前置审核系统对肾功能不全患者医嘱中禁用药物的预警情况分析  

Analysis on the pre‑warnings of contraindicated drugs in medical advices in patients with renal insufficiency by the pre‑audit system

作　　者：周佳[1] 金磊 卜书红[1] 袁茜悦 Zhou Jia;Jin Lei;Bu Shuhong;Yuan Xiyue(Department of Clinical Pharmacy,Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,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》2024年第5期268-274,共7页Adverse Drug Reactions Journal

基　　金：上海申康医院发展中心市级医院诊疗技术推广及优化管理项目(SHDC12023610)。

摘　　要：目的了解前置审核系统对慢性肾脏病(CKD)肾功能不全患者医嘱中禁用药物的预警情况。方法收集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前置审核系统肾功能不全患者禁用药物预警信息。对预警药物进行分析,确定正确预警和需要调整审核规则的药物。对正确预警中涉及的药物及临床医师对预警的接受程度进行分析;对有证据可以超说明书使用的药物根据循证证据进行备案并提出审核规则修改的建议。结果共259条肾功能不全患者禁用药物相关预警的医嘱纳入分析,涉及47种药物。169条预警为正确预警,预警的正确率达65.25%,其中107条(63.31%)被临床医师接受。外科医师对预警的接受率高于内科医师,差异有统计学意义[76.39%(55/72)比53.61%(52/97),P<0.01]。90条预警涉及的12种药物需要修改审核规则。其中1种药物(达格列净片)说明书已更新,可直接按说明书调整审核规则;11种药物根据循证证据经超说明书用药备案,6种药物调整预警级别,5种药物调整审核规则。结论利用审方系统可有效地对CKD患者禁用药物处方实施预警,预警的正确率和临床医师接受率均在60%以上。部分预警的审核规则需要随着说明书的修订或循证证据的增加经超说明书备案后进行调整。Objective advices in patients with renal insufficiency by the pre‑audit system To understand the pre‑warnings of contraindicated drugs in medical.Methods traindicated drugs in medical advices in patients with renal insufficiency by the pre The pre‑warnings of con‑Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January-audit system in Xinhua 1,2021 to December 31,2021 were collected.The drugs involved were analyzed and determined as drugs in the correct pre warnings and drugs in the audit rules that needed to be corrected.The drugs involved in the correct‑pre‑warnings and the acceptance of pre‑warnings by clinicians were analyzed;drugs that can be used off‑label ac‑cording to the evidence‑based information were recorded and the proposed suggestions on the revision of the audit rules were provided.Results A total of 259 medical advices about pre‑warnings related to con‑traindicated drugs in patients with renal insufficiency were included in the analysis,involving 47 drugs.Among the 259 pre‑warnings,169 were correct,with the correct rate of 65.25%,and 107(63.31%)of them were accepted by clinicians.The rate of acceptance by surgeons was higher than that by physicians,and the difference was statistically significant[76.39%(55/72)vs.53.61%(52/97),P<0.01].The audit rules in the 90 pre‑warnings that needed to be modified involved 12 drugs.Of them,one drug(dapagliflozin tablets)had updated instruction,thus the rules can be modified directly according to it.The other 11 drugs were recorded for off‑label drug use in the system based on evidence‑based information,and of them,pre‑warning levels were adjusted for 6 drugs,and audit rules were adjusted for 5.Conclusions The pre‑auditsystem can effectively pre‑warning the contraindicated drug prescriptions of CKD patients,and the correct rate of pre‑warning and clinician acceptance rate are more than 60%.The audit rules of some pre‑warnings need to be adjusted label drug use after with the update of the instru

关 键 词：肾功能不全 禁忌 用药错误 前置审核系统 预警 

分 类 号：R969[医药卫生—药理学]