895条中药注射剂问题医嘱的帕累托图分析及药师干预

Pareto Diagram Analysis and Pharmacist Intervention of 895 Medical Orders for Traditional Chinese Medicine Injections

目的对2021年1月~2022年3月静脉用药调配中心(PIVAS)中药注射剂问题医嘱进行帕累托图分析,为临床提供参考。方法采用回顾性分析法收集2021年1月~2022年3月PIVAS医嘱,对医嘱科室分布情况、问题医嘱类型及常见药物分类、干预情况进行统计分析。结果共审核医嘱计359678条,不合理用药医嘱5193条,其中中药注射剂问题医嘱895条。中药注射剂问题医嘱科室分布情况由高向低分别为肾内科(17.77%)、心内科(16.76%)、中西医结合科(13.85%)、肿瘤内科(12.18%)、普外科(10.28%)等。问题医嘱类型包括溶媒问题、剂量问题、配伍问题、超禁忌人群、给药途径问题、频次问题、浓度问题、其它问题等,其中溶媒问题占58.77%,其次为剂量问题(14.53%)。医嘱干预临床接受总占比93.41%,其中剂量问题、浓度问题、配伍问题临床接受比例低于90%。结论PIVAS中药注射剂问题医嘱主要集中在溶媒及剂量问题,药师初步探索其干预重点与难点,依据重点科室特殊人群进行合理用药干预,总结常见中药注射剂溶媒推荐,探索提高医嘱干预率的新模式,为临床提供可行性、合理化建议,以解决临床实际问题。

OBJECTIVE To analyze the Pareto diagram of the doctor's orders for traditional Chinese medicine injections in the intravenous drug dispensing center(PIVAS)from January 2021 to March 2022,so as to provide reference for clinical practice.METHODS The PIVAS doctor's orders from January 2021 to March 2022 were collected by retrospective analysis,and the distribution of doctor's orders,the types of problem doctor's orders,classification of common drugs and the intervention were statistically analyzed.RESULTS A total of 359678 medical orders were reviewed,including 5193 orders for irrational use of drugs,including 895 orders for problems with traditional Chinese medicine injections.The distribution of medical advice departments for traditional Chinese medicine injection problems from high to low is respectively nephrology(17.77%),cardiology(16.76%),integrated traditional and western medicine(13.85%),oncology(12.18%),general surgery(10.28%),etc.The types of medical advice problems include vehicle problems,dose problems,compatibility problems,ultra-contraindication population,drug delivery route problems,frequency problems,concentration problems,and other problems,among which the vehicle problems account for 58.77%,followed by dose problems(14.53%).The total clinical acceptance rate of medical order intervention was 93.41%,and the clinical acceptance rate of dose,concentration and compatibility problems was less than 90%.CONCLUSION The PIVAS medical advice on the problem of traditional Chinese medicine injection mainly focuses on the problem of solvent and dosage.Pharmacists initially explored the key points and difficulties of intervention,carried out rational drug use intervention according to special populations in key departments,summarized common TCM injection solvent recommendations,explored new models to improve the intervention rate of medical orders,and provided feasible and reasonable suggestions for clinical practice to solve practical clinical problems.