705例神经内科问题医嘱的帕累托图分析

Pareto chart analysis of 705 problematic prescriptions in neurology

目的临床药师通过医嘱前置审核,对神经内科705例问题医嘱进行帕累托图分析,为临床提供参考。方法对我院神经内科2017年3月1日至2018年2月28日住院的所有患者医嘱前置审核,对发现的问题医嘱进行干预,记录问题医嘱的类型、潜在风险的严重程度、干预的结果进行统计分析。结果共审核811例患者医嘱10367条,发现问题医嘱705条,包括给药方法511例,适应证不适宜66例,给药剂量不足或过大46例。按照问题医嘱严重程度,较低几率引起药品不良事件(ADE)的Ⅰ类538例(76.31%),有一定几率引起轻微ADE的Ⅱ类135例(19.15%),有较高几率引起ADE的Ⅲ类26例(3.69%),可能引起严重的ADE的Ⅳ类6例(0.85%)。医师接受药师建议的541例(76.74%)。结论神经内科住院患者用药品种多而复杂,易出现不适宜的用药医嘱,临床药师进行医嘱审核有助于发现潜在的用药风险,医师对药师建议基本能够接受,两者合作更能够提高患者用药的安全。

Objective To conduct a Pareto chart analysis of 705 problematic prescriptions by clinicians in the Department of Neurology in order to provide reference for clinical practice.Methods Prescriptions pre-audited in the Department of Neurology between March 1,2017 and February 31,2018 were collected and analyzed.The types of problems,potential risks and results of interventions were recorded.Results A total pf 10367 prescriptions for 811 patients were reviewed,705 of which were found to be problematic,including 511 cases of inappropriate medication methods,66 cases of wrong indications,and 46 cases of insufficient or excessive dosage.In terms of severity,538 cases(76.31%)were classified as ClassⅠwith a low risk of adverse drug events(ADE),135 cases(19.15%)as ClassⅡwith a medium risk of ADE,26 cases(3.69%)as ClassⅢwith much chance of ADE,and 6 cases(0.85%)as classⅣthat might cause serious ADE.Physicians took the advice of pharmacists in 541 of these cases(76.74%).Conclusion There are various medications for inpatients in a neurology department,so inappropriate medication instructions are likely.Pre-audition of prescriptions by clinical pharmacists can help identify potential risks of medication.Cooperation between physicians and pharmacists can improve the medication safety of patients.