内分泌住院患者不合理医嘱柏拉图分析及干预  

Pareto Diagram Analysis of Intervention in Irrational Medical Orders for Inpatients of Endocrinology

作　　者：俞颖[1] 刘冬玲 陈菲[2] 张帆[2] YU Ying;LIU Dongling;CHEN Fei;ZHANG Fan(Department of Pharmacy,the Second Affiliated Hospital of Nanjing Medical University,Nanjing Jiangsu 210011,China;Department of Pharmacy,Liaocheng People's Hospital,Liaocheng Shandong 252000,China)

机构地区：[1]南京医科大学第二附属医院药学部,江苏南京210011 [2]聊城市人民医院药学部,山东聊城252000

出　　处：《中国药物警戒》2020年第12期921-925,933,共6页Chinese Journal of Pharmacovigilance

基　　金：南京医科大学科技发展基金(2016NJMU047):基于多因素影响的糖尿病患者胰岛素使用差异性研究。

摘　　要：目的探讨聊城市人民医院内分泌科住院患者不合理医嘱的情况及产生原因。方法通过合理用药监测系统与人工审核相结合的方式对2017年4月至2019年3月该院内分泌科全部住院医嘱进行审核,对问题医嘱按照类别进行统计,利用柏拉图法对每季度不合理医嘱的主要、次要及一般因素进行分析,并制定干预措施。结果4056名住院患者的137904条医嘱中,795条存在用药不适宜现象,包括8种不适宜类型,分别是溶媒选择、给药频次、单次剂量、用药时间、适应证、联合用药、药物选择及给药途径的不适宜。通过加强合理用药宣传、强化用药监护、积极开展药学服务以及多部门联合干预后,该院内分泌科住院患者医嘱合理率由65.19%升至90%以上,且指标控制稳定。结论柏拉图法有助于改善临床中的用药不适宜现象,提升临床药师自身服务能力,促进医院合理用药。Objective To investigate the incidence and causes of irrational medical orders for inpatients from the department of Endocrinology of Liaocheng People’s Hospital.Methods All medical orders written between April 2017 and March 2019 from the Department of Endocrinology in this hospital were previously reviewed by the automatic screening system of prescriptions combined with manual examination.Imperfect medical orders were classified and counted according to types of problems.The Pareto diagram method was used to analyze the primary,secondary and common factors that were responsible for irrational medical orders each quarter.Interventions were formulated according to the results of analysis.Results A total of 795 out of 137,904 medical orders for 4,056 inpatients were problematic,which were of eight types involving solvents,administration frequencies,single dosage,administration time,indications,drug combinations,drug selection and administration routes.By reinforcing rational use of drugs and pharmaceutical care,providing pharmaceutical services,and carrying out multi-departmental interventions,the rate of proper medical orders for inpatients from the Department of Endocrinology increased from 65.19%to over 90%,with a stable index control.Conclusion Pareto d iagram a nalysis can help r educe i rrational d rug u sage clinically,c ontribute t o rational medications,and improve the quality of services rendered by clinical pharmacists.

关 键 词：医嘱审核 柏拉图分析 合理用药 临床药师 

分 类 号：R781.63[医药卫生—口腔医学]