审方系统对住院老年肾功能不全患者医嘱中药物剂量错误的预警情况分析  

Analysis on the pre‑warnings of drug dosage errors in medical advices in elderly inpatients with renal insufficiency by the prescription review system

作　　者：袁茜悦 陈霁晖[1] 周佳[1] Yuan Xiyue;Chen Jihui;Zhou Jia(Department of Clinical Pharmacy,Xinhua Hospital Affiliated to School of Medicine,Shanghai Jiao Tong University,Shanghai 200092,China)

机构地区：[1]上海交通大学医学院附属新华医院临床药学部,上海200092

出　　处：《药物不良反应杂志》2022年第10期528-533,共6页Adverse Drug Reactions Journal

摘　　要：目的了解审方系统对住院老年肾功能不全患者医嘱中药物剂量错误的预警情况。方法回顾2021年1月1日至2021年12月31日上海交通大学医学院附属新华医院审方软件对≥65岁老年慢性肾功能不全住院患者医嘱中药物剂量错误预警情况,分析错误预警的原因,评价正确预警中肾脏相关药物剂量错误所涉及的药物和错误类型,了解错误发生相关科室分布及医师对预警的接受程度。结果共511条≥65岁老年肾功能不全患者药物剂量有关预警的医嘱纳入分析。评价为预警错误的医嘱183条(35.8%),预警正确的328条(64.2%)。预警正确的医嘱共涉及25种药物,其中主要为抗菌药物[57.62%(189/328)];其次为心血管系统药物[24.70%(81/328)],其中最常见的是曲美他嗪片。正确预警中剂量过大315条(96.04%),剂量不足13条(3.96%);剂量过大最常见的错误内容为“单次剂量过大,日剂量过大”(53.33%,168/315),其次为“频次过多,日剂量过大”(41.59%,131/315);而剂量不足最常见的错误为“频次过少,日剂量不足”(9/13)。医师接受预警并修改的医嘱186条(56.7%),医师未接受预警的医嘱142条(43.3%)。外科医师对错误医嘱预警的接受率高于内科医师,差异有统计学意义[73.3%(96/131)比45.7%(90/197),P<0.001]。结论审方软件对肾脏相关药物剂量错误的预警作用明确。应进一步改善审方软件对肾脏相关药物剂量错误预警的准确性,提高临床医师的接受度,保障患者用药安全。Objective To understand the pre⁃warnings of drug dosage errors in medical advices in elderly inpatients with renal insufficiency by the prescription review system.Methods The pre⁃warn⁃ings of drug dosage errors in medical advices in≥65 years old inpatients with renal insufficiency by the prescription review system in Xinhua Hospital Affiliated to Shanghai Jiao Tong University Medical College from January 1,2021 to December 31,2021 were reviewed,and the reasons for the wrong pre⁃warnings were analyzed.In the correct pre⁃warnings,the drugs involved in dosage errors related to kidney and the types of errors were evaluated,and the departments related to the occurrence of errors and the acceptance of physi⁃cians for pre⁃warnings were analyzed.Results A total of 511 medical advices on pre⁃warnings related to drug dose in≥65 years old patients with renal insufficiency were included in the analysis.One hundred and eighty⁃three medical advices(35.8%)were evaluated as wrong pre⁃warnings,and 328(64.2%)were correct pre⁃warnings.The medical advices with correct pre⁃warnings involved 25 kinds of drugs,of which the most involved drugs was antibacterial drugs[57.62%(189/328)];the second was cardiovascular system drugs[24.70%(81/328)],among which trimetazidine tablets was the most common.Among the correct pre⁃warnings,315(96.04%)were excessive dose,and 13(3.96%)were insufficient dose.The most common error content of excessive dose was"excessive single dose and excessive daily dose"(53.33%,168/315),followed by"high frequency,excessive daily dose"(41.59%,131/315);the most common errors of insufficient dose was"low frequency,insufficient daily dose"(9/13).A total of 186(56.7%)medical advices were corrected by physicians after accepting the pre-warnings,and 142(43.3%)were not.The acceptance rate of surgeons for pre⁃warning of wrong orders was higher than that of physicians,with a statistically significant difference[73.3%(96/131)vs.45.7%(90/197),P<0.001].Conclusions The effect of pre⁃warnings from th

关 键 词：肾功能不全 处方药监测程序 用药错误 老年人 药学服务 

分 类 号：R969.3[医药卫生—药理学]