全营养混合液医嘱临床决策支持系统的建立  

Establishment of clinical decision support system for physician order of total nutrient admixture

作　　者：老东辉 蒋奕 杨春 张建中 Lao Donghui;Jiang Yi;Yang Chun;Zhang Jianzhong(Department of Pharmacy,Zhongshan Hospital,Fudan University,Shanghai 200032,China;Department of General Surgery,Zhongshan Hospital,Fudan University,Shanghai 200032,China;Center for Computer Network,Zhongshan Hospital,Fudan University,Shanghai 200032,China)

机构地区：[1]复旦大学附属中山医院药剂科,上海200032 [2]复旦大学附属中山医院普外科,上海200032 [3]复旦大学附属中山医院网络中心,上海200032

出　　处：《中华临床营养杂志》2021年第6期337-342,355,共7页Chinese Journal of Clinical Nutrition

摘　　要：目的建立一种全营养混合液(total nutrient admixture,TNA)计算机化医师医嘱输入系统(computerized physician order entry,CPOE)和系统内辅助临床决策支持系统(clinical decision support,CDS)的功能设计,保障TNA医嘱的正确开具。方法通过梳理TNA、医嘱开具的工作流程,改进并设计新工作流程。建立TNA医嘱专属的CPOE界面,并在界面中建立一种临床决策支持方式,在TNA医嘱各组分输入同时,通过CDS的运算与反馈,判断是否同时满足患者的临床营养需要与药学工艺要求,并在界面直接通知开具医嘱的临床医师。CDS通过确保TNA医嘱的适宜性,及时保证肠外营养的临床使用安全。通过判断医嘱选择的合理性,并对不合理医嘱提供实时报警反馈,完成前置审方功能,并对临床医师的开具肠外营养的医嘱行为兼具教育功能。结果通过CDS后台可选择药品目录的建立,杜绝了TNA医嘱中加入治疗性药物的不合理医嘱。肠外营养CPOE辅助支持系统后台运算能正确判断载体输液是否合理,并能在CPOE界面对临床医师进行实时反馈。结论该CPOE辅助支持系统的建立杜绝了TNA医嘱中成分比例不合理、加入其他治疗性药物等,确保TNA医嘱保证患者每日所需能量,成分配比合理,相容性与稳定性良好,使患者肠外营养的用药安全获得了保证。Objective To establish a design of a clinical decision support(CDS)system ithin the computerized physician order entry(CPOE)system to ensure the correct prescribing of total nutrient admixture(TNA)orders.Methods An improved new workflow was designed in consideration of both the TNA and doctor's prescription work flow.An exclusive CPOE interface for TNA physician order was established,within which a CDS mode was also created.When individual components of the TNA physician order are inputted,automatic calculation is performed through CDS to determine whether patient's clinical nutritional needs and pharmaceutical process requirements are both met.The generated feedback is presented directly to the prescribing clinician in the interface.Through rationality assessment of physician orders and real-time alarm feedback for inappropriate orders,the system can achieve pre-review of TNA orders as well as the education for clinicians on parenteral nutrition order prescription.Results The usable drug catalog is created at the back end of CDS,thus precluding unreasonable medical orders of therapeutic drugs in TNA regimens.The background CPOE auxiliary support system for parenteral nutrition can correctly evaluate the reasonability of the carrier solution and provide real-time feedback in the CPOE interface.Conclusion The establishment of the CPOE auxiliary support system eliminates the possibility of unreasonable component proportions and admixture with other therapeutic drugs in TNA orders to ensure TNA orders with rationale component proportion and good compatibility and stability,ultimately satisfying patient's daily calory need and guaranteeing medication safety of parenteral nutrition.

关 键 词：静脉用药调配中心 药师 全营养混合液 临床决策支持系统 

分 类 号：R459.3[医药卫生—治疗学]