某院重症患者超药品说明书用药情况调查

Investigation on Off-Label Drug Use for Critically Ill Patients in a Hospital

目的提高重症患者的用药安全性。方法抽取医院2021年重症医学病区(包括重症医学科、急诊重症病区)出院患者的住院病历,并提取与用药有关的医嘱,排除嘱托医嘱、退药医嘱、领药医嘱和未直接涉及用药的医嘱(如仅含0.9%氯化钠注射液)。分析超药品说明书用药具体情况,采用Logistic回归法分析超药品说明书用药的影响因素。结果共调查133份病历,涉及133例患者、18661条用药医嘱。其中,超药品说明书用药发生率以患者例数计为87.22%,以医嘱条数计为9.97%,后者中超适应证占84.15%,超给药(日)给药途径占16.44%,超剂量占0.16%,涉及药品有舒芬太尼(32.46%)、瑞芬太尼(22.46%)、右美托咪定(21.39%)。入院科室为超药品说明用药的影响因素(P<0.05)。结论该院临床重症患者超药品说明书用药现象较普遍,最主要类型为超适应证用药,且其发生受入院科室影响。

Objective To improve the medication safety of critically ill patients.Methods The medical records of patients discharged from critical care ward(including the critical care medicine department and the emergency critical care ward)of the hospital in 2021 were collected,the medical orders related to medication were extracted,and the oral orders,withdrawal orders,taking-drug orders and medical orders not directly involving medication(such as only containing 0.9%sodium chloride injection)were excluded.The specific medication information of off-label drug use was analyzed,and the influencing factors of off-label drug use were analyzed by the Logistic regression model.Results A total of 133 medical records were obtained,involving 133 patients and 18661 medication orders.Among them,the incidence of off-label drug use was 87.22%(calculated by cases)and 9.97%(calculated by medical orders).Among the medication orders with off-label drug use,the proportions of inappropriate indication,inappropriate administration route and overdose(daily dose)were 84.15%,16.44%and 0.16%respectively,involving sufentanil(32.46%),remifentanil(22.46%)and dexmedetomidine(21.39%).Department of admission was the influencing factor of off-label drug use(P<0.05).Conclusion The off-label drug use is common in critically ill patients in this hospital,the main type of this problem is the inappropriate indication,and its occurrence is affected by the department of admission.