CAJ | 학술논문

目的：对静脉药物配置中心（Pharmacy Intravenous Admixture Services，PIVAS）的差错进行分析，并针对性制定有效的防控措施，以提高患者安全用药的水平。方法：调取差错记录本并分析2014年1月1日～6月30日我院静脉药物配置中心发生的差错，归纳统计分析产生差错的具体原因，结合科室的实际情况，制定防控措施。结果：558000袋（例）的总工作量中检出88例差错。差错发生率为（0.015%）。其中审核差错2例（2.27%）、打印差错0例（0%）、排药差错17例（19.32%）、贴签差错27例（30.68%）、药品核对差错8例（9.09%）、配置差错29例（32.95%）、病区相关问题如停药问题5例（5.68%）、打包及药品装箱差错等12例（13.63%）。结论：静脉药物配置中心差错发生的原因是多方面的，发生率最高的为排药差错；有针对性地采取措施，对提高安全用药具有重大意义。
목적：대정맥약물배치중심（Pharmacy Intravenous Admixture Services，PIVAS）적차착진행분석，병침대성제정유효적방공조시，이제고환자안전용약적수평。방법：조취차착기록본병분석2014년1월1일～6월30일아원정맥약물배치중심발생적차착，귀납통계분석산생차착적구체원인，결합과실적실제정황，제정방공조시。결과：558000대（례）적총공작량중검출88례차착。차착발생솔위（0.015%）。기중심핵차착2례（2.27%）、타인차착0례（0%）、배약차착17례（19.32%）、첩첨차착27례（30.68%）、약품핵대차착8례（9.09%）、배치차착29례（32.95%）、병구상관문제여정약문제5례（5.68%）、타포급약품장상차착등12례（13.63%）。결론：정맥약물배치중심차착발생적원인시다방면적，발생솔최고적위배약차착；유침대성지채취조시，대제고안전용약구유중대의의。
Objective:To summarize and analyse the error accidents in Pharmacyh Intravenous Admixture Services,meanwhile, to make effective prevention and control measures in order to improve the level of safety about drug administration in the hospital.Methods:The error log books were taken and error accidents were analysed from Jan.1 2012 to Apr.1 2012 in PIVAS center. Some preventional and control measures were made based on the results associated with the reality of department . Results:Total 88 error accidents were detected in 558000 fusion bags. The total incidence of error accidents was 0.015%.There are nine types of error accidents including prescription auditing、printing、medicine rowing、labelling、checking、infusing、withdrawal from PIVAS、packing and problems from the wards .The incidence of error accidents is(2.27%)、(0%)、(19.32%)、(30.68%)、(9.09%)、(32.95%)、(5.68%)、(13.63%) respectively. Conclusion:The causes of errors existed in many aspects,but the incidence of infusing is highest.It is important to improve drug administration by analysing the reasons of error accidents.