我院静脉用药不合理医嘱监测、调查与探析.docVIP

我院静脉用药不合理医嘱的监测、调查与分析 　　摘 要 目的：提高我院静脉用药的合理性和安全性。方法：对我院静脉药物配置中心（PIVAS）2014年1月―2014年12月的用药医嘱进行逐一审核，收集药师审核并建议修改的不合理医嘱进行分类并统计，分析不合理用药原因，并就干预、改善不合理用药的对策进行总结。结果：发现不合理医嘱1 502组，占全部医嘱的0.12 %，包括载体种类不合理、载体量不合理、配伍禁忌、给药剂量不合理、给药时间不合理、给药途径不合理、给药顺序不合理、重复给药这8类。结论：PIVAS药师的医嘱审核促进了静脉输液的合理使用，目前我院PIVAS不合理医嘱比例较低 关键词 静脉药物配置中心 不合理医嘱 医嘱审核 中图分类号：R969.3 文献标识码：C 文章编号：1006-1533（2016）21-0057-06 Monitoring of irrational doctors advice on intravenous medication at PIVAS XIAO Lina， ZHANG Jianzhong， WANG Chunhui（Department of Pharmacy， Zhongshan Hospital affiliated to Fudan University， Shanghai 200032， China） ABSTRACT Objective： To improve the rationality and safety of intravenous medication at Pharmacy Intravenous Admixture Services （PIVAS） in our hospital. Methods： The doctors advices on intravenous medication in 2014 were reviewed one by one and the irrational doctor’s advices needed to be revived based on pharmacists’ suggestion were collected and statistically classified and the reasons of irrational medication were analyzed， and meanwhile the countermeasures to intervene and improve the irrational medication were summarized. Results： Fifteen hundreds and two pieces of irrational medication orders were found， accounting for 0.12% of the total， which could be divided into 8 categories including improper type and volume of solvents， incompatibility， improper dosage， improper time of delivery， improper route and order of administration， and repeated dosing. Conclusion： The review of medication orders by pharmacists at PIVAS can promote the rational use of intravenous infusion and our PIVAS has a relatively lower ratio of irrational medication orders at present. KEY WORDS PIVAS； irrational medication orders； review of doctors advice 静脉给药是重要的药物治疗途径，但调配不当可能引起药品理化性质变化，如沉淀、浑浊、变色、pH改变、不溶微粒增加、热原超标等，导致过敏、恶心、呕吐、胸闷、头晕、心悸、寒战、发热等不良反应，严重影响治疗效果，甚至可能危及患者生命。2014年我国药品不良反应/事件报告中静脉注射给药占57.8 %，占比较2013年升高2.1 %[1]。静脉药物配置中心（pharmacy intravenous admixture service，PIVAS）对于审核临床不合理用药医嘱、保障药品调配质量、提高静脉用药安全性具有