药师干预住院患者全肠外营养支持效果评价

Evaluation of the Effect of Pharmacists′Intervention in Total Parenteral Nutrition Support for Inpatients

目的探讨药师干预对住院患者全肠外营养(TPN)支持效果的影响。方法从医院信息系统调取2021年8月至2022年1月未经静脉用药调配中心(PIVAS)药师审核干预的全营养混合液(TNA)医嘱715份(涉及患者492例)作为对照组,以2022年2月至7月干预后的TNA医嘱882份(涉及患者608例)作为干预组。根据拟订干预标准决定药师是否参与医嘱审核干预,比较两组TNA的不规范医嘱发生率、日均费用及人均费用,并分析药师干预的理由、原则与频次。结果药师干预后,TNA不规范医嘱发生率由12.45%降至2.49%(P<0.01)。药师共协助临床调整营养支持方式21例次,包括调整为肠内营养(EN)联合肠外营养14例次,全肠内营养4例次,暂停TNA医嘱3例次。对长期(>10 d)使用TNA患者干预最多(26例次),干预原则为添加谷氨酰胺,维护肠黏膜屏障,预防肠源性感染。干预组患者日均TNA费用为(458.62±96.15)元,明显低于对照组的(572.82±84.23)元(P<0.01);干预组患者人均TNA费用为(3169.02±1908.36)元,与对照组的(3572.97±1863.15)元相当(P=0.412)。结论药师干预可促进住院患者TPN支持的规范性和合理性,保障肠外营养用药安全,减轻患者的经济负担,体现自身专业价值。

Objective To investigate the effect of pharmacists′intervention in the total parenteral nutrition(TPN)support for inpatients.Methods A total of 715 total nutrient admixture(TNA)medical orders(involving 492 patients)not reviewed and intervened by pharmacists of Pharmacy Intravenous Admixture Services(PIVAS)from August 2021 to January 2022 in the hospital information system(HIS)were collected as the control group,and 882 TNA medical orders(involving 608 patients)reviewed and intervened by pharmacists of PIVAS from February 2022 to July 2022 in the HIS were collected as the intervention group.Whether pharmacists participated in the review and intervention of medical orders was determined based on the proposed intervention standards,the incidence of irrational TNA medical orders,daily average cost and per capita cost between the two groups were compared,and the reasons,principles and frequency of pharmacists′intervention were analyzed.Results After the intervention of pharmacists,the incidence of irrational TNA medical orders decreased from 12.45%to 2.49%(P<0.01).Pharmacists assisted in 21 cases of clinical adjustments of nutrition support methods,including 14 cases of adjustment to enteral nutrition(EN)combined with parenteral nutrition,4 cases of adjustment to total enteral nutrition and 3 cases of adjustment to suspension of TNA medical orders.The patients with long-term(>10 d)use of TNA were given the most interventions(26 cases).The intervention principles were adding glutamine,maintaining the intestinal mucosal barrier and preventing enterogenic infection.The daily average cost of TNA in the intervention group was CNY(458.62±96.15),which was significantly lower than CNY(572.82±84.23)in the control group(P<0.01).The per capita cost of TNA in the intervention group was CNY(3169.02±1908.36),which was similar to CNY(3572.97±1863.15)in the control group(P=0.412).Conclusion Pharmacists′intervention can promote the standardization and rationality of TPN support in inpatients,ensure the medication safety of parenteral nutrition,lighten the economic burden of patients,and reflect their professional value.