临床药师以利福平药物相互作用为切入点开展医嘱审核的研究

The study of auditing prescription on interaction of rifampicin in patients with brucellosis conducted by clinical pharmacists

目的:临床药师以利福平药物相互作用为切入点,审核布氏菌病患者的用药医嘱,为建立医嘱审核实践模式提供参考。方法:以北京地坛医院收治的布氏菌病患者为研究对象,以2018年7—12月的住院患者为观察组,2018年1—6月住院患者为对照组,依据提前设计的利福平药物相互作用模板,开展医嘱审核和干预,并对干预的效果进行评价。结果:观察组59例患者,医嘱749条,男性49例(83.1%),女10例(16.9%),年龄17月~71岁,平均年龄(50.0±15.6)岁,平均住院(16.5±9.4)d。对照组患者50例,医嘱653条,男性43例(86.0%),女7例(14.0%),年龄31月~71岁,平均年龄(51.4±12.9)岁;平均住院(16.7±11.0)d,2组患者年龄、性别、住院天数、医嘱条数等差异无统计学意义(P>0.05)。建立联合用药模板,主要包括奥美拉唑、硝苯地平、苯磺酸氨氯地平、咪达唑仑、酒石酸美托洛尔、地西泮和氟康唑7种药物。临床药师干预观察组相互作用医嘱32条,干预率4.30%(32/749),医师接受了23条临床药师建议,接受率71.88%;对照组存在相互作用却没有干预的医嘱35条,漏审率5.40%(35/653)。结论:以利福平药物相互作用为切入点进行审核医嘱,可显著提高医嘱审核的准确性,减少漏审率,保障患者用药安全。

Objective:This study was designed to provide reference for the establishment of the mode of auditing prescription with rifampicin relevant interaction in patients with brucellosis.Methods:Patients with brucellosis admitted and treated in Beijing Ditan Hospital were selected as the study subjects.Inpatients from July 2018 to December 2018 were selected as the study group and inpatients from January 2018 to June 2018 as the control group.Auditing and interventions were conducted on doctors’medical orders according to the interaction template of rifampicin designed in advance,and the intervention effect was evaluated.Results:There were 59 patients with 749 medical orders in the study group including 49 males(83.1%)and 10 females(16.9%)aged from 17 months to 71 years old with an average age of(50.0±15.6)years old.Their average hospitalization duration was(16.5±9.4)days.There were 50 patients with 635 medical orders in the control group,including 43 males(86.0%)and 7 females(14.0%)aged from 31 months to 71 years old with an average age of(51.4±12.9)years old.Their average hospitalization duration was(16.7±11.0)days.There was no statistical difference between the two groups in age and gender ratio,the length of stay and number of medical orders(P>0.05).The combined drug template was established for 7 drugs including omeprazole,nifedipine,amlodipine besylate,midazolam,metoprolol tartrate,diazepam and fluconazole.Clinical pharmacists advised on 32 medical orders of the study group with an intervention rate of 4.3%(32/749).The doctors accepted 23 clinical pharmacists’recommendations with a rate of 71.88%.There were 35 unreasonable medical orders which were not be intervened,and the rate is 5.40%(35/653).Conclusion:Clinical pharmacist reviewed patients’medical orders placing the emphasis on rifampicin interaction,which can remarkably improve the accuracy of the examination,decrease the rate of missing and ensure patients administration security.