临床药师基于FOCUS-PDCA模式管理PIVAS抗肿瘤药物医嘱审核实践  

Practice of clinical pharmacists'management of PIVAS anti-tumor drug order review based on the FOCUS-PDCA mode

作　　者：代雪飞 邱昌露 余越 毕红朋 Dai Xuefei;Qiu Changlu;Yu Yue;Bi Hongpeng(Department of Pharmacy,the First Affiliated Hospital of Anhui Medical University,Hefei 230032,China;Department of Pharmacy,Anhui Public Health Clinical Center,Hefei 230032,China)

机构地区：[1]安徽医科大学第一附属医院药学部,安徽合肥230032 [2]安徽省公共卫生临床中心药学部,安徽合肥230032

出　　处：《实用药物与临床》2024年第12期923-929,共7页Practical Pharmacy and Clinical Remedies

基　　金：安徽省高校科研编制计划重点项目(2022AH050641);安徽医科大学校科研基金项目(2023xkj303)。

摘　　要：目的通过FOCUS-PDCA管理提高医疗机构静脉药物配置中心(Pharmacy intravenous admixture services,PIVAS)审方药师抗肿瘤药物医嘱审核能力,降低抗肿瘤药物医嘱不合理率,促进抗肿瘤药物合理应用。方法对安徽医科大学第一附属医院PIVAS 2023年4-6月共4973条抗肿瘤药物医嘱进行合理性点评,运用FOCUS-PDCA分析未及时拦截的不合理医嘱的原因并进行改善管理,通过临床药师参与审方、带动PIVAS审方药师采用“九步法”审核抗肿瘤药物医嘱、加强对临床抗肿瘤药物合理使用专项培训等措施,对管理后2023年7-9月共5302条抗肿瘤医嘱进行点评,对比管理前后合理性差异。结果通过FOCUS-PDCA管理,全院PIVAS抗肿瘤药医嘱不合理率由10.07%降至3.75%,差异有统计学意义(P<0.01);除血液科外,其他开具抗肿瘤药物医嘱科室不合理率均下降,其中肿瘤科、胸外科、普外科管理前后差异有统计学意义(P<0.01);不合理类型主要有功能状态(PS)评分不适合当前方案、诊断/分期不明确、无基因检测结果用药、禁忌证用药、非指南推荐标准方案、超说明书用药,给药方法、预处理、药物相互作用不适宜等,管理后所有不合理类型医嘱占比均下降,且超说明书用药、给药方法、预处理、药物相互作用不适宜方面比较,差异有统计学意义(P<0.01)。结论临床药师基于FOCUSPDCA模式管理PIVAS抗肿瘤药物医嘱,可提高药师医嘱审核能力,保障抗肿瘤药物合理使用。Objective To improve the ability of pharmacists in Pharmacy intravenous admixture services(PIVAS)to review anti-tumor drug orders through FOCUS-PDCA management,so as to reduce the unreasonable rate of anti-tumor drug orders and promote the rational use of anti-tumor drugs.Methods A total of 4973 orders for antitumor drugs in PIVAS of the First Affiliated Hospital of Anhui Medical University from April to June 2023 were evaluated for rationality.FOCUS-PDCA was used to analyze the reasons for untimely interception of unreasonable medical orders and to improve management.By participating in the review,clinical pharmacists drove PIVAS reviewing pharmacists to use the"nine-step method"to review anti-tumor drug orders,and special training on the rational use of clinical anti-tumor drugs was strengthened.A total of 5302 orders for anti-tumor drugs after management from July to September 2023 were evaluated,and the differences in rationality before and after management were compared.Results Through FOCUS-PDCA management,the rate of unreasonable PIVAS anti-tumor drug orders in the entire hospital decreased from 10.07%to 3.75%,with a statistically significant difference(P<0.01).Except for the Hematology Department,the rate of unreasonably prescribing anti-tumor drugs in other departments decreased.Among them,there was a statistically significant difference before and after the management in the departments of oncology,general thoracic surgery,and general surgery(P<0.01).Unreasonable types mainly included:PS scores not suitable for the current protocol,unclear diagnosis/staging,medication without genetic testing results,medications of contraindications,nonguideline recommended standard protocols,off-label medication,and inappropriate administration methods,pretreatment and drug interactions.After management,the proportion of all unreasonable types of medical orders decreased,and there were statistically significant differences in off-label medication and inappropriate administration methods,pre-treatment and drug interactio

关 键 词：临床药师 FOCUS-PDCA模式 抗肿瘤药物 医嘱审核 

分 类 号：R95[医药卫生—药学]