某院全肠外营养不合理处方的帕累托图分析

Analysis of Pareto Diagram on Irrational Prescription of Total Parenteral Nutrition

目的应用帕累托图分析年龄<60岁和年龄≥60岁的患者(老年患者)全肠外营养(total parenteral nutrition,TPN)不合理处方的情况及原因,为保障患者营养支持的安全性提供参考。方法选取福建医科大学附属泉州第一医院2023年1月至12月住院患者病历,每月随机抽取30份的TPN处方,应用帕累托图针对不合理处方的主、次要和一般因素进行分析。结果年龄<60岁的患者和老年患者TPN不合理处方类型几乎一致。但造成年龄<60岁的患者TPN不合理处方的主要因素为超适应症、热氮比不合理、糖脂比不合理,次要因素为谷氨酰胺用量不适宜;而造成老年患者TPN不合理处方的主要因素为热氮比不合理、谷氨酰胺用量不适宜、糖脂比不合理,次要因素为超适应症;一般因素均为脂溶性维生素用量不适宜和添加物不稳定。结论应用帕累托图分析年龄<60岁的患者和老年患者TPN不合理处方情况,可及时发现主次要因素,有利于临床药师针对性地进行相应的干预及营养基础知识的培训,以保障临床营养治疗的安全性和有效性。

Objective Analyze the situation and reasons of irrational prescriptions of total parenteral nutrition(TPN)in patients aged<60 years and≥60 years(elderly patients)by using Pareto Diagram,so as to provide reference for ensuring the safety of nutritional support.Methods 30 TPN prescriptions were randomly selected in Quanzhou First Hospital Affiliated to Fujian Medical University from January to December 2023.Pareto Diagram was used to analyze the main,secondary and general factors of irrational prescriptions.Results The types of TPN irrational prescriptions in elderly patients and ordinary patients were almost the same.But the main factors causing TPN irrational prescription in patients aged 60<years were inappropriate indications,unreasonable ratio of heat-to-nitrogen,and unreasonable ratio of glycol to lipid,while the secondary factor is inappropriate dosage of glutamine.The main factors in patients over 60 years old were unreasonable ratio of heat-to-nitrogen,inappropriate dosage of glutamine and unreasonable ratio of glycol to lipid,while the secondary factor is inappropriate indications.Common factors were inappropriate dosage of fat-soluble vitamins and unstable additives.Conclusion Based on the analysis of Pareto Diagram,we found out the primary and secondary factors of TPN irrational prescription in time,which is conducive for the clinical pharmacists to carry out targeted intervention and nutrition basic knowledge training,so as to ensure the safety and effectiveness of clinical nutrition treatment.