312和0.207,与第2轮函询结果比较存在些许波动性;第2轮函询时,函询条目重要性、可操作性的CV、W值已基本趋于一致,CV值分别为1.01~18.65和7.55~23.69,W值分别为0.472和0.351,函询赋值与ISI的DUR标准体系各条目认可度高度一致。第2轮函询赋值时,一级、二级指标的重要性、可操作性的CV<0.3,W≥3.5;从权重大小来看,用药指征>用药过程>用药结果。使用ISI的DUR标准体系后,用药频率不当发生率为46.67%,较ISI的DUR标准体系使用前降幅为53.33%。第2阶段干预组的ISI使用综合合理率均显著优于干预前组、第1阶段干预组(P<0.05)。结论ISI的DUR标准体系均满足科学性、实用性和可应用性原则,可为其预防策略的构建提供科学、合理的依据。可降低用药指征、用药过程中的潜在或已存在的不良用药现象,提升ISI合理使用率。

Objective To identify the problems and high-risk points of iron sucrose(IS)in clinical use using PDCA circulation model,so as to construct the evaluation system of rational use of IS and verify it with examples.Methods A total of 120 patients from the top 5 departments using iron sucrose injection(ISI)and having adverse reactions in this hospital from January 2017 to the end of December 2020 were selected as the study subjects.According to the previous relevant literature and guidelines,pharmaceutical and clinical experts discussed and revised the system of drug indications,drug process and drug results,and then formulated the drug utilization evaluation(DUR)system for rational use of ISI,and finally included it in the selected cases in this study for verification.Results During the first round of letter inquiry of the DUR standard system for rational use of ISI,the CV values of importance and maneuverability of Delphi instruction items are 4.58≤CV≤24.56 and 9.52≤CV≤35.76,W values were 0.312 and 0.207.When compared with the first round.In the second round of letter inquiry,the CV and W values of importance and operability had been basically the same,with CV values of 1.01-18.65 and 7.55-23.69 respectively,and W values of 0.472 and 0.351 respectively,which indicating that the letter inquiry assignment was highly consistent with the recognition of the items in the DUR standard system reasonably used by ISI.In the second round of letter assignment,the CV of the primary and secondary indicators and operability were less than 0.3,and the W value was 3.5;in the terms of weight,drug indications>drug process>drug results.After the use of DUR standard system,the frequency of inappropriate drug use was 46.67%which was 53.33%lower than that before using the DUR standard system for rational use of ISI.In the second round,the comprehensive rational rate of ISI use in the intervention group was significantly better than that in the pre-intervention group and the first round intervention group(P<0.05).Conclusion The DUR standard system for the rational use of ISI is scientific,practical and applicable,which can provide scientific and reasonable basis for the construction of its preventive strategy.It can reduce the indication of drug use,the potential or existing adverse drug use in the process of drug use,and improve the rational utilization rate of ISI.