对临床药师拒绝调配的静脉用药不合理医嘱的帕累托图分析  

Plato Analysis on Irrational Intravenous Prescription Rejected by Clinical Pharmacists

作　　者：张哲弢 马旖旎[1] 邓晓媚[1] 王晓宇[1] 韩静文 史天陆[1] 

机构地区：[1]安徽省立医院药剂科,安徽合肥230036

出　　处：《中国医院用药评价与分析》2017年第11期1552-1554,1558,共4页Evaluation and Analysis of Drug-use in Hospitals of China

基　　金：2017年安徽省自然科学基金(No.1708085MH225)

摘　　要：目的:探讨安徽省立医院(以下简称"我院")临床医师拒绝调配的住院患者静脉用药不合理医嘱情况,为合理用药提供参考。方法:汇总2016年我院临床药师拒绝调配的静脉用药不合理医嘱12 818条,绘制帕累托图,探讨其科室分布及主要影响因素。结果:12 818条临床药师拒绝调配的静脉用药不合理医嘱分布于20个临床科室,不合理医嘱数排序居前9位的分别为心血管内科、神经内科、综合内科、骨科、肿瘤化疗科、冠心病监护病房、重症加强护理病房、中医科和神经外科,合计占不合理用药医嘱总数的79.97%(10 251/12 818),为不合理静脉用药的主要科室;胸外科、内分泌科、日间病区的累计构成比为>80%~90%,为次要科室。不合理医嘱按拒绝调配原因可分为给药途径不适宜、溶剂选择不适宜、给药剂量不适宜、溶剂用量不适宜及联合用药不适宜等12类。其中,给药途径不适宜、溶剂选择不适宜、给药剂量不适宜及溶剂用量不适宜等医嘱合计占不合理用药医嘱总数的77.86%(9 980/12 818),为主要表现形式;联合用药不适宜医嘱的累计构成比约为89%,为次要表现形式。结论:通过帕累托图分析法可了解不合理医嘱的主要分布科室和影响因素,为合理用药提供依据。我院应加强对静脉用药不合理医嘱的干预,积极发挥临床药师的作用,降低不合理用药率。OBJECTIVE： To invesgate the irrational intravenous prescription which is advisable to reject dispensing by clinical pharmacists in inpatients from Anhui Provincial Hospital（ hereinafter referred to as＂our hospital＂）,so as to provide reference for the rational drug use in clinic. METHODS： 12 818 irrational intravenous prescriptions which is advisable to refuse dispensing by clinical pharmacists in 2016 were summarized,and the Plato was made,distribution of departments and main influencing factors were discussed. RESULTS： Irrational intravenous prescriptions contained a total of 12 818,mainly distributed in 20 departments,among which,the top 9 ranked by the number of irrational prescriptions took 79. 97%（ 10 251/12 818） of the total irrational prescriptions and were the main departments of irrational intravenous prescription,respectively cardiovascular medicine,neurology,comprehensive medicine,orthopedics,cancer chemotherapy,CCU,ICU,traditional Chinese medicine and neurosurgery,etc; followed by thoracic surgery,endocrinology and daytime ward,the cumulative constituent ratio of the above three departments were 80%-90%. The reasons for prescription-rejected mainly performed as improper route of administration,improper solvent selection,improper administration dosage,improper dosage of solvent,and improper combination,etc; among which,improper route of administration,irrational selection of solvent,improper administration dosage and improper dosage of solvent accounted 77. 86%（ 9 980/12 818） of the total irrational prescriptions; followed by improper drug combination,and the cumulative constituent ratio of which was 89% approximately.CONCLUSIONS： The distribution of departments and main effect factors of irrational prescriptions can be found through Platonic analysis,which can provide reference for the rational drug use in clinic and reduce the irrational use rate of drugs.

关 键 词：临床药师 静脉用药 医嘱审核 不合理医嘱 帕累托图分析 

分 类 号：R969.3[医药卫生—药理学]