临床药师对96例肾功能重度不全患者医嘱的优化干预效果分析  

Intervention effect on optimizing medication orders in 96 cases inpatients with severe renal insufficiency by clinical pharmacists

作　　者：陈集志[1] 李刚[1] 李忠东[2] 徐小燕[1] 宋景春[3] 张增珠[1] 熊贤兵[1] 汪启炉[1] 

机构地区：[1]解放军第九四医院药学科,江西南昌330002 [2]空军总医院药学部,北京100142 [3]解放军第九四医院ICU,江西南昌330002

出　　处：《中国药物应用与监测》2016年第4期247-250,共4页Chinese Journal of Drug Application and Monitoring

摘　　要：目的:评价临床药师对肾功能重度不全患者用药医嘱优化干预的效果,为临床药师进一步深入开展临床工作提供参考。方法:临床药师通过对2014年12月–2015年5月肾功能重度不全患者的住院医嘱进行审核,对不合理医嘱在药物选择、剂量、给药间隔等方面提出建议并进行优化,与医师进行交流并追踪医嘱的修改情况。结果:对96例肾功能重度不全患者的医嘱进行优化干预,累计审核医嘱12 032条,发现186例次不合理医嘱,干预成功率为70.97%,其中剂量调整方案占40.86%,抗感染药物干预成功率占86.21%;不合理医嘱发生率由第1个月的1.60%逐步降低至最后一个月的0.54%;为部分患者节省了医疗费用。结论:临床药师针对肾功能不全患者的药物选择和剂量方面进行干预,显著降低了不合理医嘱发生率,在一定程度上改善临床医师的用药习惯,确保了患者的用药安全。Objective： To explore the intervention effect on optimizing medication orders in inpatients with severe renal insufficiency by clinical pharmacists, and provide a reference for clinical pharmacists on carring out the clinical work further. Methods： Medical records of inpatients with sever renal insufficiency from December 2014 to May 2015 were reviewed by clinical pharmacists, and suggestions on drug selection, dosage and frequency of inappropriate orders were given to optimize medication. Also pharmacists communicated with physicians and tracked the results of modification medical orders. Results： Medication orders of 96 inpatients with sever renal insufficiency were intervened by clinical pharmacists, and a total of 12 032 medication orders were reviewed, 186 inappropriate orders were found and finally 70.97% of inappropriate orders were revised by intervention, in which 40.86% was adjusting the dosage, and the success rate of intervention for antimicrobial medications was 86.21%. The baseline rate of inappropriate order was 1.60%, the rate fell to 0.54% in the last month, and the medical expenses were saved for some patients. Conclusion： The clinical pharmacists＇ participation in guiding medication selecting and adjusting dosage for inpatients with severe renal insufficiency reduced the incidence of inappropriate orders, and most of the unreasonable orders could be corrected. By discussing inappropriate orders with physicians, the prescription habits and patient＇s medication safety can be improved.

关 键 词：肾功能重度不全患者 临床药师 优化干预 效果 

分 类 号：R692.5[医药卫生—泌尿科学]