某院新生儿科肠外营养处方的药师干预效果分析

Intervention Effect of Pharmacists on Parenteral Nutrition Prescription in the Neonatology Department in a Hospital

目的探讨药师对医院新生儿科肠外营养处方的干预效果。方法回顾性分析医院新生儿科2020年(干预后)肠外营养处方3098张(涉及患儿255例)和2019年(干预前)的肠外营养处方6276张(涉及患儿430例),评价处方的稳定性和有效性。结果干预前有不合理处方130张(2.07%),干预后有40张(1.29%),较干预前明显减少(P<0.05)。干预后,部分肠外营养处方存在不合理现象,包括阳离子浓度过高(0.26%)、葡萄糖浓度过高(0.03%)、热氮比不合理(0.19%)、糖脂比不合理(0.16%),均较干预前明显改善(P<0.05);氨基酸浓度过低(0.65%)改善不明显(P>0.05)。使用了不合理处方的患儿,在2~3周观察期内均未出现新的或严重的药品不良反应。结论干预后的肠外营养处方总体合理,患儿使用后未出现新的不良事件,但仍存在用药及营养素配比不合理现象,药师应加强处方前置审核工作,发现不合理处方及时与临床医师沟通,提高临床合理用药水平。

Objective To investigate the intervention effect of pharmacists on the parenteral nutrition(PN)prescription in the neonatology department in a hospital.Methods A total of 3098 PN prescriptions(involving 255 children)in 2020(after the intervention)and 6276 PN prescriptions(involving 430 children)in 2019(before the intervention)in the neonatology department in the hospital were retrospectively analyzed to evaluate the stability and effectiveness of the prescriptions.Results There were 40 irrational prescriptions(1.29%)after the intervention,which were significantly less than 130 irrational prescriptions(2.07%)before the intervention(P<0.05).After the intervention,there were some irrational PN prescriptions with problems such as high concentration of cation(0.26%),high concentration of glucose(0.03%),irrational ratio of heat to nitrogen(0.19%)and irrational ratio of sugar to fat(0.16%),which were improved significantly than those before the intervention(P<0.05),while the problem of low concentration of amino acid(0.65%)was not improved significantly than that before the intervention(P>0.05).No new or serious adverse drug reactions occurred in children who were treated according to the irrational prescriptions during the observation period of two to three weeks.Conclusion After the intervention,the PN prescriptions are generally rational,and there is no new adverse event after children are treated according to the prescriptions,but there are still some problems such as irrational ratio of medication and nutrient.Pharmacists should strengthen the work of prescription pre-audit,communicate with clinicians timely when irrational prescriptions are found to promote the rational drug use in the clinic.