| 摘要: |
| 目的:探讨首都医科大学附属北京儿童医院心血管专业门急诊处方用药现状,为临床合理用药提供参考。 方法:采用回顾性研究方法,收集 2021 年我院心血管专业门急诊处方在每日经合理用药软件审核后的所有阳性不合理处方,再经药师、医师双方复审判定的真阳性不合理处方,采用 Excel 软件进行统计分析。 结果:2021 年我院心血管专业门急诊处方共 84 821 张,经合理用药软件点评得到不合理阳性处方 335 张,包含 360 条药品信息条目,其中适应证不适宜 169 条(46. 94%)、用法用量不适宜 134 条(37. 22%)、重复用药 24 条(6. 67%)、药品遴选不适宜 17 条(4. 72%)、药物相互作用 10 条(2. 78%)、给药途径不适宜6 条(1. 67%)。 经儿童心血管专科临床药师、医师联合复审前置审核系统筛出的阳性不合理处方后,判定真阳性不合理处方166 张,占抽查处方的 0. 20%,涉及不合理用药条目共 171 条,其中适应证不适宜 88 条( 51. 46%)、用法用量不适宜 63 条(36. 84%)、药品遴选不适宜 17 条(9. 94%)、重复用药 2 条(1. 17%)、给药途径不适宜 1 条(0. 59%)。 帕累托图分析显示,适应证不适宜和 2 种用药量不适宜为主要因素,药品遴选不适宜为次要因素,3 种用法用量不适宜、1 种用法用量不适宜、重复用药和给药途径不适宜为一般因素。 不合理处方涉及的 62 种药品中,心血管专业极少存在用药问题。 结论:儿童心血管专业门急诊处方用药不合理情况较少,目前存在的不合理用药情况主要表现为适应证不适宜和用法用量不适宜。 为进一步优化儿童心血管专业门急诊的合理用药,在实施前置处方审核的基础上,应不断完善超说明书用药规范化管理和精细化用法用量系统规则,并针对现存的主要用药问题进行重点药学干预以进行持续改进与优化。 |
| 关键词: 心血管专业 儿童 处方点评 合理用药 |
| DOI：10.13407/j.cnki.jpp.1672-108X.2023.08.006 |
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| 基金项目: |
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| Review and Analysis of Outpatient and Emergency Prescriptions of Children of Cardiovascular Specialty in a Hospital |
| Du Zhaoyang, Shi Qiang, Shao Wei, Zhang Lei, Yuan Yue, Wang Xiaoling |
| (Beijing Children’s Hospital, Capital MedicalUniversity, National Center for Children’s Health, Beijing 100045, China) |
| Abstract: |
| Objective: To probe into the current status of drug use in outpatient and emergency prescriptions of children of cardiovascular specialty in Beijing Children’s Hospital, Capital Medical University, so as to provide reference for clinical rational drug use. Methods: Retrospective analysis was used to collect the irrational positive outpatient and emergency prescriptions in cardiology department in 2021 after the daily review by the software of rational drug use. After the review by pharmacists and clinicians, the true positive irrational prescriptions were analyzed statistically by Excel software. Results: A total of 84,821 outpatient and emergency prescriptions in cardiology department of our hospital in 2021 were collected, and 335 irrational positive prescriptions were reviewed by software of rational drug use, including 360 drug information entries, of which 169 ( 46. 94%) were inappropriate indications, 134 (37. 22%) were improper usage and dosage, 24 (6. 67%) were inappropriate repeated drug use, 17 (4. 72%) were irrational drug selection, 10 (2. 78%) were improper drug interactions, and 6 (1. 67%) were inappropriate route of administration. After the positive irrational prescriptions screened by the joint clinical pharmacist/ clinician pre-review system for pediatric cardiovascular specialty, 166 true positive irrational prescriptions were determined, accounting for 0. 20% of the sampled prescriptions, involving a total of 171 irrational medication entries, including 88 ( 51. 46%) inappropriate indications, 63 ( 36. 84%) improper usage and dosage, 17 (9. 94%) improper drug selection, 2 (1. 17%) repeat drug use, and 1 (0. 59%) inappropriate route of administration. According to Pareto chart analysis, inappropriate indications and 2 kinds of improper usage and dosage were the main factors, improper drug selection was the secondary factor, 3 kinds of improper usage and dosage, 1 kind of improper usage and dosage, repeated drug use and inappropriate route of administration were the general factors. Among the 62 drugs involved in irrational prescription, there were few problems in professional cardiovascular medicine. Conclusion: There are few cases of irrational drug use in outpatient and emergency department of children of cardiovascular specialty, and the existing irrational drug use situation mainly manifest as inappropriate indications and improper usage and dosage. In order to further optimize rational drug use in outpatient and emergency departments of children of cardiovascular specialty, on the basis of real-time prescription pre-review, the standardized management of off-label drug use and refined system rules of usage and dosage are constantly improved, and key pharmaceutical intervention is conducted for the existing main drug use problems so as to make continuous improvement and optimization. |
| Key words: cardiology specialty children prescription review rational drug use |
