静脉用药调配中心肠外营养液处方审核优化的药学实践与思考

Pharmaceutical practice and thinking on prescription audit and optimization of total parenteral nutrition in pharmacy intravenous admixture service

目的 探讨静脉用药调配中心(PIVAS)关于肠外营养液(TNA)处方的合理性审核。方法 临床药师在某三甲医院PIVAS开展了系列优化TNA合理审核的措施,包括开展内部营养培训、筛选审核指标及建立审核标准操作规程等。结果 临床医师普遍认可TNA审核结果。并且,PIVAS内部TNA处方审核的假阴性率(从21.43%降至0.00%)和假阳性率(从28.07%降至6.94%)在干预后1个月内明显下降。结论 本次优化提升了TNA处方合理性及审核同质性。同时,探讨了PIVAS层面及临床医师层面关于TNA处方的不同关注点。本研究通过建立良好的临床沟通及适宜的审核流程,使患者更多获益。

Objective To explore the rationality audit of the prescription of total nutrition admixture(TNA)in pharmacy intravenous admixture service(PIVAS).Methods Clinical pharmacists carried out a series of measures to optimize the rationality audit of TNA in PIVAS,including conducting internal nutrition training,screening audit indicators and establishing standard operating procedures for audit.Results The clinical pharmacists generally recognized the results of TNA audit.Moreover,the fa lse negative rate(decreased from 21.43%to 0.00%)and false positive rate(decreased from 28.07%to 6.94%)of internal TNA prescription audit in PIVAS decreased significantly within one month after intervention.Conclusion This optimization has improved the rationality and audit homogeneity of TNA prescription.At the same time,the different concerns about TNA prescription at PIVAS level and clinical pharmacist level were discussed.This study will benefit patients more by establishing good clinical communication and appropriate audit process.