中国全科医学
中國全科醫學
중국전과의학
Chinese General Practice
2015年
35期
4358-4361
,共4页
抗肿瘤药%处方不当%药物评价%PDCA管理循环
抗腫瘤藥%處方不噹%藥物評價%PDCA管理循環
항종류약%처방불당%약물평개%PDCA관리순배
Antineoplastic agents%Inappropriate prescribing%Drug evaluation%PDCA cycle
目的：评价抗肿瘤药物是否合理应用，以提高抗肿瘤药物临床使用的有效性和安全性。方法以随机数字表法抽取泸州医学院附属医院2014年抗肿瘤药物医嘱，每月40份，应用临床药师设计的抗肿瘤药物不合理医嘱点评表进行调查。参照《抗肿瘤药物处方点评指南》《抗肿瘤药物临床应用指导原则（征求意见稿）》等相关诊治指南，制订合理性评价标准。评价内容包括：适应证、药物选择、给药途径、用法、用量、溶媒、联合用药、用药顺序、配伍禁忌或相互作用、重复用药、化疗方案选择、医师权限及其他不合理情况。在项目周期内以4次PDCA循环进行用药干预，每个循环实施1个季度。结果共发现抗肿瘤药物不合理医嘱59例，占总抽取医嘱的12.3％（59/480）。各季度不合理医嘱率比较，差异有统计学意义（χ2＝16.600，P﹤0.001），其中第3、4季度不合理医嘱率低于第1季度，第4季度不合理医嘱率低于第2季度（P﹤0.05）。不合理医嘱类型有不良相互作用及化疗方案、用量、药物选择、用法、溶媒和用药顺序不合理。结论不合理医嘱类型主要有不良相互作用及化疗方案、用量、药物选择不合理等，采用PDCA循环干预后，各季度不合理医嘱率逐渐降低。
目的：評價抗腫瘤藥物是否閤理應用，以提高抗腫瘤藥物臨床使用的有效性和安全性。方法以隨機數字錶法抽取瀘州醫學院附屬醫院2014年抗腫瘤藥物醫囑，每月40份，應用臨床藥師設計的抗腫瘤藥物不閤理醫囑點評錶進行調查。參照《抗腫瘤藥物處方點評指南》《抗腫瘤藥物臨床應用指導原則（徵求意見稿）》等相關診治指南，製訂閤理性評價標準。評價內容包括：適應證、藥物選擇、給藥途徑、用法、用量、溶媒、聯閤用藥、用藥順序、配伍禁忌或相互作用、重複用藥、化療方案選擇、醫師權限及其他不閤理情況。在項目週期內以4次PDCA循環進行用藥榦預，每箇循環實施1箇季度。結果共髮現抗腫瘤藥物不閤理醫囑59例，佔總抽取醫囑的12.3％（59/480）。各季度不閤理醫囑率比較，差異有統計學意義（χ2＝16.600，P﹤0.001），其中第3、4季度不閤理醫囑率低于第1季度，第4季度不閤理醫囑率低于第2季度（P﹤0.05）。不閤理醫囑類型有不良相互作用及化療方案、用量、藥物選擇、用法、溶媒和用藥順序不閤理。結論不閤理醫囑類型主要有不良相互作用及化療方案、用量、藥物選擇不閤理等，採用PDCA循環榦預後，各季度不閤理醫囑率逐漸降低。
목적：평개항종류약물시부합리응용，이제고항종류약물림상사용적유효성화안전성。방법이수궤수자표법추취로주의학원부속의원2014년항종류약물의촉，매월40빈，응용림상약사설계적항종류약물불합리의촉점평표진행조사。삼조《항종류약물처방점평지남》《항종류약물림상응용지도원칙（정구의견고）》등상관진치지남，제정합이성평개표준。평개내용포괄：괄응증、약물선택、급약도경、용법、용량、용매、연합용약、용약순서、배오금기혹상호작용、중복용약、화료방안선택、의사권한급기타불합리정황。재항목주기내이4차PDCA순배진행용약간예，매개순배실시1개계도。결과공발현항종류약물불합리의촉59례，점총추취의촉적12.3％（59/480）。각계도불합리의촉솔비교，차이유통계학의의（χ2＝16.600，P﹤0.001），기중제3、4계도불합리의촉솔저우제1계도，제4계도불합리의촉솔저우제2계도（P﹤0.05）。불합리의촉류형유불량상호작용급화료방안、용량、약물선택、용법、용매화용약순서불합리。결론불합리의촉류형주요유불량상호작용급화료방안、용량、약물선택불합리등，채용PDCA순배간예후，각계도불합리의촉솔축점강저。
Objective To evaluate whether antineoplastic drugs are rationally used, in order to improve the effectiveness and safety of the clinical use of antineoplastic drugs. Methods Using random number table method,we collected doctors'advice on antineoplastic drugs in 2014,with 40 in each month. Investigation was undertaken by applying an assessment table of doctors' irrational advice on antineoplastic drugs which was designed by clinical pharmacists. Standard of irrationality assessment was made based on relevant guidelines,such as " assessment guideline for antineoplastic drug prescription" and "guiding principles for the clinical application of antineoplastic drugs". The content of assessment included indications, drug choice,drug administration route,usage and dose,solvent,combined drug therapy,order of medication,incompatibility or interaction,repeated drug use,choice of chemotherapy regimens,doctors' rights and other irrationalities. Within the cycle of the program,PDCA was made for 4 times every quarter to conduct drug intervention. Results A total of 59 cases of irrationality in doctors' advice were found,accounting for 12. 3%(59/480)in all doctors' advice. The four quarters were significantly different in the ratio of doctors'irrational advice(χ2 =16. 600,P﹤0. 001),with the third quarter and the fourth quarter lower (P﹤0. 05)than the first quarter and the fourth quarter lower(P﹤0. 05)than the second quarter. Irrationality of doctors'advice was shown in the aspects of adverse interaction,chemotherapy regimens,dose,drug choice,usage,solvent and medication order. Conclusion Irrationality of doctors' advice is mainly shown in the aspects of adverse interaction, chemotherapy regimens,dose and drug choice. After the intervention of PDCA cycle,the ratio of doctors'irrational advice decreases.
