FOCUS-PDCA循环管理在降低肠外营养不合理医嘱发生率中的应用  

Application of FOCUS-PDCA Cycle Management in Reducing the Incidence of Irrational Medical Orders of Parenteral Nutrition

作　　者：贺银丽 罗秦英[1] 董乐乐 庞成森[1] 鲁会侠[1] 张亚婷[1] 张晓霞[1] 董卫华[1] 王曙逢[2] 封卫毅[1] 施秉银[3] 

机构地区：[1]西安交通大学第一附属医院药学部,西安710061 [2]西安交通大学第一附属医院普通外科,西安710061 [3]西安交通大学第一附属医院内分泌科,西安710061

出　　处：《中国药房》2017年第34期4842-4845,共4页China Pharmacy

摘　　要：目的:降低我院肠外营养不合理医嘱的发生率,促进肠外营养的合理使用。方法:收集我院普通外科2016年第一季度的肠外营养医嘱,统计其不合理医嘱数量及发生类型,然后运用FOCUS-PDCA(Find-organize-clarify-understand-select-plan-docheck-act)循环管理对肠外营养医嘱开具过程中存在的问题进行分析和改善,再收集改善后(2016年第三季度)的肠外营养医嘱对其不合理医嘱数量及发生类型进行统计,评价管理效果。结果:我院通过采取成立营养支持小组、加强对医护人员的培训与沟通、在医院信息系统中加入肠外营养审方模块等多项措施进行持续改进,使普通外科肠外营养的不合理医嘱发生率由改善前的48.25%(1 433/2 970)下降至改善后的5.67%(120/2 118),不合理类型中阳离子超量、遴选药品不适宜、配伍不适宜发生率降为0。结论:采用FOCUS-PDCA循环管理可降低肠外营养不合理医嘱发生率,促进医院肠外营养的合理使用。OBJECTIVE：To reduce the incidence of irrational medical orders for parenteral nutrition,and promote the rational use of parenteral nutrition. METHODS：The medical orders for parenteral nutrition of the first quarter of 2016 in general surgery department of our hospital were collected,and the number and types of its irrational medical orders were summed up. Then FOCUSPDCA（Find-organize-clarify-understand-select-plan-do-check-act）cycle management was adopted to analyze and improve the existing problems in issuing medical orders for parenteral nutrition. The improved（the third quarter of 2016）medical orders for parenteral nutrition were collected,the number and types of its irrational medical orders were summed up,and management effect was evaluated. RESULTS：Establishing nutrition support group,strengthening the training and communication of medical staff,adding prescription evaluation module for parenteral nutrition in hospital information system and a number of measures had made the incidence of irrational medical orders for parenteral nutrition in general surgery department declined from 48.25%（1 433/2 970）before improvement to 5.67%（120/2 118）after improvement. The incidences of cation excess,inappropriate selection of drugs and inappropriate compatibility in irrational types were 0. CONCLUSIONS：FOCUS-PDCA cycle management can reduce the irrational rate of medical orders for parenteral nutrition and promote the rational use of parenteral nutrition in hospital.

关 键 词：FOCUS-PDCA 肠外营养 医嘱 合理用药 

分 类 号：R95[医药卫生—药学]