审方药师对某院生殖科门诊超说明书用药的分析与思考  

Analysis and thinking of the examiner′s pharmacist on the off-label medicines in a reproductive department of a hospital

作　　者：骆雨璇[1] 陈醒 王楠[1] 陈旭青[1] 王兴东[1] LUO Yu-xuan;CHEN Xing;WANG Nan;CHEN Xu-qing;WANG Xing-dong(Department of Pharmacy,Medical Supplies Center,General Hospital of Eastern Theater Command,PLA,Nanjing 210002,Jiangsu,China;Wuxi Joint Logistics Supporting Center Supervision And Inspection Station for Drug And Instrument,Nanjing 210002,Jiangsu,China)

机构地区：[1]东部战区总医院(原南京军区南京总医院)医疗保障中心药剂科,南京210002 [2]无锡联勤保障中心药品仪器监督检验站,南京210002

出　　处：《东南国防医药》2022年第5期500-503,共4页Military Medical Journal of Southeast China

摘　　要：目的通过对某院生殖科门诊超说明书用药进行合理性分析,为药师在审方过程中遇到类似问题提供参考。方法采用回顾性分析法,选取某院2021年1-12月生殖科门诊的所有医嘱,共58518条,结合循证证据判断用药医嘱是否超说明书,并对其合理性进行分析。结果某院生殖科门诊超说明书用药17968条,超说明书用药比例30.71%,主要类型包括超适应证用药(60.27%)、超剂量用药(26.79%)、超给药途径用药(10.43%)、超适应人群给药(1.53%)以及超禁忌证用药(0.98%),主要涉及药品包括地屈孕酮片(17.99%)、胰激肽原酶肠溶片(13.75%)、雌二醇/雌二醇地屈孕酮片(10.73%)等。经合理性分析后,其中合理医嘱17535条,占97.59%;不合理医嘱433条,占2.41%,涉及药品吲哚美辛栓、羟乙基淀粉注射剂、莫西沙星片、沙丁胺醇片和莉芙敏片。结论某院生殖科门诊超说明书用药较为普遍,根据循证医学证据以及相关指南、专家共识分析基本合理,但也存在一定的用药风险,建议通过一定的管理手段促进临床用药更为安全、合理。Objective To provide a reference for pharmacists to meet the similar problems during review of prescriptions by analyzing the rationality of off-label medicines in a Reproductive Department of a hospital.Methods A retrospective analysis method was used to select all prescriptions in a Reproductive Outpatient Clinic in a hospital from January to December 2021.A total of 58518 prescriptions combined with evidence-based evidences were analyzed to determine whether the prescriptions exceeded the instructions and analysis its rationality.Results There were 17968(30.71%)off-label medicines in the Reproductive Department of a hospital.The main types include over-indication medication(60.27%),over-dose medication(26.79%),over-administration route(10.43%),over-adapted population administration(1.53%),and over-contraindication medication(0.98%).The drugs included dydrogesterone tablets(17.99%),pancreatic kininogenase enteric-coated tablets(13.75%),estradiol/estradiol dydrogesterone tablets(10.73%)and so on.After a reasonableness analysis,17535 prescriptions(97.59%)were reasonable prescriptions,while 433 prescriptions(2.41%)were unreasonable prescriptions.Irrational medication involved drugs such as indomethacin suppositories,hydroxyethyl starch injections,moxifloxacin tablets,salbutamol tablets and Livmin tablets.Conclusion The off-label medicines in the Reproductive Department of a hospital are relatively common.The analysis based on evidence-based medicine evidence,relevant guidelines,and expert consensus is basically reasonable,however,there is still a certain medication risk.It is recommended to strictly manage off-label medications through certain management methods.

关 键 词：生殖科 超说明书用药 审方药师 合理用药 

分 类 号：R95[医药卫生—药学]