临床药师参与中药注射剂合理用药管理的实践与评价

Practice and Evaluation of Clinical Pharmacists Involved in Rational Drug Use Management of Traditional Chinese Medicine Injections

目的:探讨临床药师基于计划-实施-检查-处理(Plan-Do-Check-Action,PDCA)循环参与中药注射剂合理用药管理的实施情况及效果,为保障临床合理用药提供方法与参考。方法:利用鱼骨图推测分析引起中药注射剂临床不合理应用的原因,针对存在的问题实施PDCA循环管理方案。选择某院临床使用中药注射剂的出院患者作为研究对象,比较PDCA循环管理前(2019年7~12月)、PDCA循环管理后(2021年7~12月)的合理用药相关指标情况,评价基于PDCA循环的中药注射剂用药管理的效果。结果:PDCA循环管理后,合理应用中药注射剂的出院患者比例由71.3%提升至76.5%(P<0.05);溶媒选择不适宜、适应症或证型不适宜、配伍禁忌、用药前后未冲管等药学相关问题发生率均低于PDCA循环管理前(P<0.05);药品不良反应/事件(ADR/ADE)发生率低于PDCA循环管理前(P<0.05)。结论:基于PDCA循环的中药注射剂合理用药管理实践在一定程度上规范了医院中药注射剂的用药合理性,有助于促进临床合理用药,但仍需从用药评价、药学监测信息化、PDCA管理理念的落实等方面进一步完善,确保中药注射剂用药安全、有效。

Objective:To explore the implementation and effect of clinical pharmacists participating in PDCA(Plan-Do-Check-Action)-cycle-based rational drug use management of traditional Chinese medicine(TCM)injections,and to promote rational drug use in clinical practice.Methods:Using fishbone diagrams to analyze the reasons for the unreasonable clinical application of TCM injections,and implement PDCA cycle management programs for existing problems.Choose the discharged patients who used TCM injections as the study subjects.Compare the related rational drug use index of discharged patients who use TCM injections manufactured before(July to December,2019)versus after PDCA cycle management lanched(July to December,2021),and evaluate the effect of PDCA cycle management.Results:After the PDCA cycle management lanched,the rate of the rational drug use of TCM injections documented in the medical records has been increased from 71.3%to 76.5%.And unsuitable choice of solvent,unsuitable indication or syndrome,incompatibility of compatibility,event of no washing before and after the use of medicines,the incidence of adverse drug reactions/events(ADR/ADE)was significantly lower(P<0.05).Conclusion:PDCA-cycle-based rational drug use management of TCM injections standardized the rationality of TCM injections in hospital to a certain extent,it is helpful to promote rational clinical drug use and it still needs to be further improved in terms of medication evaluation,pharmaceutical monitoring information,and the implementation of PDCA management concepts to ensure the safe and effective use of TCM injections.