单中心儿科呼吸病房住院医嘱超说明书用药横断面调查  

A cross-sectional survey on drug use exceeded specification of children's respiratory wards in single center

作　　者：汤微微 张四喜[1] 周微[1] 宋燕青[1] 

机构地区：[1]吉林大学第一医院药学部,长春130021

出　　处：《中国循证儿科杂志》2017年第1期33-37,共5页Chinese Journal of Evidence Based Pediatrics

摘　　要：目的调查吉林大学第一医院(我院)儿科呼吸病房住院病历医嘱的超说明书用药情况,分析超说明书用药的影响因素。方法以横断面研究设计试验方案,采用等距抽样原则,从2014年9月至2015年9月我院HIS系统儿科呼吸病房的连续的0~18岁连续住院病历中抽取500份病历,提取与用药有关的全部医嘱,排除嘱托医嘱、退药医嘱、领药医嘱和0.9%氯化钠注射液等类似的医嘱。采集病历的一般信息和医嘱信息,判断每条医嘱的超说明用药情况,从年龄、药品种类、疾病和医嘱类型等方面行分层分析,采用Logistic回归法分析超说明书用药的影响因素。结果进入本文分析的500份病历包括465例患儿,共提取18 082条医嘱,住院用药医嘱16 618条,出院带药医嘱1 464条;涉及196种药物,主要为呼吸系统用药和系统抗感染药医嘱。(1)500份病历的超说明书用药率为100%,超说明书用药医嘱4 717条(26.1%),平均每份病历超说明书用药9.4条医嘱,平均每份病历每日超说明书用药1.4条医嘱。(2)无儿童用法和用量超说明书用药的发生率(17.4%)是其他类型超说明书用药发生率总和的2倍。(3)不同年龄阶段:总体超说明书用药发生率差异有统计学意义,年龄越小超说明书用药发生率越高(P=0.000)。(4)不同药物品种:总体超说明书用药发生率,系统抗感染药(35.7%)、呼吸系统用药(32.1%)和心血管系统用药(21.8%)较高;抗病毒药物高于抗细菌药物(P=0.000),均主要集中于无儿童用法用量;抗哮喘药高于镇咳祛痰药(P=0.020),前者主要集中于无儿童用法用量,后者主要集中于无给药途径和无儿童用法用量;超禁忌用药见于消化系统用药和其他药物。(5)不同疾病类型:总体超说明书用药发生率由高到低依次为肺炎、重症肺炎、支气管炎、支气管哮喘、其他疾病、咽炎和支气管异物。(6)不同医嘱类型:总体超说明书发生率出院带药医嘱高于住�Objective：To investigate the exceeded manual medicine situation of pediatric respiratory ward of the First Hospital of Jilin University , and to analyze the influencing factors. Methods： A cross-sectional study was used to design scheme of experiment, by using the principle of equidistant sampling from September 2014 to September 2015, 500 aged 0 to 18 years patient records of pediatric respiratory ward of the hospital HIS system were selected, the doctor＇s advice related to the drug was extracted, anddoctor＇s oral advice, carrying or returning advice, and about 0.9% sodium chloride injection and other similar orders were excluded. The general information and advice were collected to judge if the orders exceeded the manual by age, drug kinds, types of disease and the doctor＇s advice, logistic regression analysis was used to analyze the risk factors. Results： 500 patient records were included into in this paper, including 465 cases, 18 082 orders, 16 618 hospital medication orders, 1 464 off-hospital carrying medicine orders. 196 drugs were involved, mainly were the respiratory medicine and system anti-infection medicine. （1） In 500 patient records the exceeding medicine rate was 100%. There were 4 717 exceeded medicine orders （26.1%）, 9.4 super medication orders in each patient record, and 1.4 super medicine orders in each record. （2） Different exceeded manual medicine comparison： the incidence of without children＇s usage and dosage （17.4%） was twice of the incidence of other types. （3） Different ages： the overall incidence of exceeded manual medicine difference was statistically significant, the smaller the age, the higher the incidence （P=0.000）. （4） Different drug varieties comparison： the overall incidence of exceed manual medicine use system anti-infection drugs （35.7%）, respiratory medicine drugs （32.1%） and cardiovascular system （21.8%） were higher; Antiviral drugs were higher than antibacterial drugs （P=0.000）, and focused on no child usage a

关 键 词：超说明书用药 小儿呼吸 用药安全 

分 类 号：R985[医药卫生—药品]