某医院906条不合理医嘱用药分析

Analysis of 906 irrational prescriptions in a hospital

目的讨论某医院审方药师审核的住院病人长期医嘱静脉用药不合理情况,为临床合理用药提供参考。方法收集2020年1—5月该院审方药师拦截的不合理用药医嘱906条,绘制帕累托图,探讨其科室分布情况及影响因素。结果906条不合理医嘱分布在该院的23个临床科室,不合理医嘱数排在前10位的分别是普外科、肿瘤内科、神经内科、呼吸科、胸口科(胸外科和口腔科)、介入科、重症监护、心内科、神经外科、促醒中心,合计占不合理用药医嘱总数的77.15%(699/906),是不合理医嘱用药的主要科室;高压氧科、肾内科、全科、妇科的累计构成比介于80%~90%,为次要科室。不合理医嘱的类型有浓度不适宜、溶媒不适宜、录入错误、医嘱未成组、配伍不适宜及给药频次不适宜等9类。其中,药物浓度不适宜和溶媒不适宜医嘱合计占不合理医嘱用药总数的79.59%(721/906),为主要不合理的形式;录入错误医嘱累计构成比为90.85%,为次要表现形式。结论该院应加强对静配中心不合理医嘱的干预,积极发挥审方药师的作用,降低不合理医嘱的发生率。

Objective To discuss the irrational use of intravenous prescriptions for inpatients reviewed by a hospital prescription pharmacist and to provide a reference for the rational clinical use of drugs.Methods A total of 906 irrational prescriptions intercepted by prescription-checking pharmacists from January to May 2020 were collected,and a Pareto chart was drawn to explore their departmental distribution and influencing factors.Results There were 906 irrational prescriptions distributed in 23 clinical units of the hospital,and the top 10 irrational prescriptions were in general surgery,internal oncology,internal neurology,respiratory medicine,chest(thoracic surgery and oral medicine),interventional medicine,intensive care,internal cardiology,neurosurgery,and wake-up center,which together accounted for 77.15%(699/906)of the total number of irrational prescriptions and were the main departments of irrational prescriptions.The cumulative composition ratio of hyperbaric oxygen,nephrology,general practice,and gynecology was between 80%and 90%,which were minor departments.The types of irrational prescriptions consisted of 9 categories,including inappropriate concentration,inappropriate solvents,incorrect entries,inappropriate prescriptions,inappropriate combinations,and inappropriate frequency of administration.Among them,inappropriate concentrations of drugs and inappropriate solvents of medical advice together accounted for 79.59%(721/906)of the total number of irrational prescriptions,which was the main form of irrationality.The cumulative composition ratio of recorded wrong medical advice was 90.85%,which was the secondary form of presentation.Conclusion This hospital should strengthen the intervention of irrational prescriptions in pharmacy intravenous admixture services and actively play the role of prescription-checking pharmacists to reduce the incidence of irrational prescriptions.