焦点管理循环法对某院放化疗科静脉用药不合理医嘱的分析与干预  

Analysis and Intervention of Irrational Medical Orders for Intravenous Medication in Oncology Department of Our Hospital by FOCUS-PDCA Method

作　　者：金晶[1] 杨莹菲[1] 吴东方[1] Jin Jing;Yang Yingfei;Wu Dongfang(Department of Pharmacy,Zhongnan Hospital of Wuhan University,Wuhan 430071,China)

机构地区：[1]武汉大学中南医院药学部,武汉430071

出　　处：《中国药师》2021年第12期2216-2221,共6页China Pharmacist

摘　　要：目的:考察某院放化疗科静脉用药的合理性,对不合理医嘱进行分析与干预。方法:采用焦点管理循环法(FOCUS-PDCA)对2020年6~11月(干预前)与2020年12月~2021年5月(干预后)某院静脉药物调配中心(PIVAS)接受的放化疗科所有医嘱进行回顾性评价,采用帕累托图对不合理医嘱类型分级,筛选出主要、次要以及一般类型进行分析,制定干预方案,将干预前后不合理医嘱情况进行对比分析。结果:干预前,126 130份医嘱中存在600份不合理医嘱(0.476%),共计6种类型,溶媒种类(46.17%)和体积不适宜(19.83%)为不合理医嘱的主要类型,用药剂量不适宜(17.17%)为次要类型,用药频次不适宜(9.50%)、药品配伍禁忌(4.33%)和其他(3.00%)为一般类型。经FOCUS-PDCA法干预后,125 786份医嘱中不合理医嘱259份(0.206%),发生率明显下降。结论:以FOCUS-PDCA法形成的持续改进方案,降低不合理医嘱发生率,从而减少用药差错,可极大提升临床合理用药水平,并为肿瘤患者用药的安全性、有效性提供保障。Objective: To investigate the rationality of intravenous medication in oncology department of a hospital, analyze and intervene irrational medical orders, and ensure rational medications for cancer patients. Methods: The FOCUS-PDCA diagram was used to evaluate medical orders of PIVAS from June 2020 to November 2020(before intervention) and from December 2020 to May 2021(after intervention) for retrospective evaluation. Combined with the Pareto diagram to classify the types of irrational medical orders, the main, secondary and general factors were screened for analysis, so as to formulate intervention plans. The irrational medical orders before and after intervention were compared and analyzed. Results: Before intervention, among 126 130 medical orders, 600(0.476%) irrational medical orders were found and classified into 6 types, and the main factors included inappropriate solvent type(46.17%) and volume(19.83%), the secondary factor was inappropriate drug dose(17.17%), and inappropriate drug use frequency(9.50%), drug contraindications(4.33%) and other factors(3.00%) were the general factors. Under the continuous quality improvement of the FOCUS-PDCA model, there were 259 irrational medical orders(accounting for 0.206%) in 125 786 medical orders after intervention, and the incidence of irrational medical orders was decreased. Conclusion: The continuous improvement plan formed by the FOCUS-PDCA model reduces the incidence of irrational medical orders, thereby reducing medication errors, greatly improving the level of clinical rational medication, and providing guarantee for the safety and effectiveness of medications for cancer patients.

关 键 词：焦点管理循环 放化疗科 静脉药物调配中心 不合理医嘱 帕累托图 用药差错 

分 类 号：R969.3[医药卫生—药理学]