基于欧洲医药保健网分类系统的某中医医院重症医学科药物相关问题的分析  

Analysis on Drug-Related Problems in Department of Intensive Care Unit in A Certain Hospital of Traditional Chinese Medicine Based on the Classification System of Pharmaceutical Care Network Europe

作　　者：李文喆[1] 刘洋[2] 吴茜 许一彤 董雪峰[1] 马园 LI Wenzhe;LIU Yang;WU Qian;XU Yitong;DONG Xuefeng;MA Yuan(Dept.of Pharmacy,Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University,Beijing 100010,China;Dept.of Clinical Pharmacy,Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University,Beijing 100010,China)

机构地区：[1]首都医科大学附属北京中医医院药学部,北京100010 [2]首都医科大学附属北京中医医院临床药学科,北京100010

出　　处：《中国医院用药评价与分析》2021年第2期232-236,共5页Evaluation and Analysis of Drug-use in Hospitals of China

基　　金：北京市属医院科研培育计划(No.PG2020022)。

摘　　要：目的:通过将欧洲医药保健网(pharmaceutical care network Europe,PCNE)分类系统应用于重症医学科患者的药学监护,探索解决重症医学科的药物相关问题(drug related problem,DRP)的闭环管理模式(发现问题-分析问题-解决问题-评价结果)。方法:收集某中医医院刚开始实施PCNE分类系统(2018年)、实施1年后(2019年)重症医学科患者的DRP,对DRP数量、问题类别、原因、临床药师的干预情况、转归和涉及药物等因素进行比较分析。结果:2018年共对216例患者进行药学干预,发现DRP 101例次;2019年度共对245例患者进行药学干预,发现DRP 50例次,DRP数量明显少于2018年。DRP问题类别方面,2018年、2019年均以治疗安全性问题为主;出现DRP的原因方面,2018年主要为其他说明(包括不良反应、注射剂配伍禁忌)、选药不适宜(使用禁忌)和无指征用药,2019年主要为无指征用药、选药不适宜(未依据指南)和其他说明;2018年与2019年药师对医师层面、药物层面和其他层面(主要体现在对护士层面的干预)的干预情况比较,差异均有统计学意义(P<0.01);干预接受率由2018年的90.10%(91/101)提升至2019年的98.00%(49/50),问题全部解决的比例由2018年的79.21%(80/101)提升至2019年的94.00%(47/50),差异均有统计学意义(P<0.01);重症医学科DRP涉及的药物种类较多,以抗菌药物为主。结论:PCNE分类系统可以对重症医学科的DRP实现有效的药学监护闭环管理,并且有助于形成标准化和规范化的药学监护,为临床药师的工作提供数据依据。OBJECTIVE:To probe into the closed-loop management model(problem discovery-problem analysisproblem solving-result evaluation)to solve drug-related problems(DRP)in ICU by applying the classification system of Pharmaceutical Care Network Europe(PCNE)on the pharmaceutical care on ICU patients.METHODS:DRP in ICU patients at the beginning of implementation of classification system of PCNE(2018)and one year after implementation(2019)in a certain TCM hospital were collected,comparison and analyzed were conducted in terms of the numbers,categories,causes,clinical pharmacist’interventions,outcomes and involved drugs of DRP.RESULTS:Totally 216 patients received pharmaceutical intervention in 2018,and 101 DRP cases were found;245 patients received pharmaceutical intervention in 2019,and 50 DRP cases were found,which was significantly less than that of 2018.In terms of the categories of DRP,both 2018 and 2019 focused on treatment safety issues;in terms of the causes of DRP,other instructions(including adverse drug reactions,incompatibility of injections),inappropriate drug selection(contraindication)and non-indication medication were the main reasons in 2018,while the non-indication medication,inappropriate drug selection(not in accordance with the guideline)and other instructions were the main reasons in2019;the comparisons of pharmacists’interventions at the physician level,drug level and other levels(mainly reflected in the intervention at nurse level)between 2018 and 2019 were statistically significant(P<0.01);the acceptance rate of intervention increased from 90.10%(91/101)in 2018 to 98.00%(49/50)in 2019,and the proportion of all problems solved had increased from 79.21%(80/101)in 2018 to 94.00%(47/50)in 2019,with statistically significant differences(P<0.01);DRP in ICU had involved many categories of drugs,mainly were antibiotics.CONCLUSIONS:The classification system of PCNE can achieve effective closed-loop management of pharmaceutical care for DRP in ICU,which is helpful to form standardized and normalized pharma

关 键 词：欧洲医药保健网 分类系统 药物相关问题 重症医学科 药学监护 

分 类 号：R97[医药卫生—药品]