2016-2020年某三甲医院静脉用药调配中心抗肿瘤药物不合理用药横断面调查分析

Cross-sectional investigation and analysis of irrational use of anti-tumor drugs in the intravenous drug deployment center of a tertiary hospital from 2016 to 2020

目的 调查分析2016-2020年某三甲医院静脉用药调配中心(PIVAS)抗肿瘤药物不合理用药情况。方法 回顾性分析2016年2月至2020年12月某三甲医院PIVAS抗肿瘤药物医嘱84 357份,收集并统计不合理用药类型。结果84 357份医嘱中有682份不合理,占比0.81%。2016-2020年医院抗肿瘤药物不合理医嘱占比呈逐年下降趋势,且2016-2020年每2年医院抗肿瘤药物不合理医嘱占比比较差异无统计学意义(P>0.05)。682份不合理医嘱主要分为6种类型:溶媒选择不合理(60.41%)、溶媒用量不合理(13.05%)、用药剂量不合理(9.82%)、用药次序不合理(8.50%)、不符合用药经济学(5.13%)、用药方式不合理(3.08%)。412份溶媒选择不合理医嘱中,排名前3名的分别为注射用奈达铂(21.60%)、依托泊苷注射液(20.39%)、注射用顺铂(18.20%)。89份溶媒用量不合理医嘱中,排名前3名的分别为艾迪注射液(31.46%)、注射用吉西他滨(22.47%)、多西他赛注射液(15.73%)。67份用药剂量不合理医嘱中,排名前3名的分别为注射用奥沙利铂(38.81%)、注射用雷替曲塞(28.36%)、注射用培美曲塞(19.40%)。58份用药次序不合理医嘱中,排名前3名的分别为紫杉醇→顺铂(31.03%)、注射用表柔比星→紫杉醇(27.59%)、吉西他滨→顺铂(22.41%)。结论 2016-2020年某三甲医院PIVAS对抗肿瘤药物审核及干预效果良好,临床用药比较合理,临床医师仍应加强对药品说明书的掌握,确保用药安全。

Objective To investigate and analyze irrational use of anti-tumor drugs in the pharmacy intravenous admixture service(PIVAS) of a certain tertiary hospital from 2016 to 2020.Methods 84 357 PIVAS anti-tumor drug orders from a certain tertiary hospital from February 2016 to December 2020 were retrospectively analyzed, and the types of irrational medication were collected and statistically analyzed.Results Of the 84 357 medical orders, 682 were irrational, accounting for 0. 81%. The proportion of irrational medical orders for anti-tumor drugs in the hospital from 2016 to 2020 displayed a downward trend year by year, and there was no statistical significance in the proportion of irrational medical orders for anti-tumor drugs in the hospital every other years from 2016 to 2020(P>0. 05). The 682 irrational medical orders could be divided into 6 types: unreasonable solvent selection(60. 41%), unreasonable solvent dosage(13. 05%), unreasonable dosage(9. 82%), unreasonable medication sequence(8. 50%), irrational in terms of pharmacoeconomics(5. 13%) and irrational medication method(3. 08%). Of the 412 unreasonable orders for solvent selection, the top three were nedaplatin for injection(21. 60%), etoposide for injection(20. 39%) and cisplatin for injection(18. 20%). Of the 89 medical orders with irrational solvent dosage, the top three were Aidi for injection(31. 46%), gemcitabine for injection(22. 47%) and docetaxel for injection(15. 73%). Of the 67 medical orders of unreasonable dosages, the top three were oxaliplatin for injection(38. 81%), raltitrexed for injection(28. 36%) and pemetrexed for injection(19. 40%). Of the 58 medical orders with unreasonable medication, the top three were paclitaxel→cisplatin(31. 03%), epirubicin for injection→ paclitaxel(27. 59%) and gemcitabine→cisplatin(22. 41%).Conclusion The effects of PIVAS anti-tumor drug review and intervention of a tertiary hospital from 2016 to 2020 were on the whole good, and clinical medication is relatively reasonable. Clinicians should further strengthen the understanding of drug instructions, so as to ensure drug safety.