某院PIVAS 669张不合理用药医嘱的原因分析及其对策  

Analysis on Causes of 669 Unreasonable Medication of Doctor’s Orders in PIVAS in a Hospital and Its Countermeasures

作　　者：苏卉[1,2] 张桂芬 陆敏[1,2] 邹音 SU Hui;ZHANG Gui-fen;LU Min;ZOU Yin(Department of Pharmacy,Changshu No.1 People’s Hospital,Changshu Jiangsu 215500,China;Department of Pharmacy,Changshu Hospital Affiliated to Soochow University,Changshu Jiangsu 215500,China)

机构地区：[1]常熟市第一人民医院药剂科,江苏常熟215500 [2]苏州大学附属常熟医院药剂科,江苏常熟215500

出　　处：《抗感染药学》2021年第4期475-482,共8页Anti-infection Pharmacy

摘　　要：目的:分析医院静脉用药集中调配中心(PIVAS)不合理医嘱的用药原因及其对策,为促进临床合理用药提供参考。方法:收集医院2018年1月—2020年10月间PIVAS审方记录的2 492 981张医嘱,分析其医嘱用药的合理性以及不合理医嘱用药的原因。结果:2 492 981张医嘱中,不合理用药医嘱有669张(占调配输液医嘱的0.268‰),其中不合理抗菌药物医嘱占不合理医嘱的10.31%;不合理医嘱中TOP 3的病区有急诊内科、肿瘤科(20病区)和中医科;不合理用药类型TOP 3有溶媒用量不适宜、溶媒种类不适宜和给药频次不适宜;TOP 3药品类别有消化系统用药、免疫调节剂和血液系统用药;不合理医嘱中涉及药品种数较多的类别有抗肿瘤药物、抗菌药物和消化系统药物;不合理医嘱中涉及的单品种药品为香菇多糖、卡络磺钠和氢溴酸山莨菪碱;克林霉素在不合理医嘱中列抗菌药物类别TOP 1。结论:PIVAS审方药师在确保患者静脉用药的有效性和安全性等方面发挥了重要作用,采用审方干预可确保患者静脉用药的安全性。Objective: To analyze of the causes of 669 unreasonable medications of Doctor’s Orders in Pharmacy Intravenous Admixture Services(PIVAS) in a hospital and its countermeasures and to provide reference for promoting rational drug use in clinic. Methods: A total of 2 492,981 medical orders in PIVAS prescription review records from January2018 to October 2020 were collected to analyze the rationality of the medication of Doctor’s Orders and the reasons for irrational drug usage. Results: In the 2 492 981 Doctor’s Orders, 669 medical orders for unreasonable drug usage accounted for 0.268‰ of the Doctor’s Orders for infusion deployment, and the unreasonable medical orders for antibacterial drugs accounted for 10.31% of the unreasonable medical orders.Emergency internal medicine, oncology(20 wards)and traditional Chinese medicine were the TOP 3 wards of unreasonable medical orders. The TOP 3 types of unreasonable drug use included unsuitable dosage of solvent, unsuitable type of solvent and unsuitable frequency of drug administration. The TOP 3 drugs categories were digestive system drugs, immunomodulator and hematological system drugs.There were many types of drugs involved in unreasonable medical orders, including anti-tumor drugs, antimicrobial drugs and digestive system drugs. The single variety drugs involved in unreasonable medical orders were lentinan, sodium carotene sulfonate and anisodamine hydrobromide. Clindamycin was ranked as the TOP 1 antibiotic in unreasonable advice. Conclusions: The Prescription checking pharmacists in PIVAS played an important role in ensuring the effectiveness and safety of patients’ intravenous medication. Prescription checking intervention was adopted to ensure the safety of patients’ intravenous medication.

关 键 词：静脉用药 医嘱审核 合理用药 抗菌药物 PIVAS 

分 类 号：R969.3[医药卫生—药理学]