我国医疗机构PIVAS医嘱审核情况调研分析

Investigation and analysis of the medical prescription approval in PIVAS in China

目的 了解全国医疗机构静脉用药调配中心(PIVAS)医嘱审核现状,进一步提升PIVAS医嘱管理水平,减少与杜绝静脉给药错误的发生。方法 通过问卷调研法,针对全国医疗机构PIVAS医嘱审核的问题和现状,由调研组中的各省(自治区、直辖市)专家负责组织本省份内相关医疗机构的PIVAS负责人填写医嘱审核和不适宜医嘱干预情况的问卷,并对结果进行统计分析。结果 共收到关于PIVAS医嘱审核的有效问卷751份。我国PIVAS医嘱审核主要以人工与计算机相结合的方式进行。PIVAS每日医嘱审核条数的中位数为700.00~771.00条;每日新增医嘱审核条数的中位数为209.68~215.00条;平均医嘱审核率为85.50%~92.44%;不适宜医嘱平均占比为1.82%~1.89%;不适宜医嘱平均干预率为74.90%~79.41%,平均干预成功率为79.62%~87.28%;退药率为2.92%~3.08%。结论 我国大部分医疗机构PIVAS的医嘱审核采用审方软件辅助,个别PIVAS存在医嘱不审核、不适宜医嘱不干预等情况,医嘱审核的标准及流程有待完善。建议强调药师审方责任制,规范化使用审方软件,逐步扩大医嘱审核范围,并采用多部门协作方式,从而提高不适宜医嘱的干预成功率、降低PIVAS退药率。

OBJECTIVE To know about the current status of medical order auditing in pharmacy intravenous admixture service(PIVAS)of medical institutions nationwide,further improve the management of medical orders in PIVAS,and reduce and eliminate the occurrence of intravenous medication administration errors.METHODS Through the questionnaire survey method,to address the problems and current situation of PIVAS medical order auditing in medical institutions nationwide,experts from each province(autonomous region,municipality directly under the central government)in the research group were responsible for organizing the PIVAS directors of relevant medical institutions in their provinces to fill in the questionnaires on medical order audit and inappropriate medical order interventions,and conduct a statistical analysis of the results.RESULTS A total of valid 751 responses were received to the PIVAS questionnaire on the review of medical prescriptions.Our PIVAS medical order audit is mainly carried out by a combination of manual and computer.The median number of medical orders were audited by PIVAS per day were 700.00-771.00;the median number of new medical orders were audited by PIVAS per day were 209.68-215.00;medical order auditing rates were 85.50%-92.44% averagely;the inappropriate doctor’s orders accounted for 1.82%-1.89% averagely;the intervention rates of inappropriate medical orders ranged 74.90%-79.41%,the success rates of intervention were 79.62%-87.28% averagely;the medication refund rates were 2.92%-3.08%.CONCLUSIONS Most of the PIVAS in China’s healthcare institutions use medical order review software to assist in the review of medical orders,and there are cases of individual PIVAS in which medical orders are not reviewed comprehensively and inappropriate orders are not intervened in,and the standards and processes of medical prescription review need to be improved.It is recommended to emphasize the pharmacist’s responsibility system,standardize the use of prescription review software;gradually expand the scope of medical order review,and adopt a multi-departmental collaborative approach so as to increase the success rate of intervention for inappropriate prescriptions and reduce the rate of PIVAS withdrawals.