研究HIMSS EMRAM 7级评审在住院药房中的应用

目的探讨美国医疗信息与管理系统学会电子病历应用模型(Healthcare Information and Management Systems Society Electronic Medical Record Adoption Model,HIMSS EMRAM)7级评审在住院药房工作中的应用价值。方法回顾性统计厦门大学附属第一医院住院药房2016年10月1日—2017年7月31日HIMSS EMRAM 7级评审前每条医嘱(非包药机摆药医嘱,以下简称医嘱)平均调剂时间、人力成本、医嘱调配差错率、耗材使用量等指标,与2017年9月1日—2018年6月30日HIMSS EMRAM 7级评审后的相应指标进行比较分析。结果 (1)评审后每条医嘱平均调剂时间为(19.24±0.31)s,低于评审前的(29.73±0.56)s(t=244.73,P <0.01)。(2)同样调剂1 642 867条医嘱,评审后比评审前节省人员2.75人,节省人力成本137 500元。(3)评审后的医嘱调配差错率为1.35‰(2 219/1 642 867),低于评审前的2.13‰(3 455/1 625 694)(χ2=282.89,P <0.01)。(4)评审后打印纸消耗、打印机维保及打印机损耗等耗材使用量仅为评审前的5.14%,可节约43 597.67元。结论 HIMSS EMRAM 7级评审过程,通过对住院药房进行信息化管理,缩短了医嘱平均调剂时间、减少了医嘱调配差错率、节约人力成本、减少耗材消耗,是实现药品安全质量管理目标的有效措施

Analysis of recombinant human endostatin injection off label use in 120 inpatients in our hospital

目的:分析某院住院患者恩度用药医嘱的合理性,促进临床合理用药。方法:收集2016年1月-2016年12月期间出院的住院患者的恩度用药医嘱,将患者诊断、用法用量与恩度药品说明书进行对比分析,统计超药品说明书情况。结果:120例使用恩度的患者中,男性多于女性,超说明书适应证医嘱24条,占20.00%,超说明书用法用量医嘱117条,占97.50%;有1例发生不良反应,表现为发热。结论:恩度超药品说明书较为普遍,需要设计合理、大样本的随机对照双盲研究提供依据支持

临床药师干预肿瘤患者药物治疗的效果分析

目的探讨临床药师参与药物治疗的有效方法。方法对2012年解放军第175医院临床药师干预肿瘤患者用药医嘱的192条内容及效果进行分析。结果低学历、低年资医师对用药建议的采纳率最高,证据充分的用药建议和医嘱问题明显的用药干预易被采纳,非专科用药的干预也较易成功。结论临床药师可通过关注低年资、低学历医师的用药医嘱,重点干预问题明显的医嘱和非专科用药医嘱,并以此形成临床药师的工作模式

我院PIVAS对于细胞毒药物的合理使用

目的静脉配置中心对细胞毒药物的配置过程进行质量控制,保证药物的合理使用。方法通过查阅药品说明书以及相关的参考文献,对细胞毒药物医嘱的合理性进行分析,对其中不合理医嘱进行归类,汇总和分析。结果提高调配医嘱的准确性,减少不合理医嘱,保证细胞毒药物的合理安全使用。结论为确保细胞毒药物的用药安全合理有效,药师必须对药品有深入的了解,加强医嘱的审核,建立合理的用药规范,与临床的医生,护士共同讨论用药方案,保证药品的质量,提高合理用药水平

我院2016年度静配中心不合理医嘱分析

目的对我院静配中心不合理医嘱进行统计和分析,促进临床合理用药。方法收集我院不合理输液医嘱,采用回顾性分析,运用Excel电子表格对14471份不合理医嘱进行分类统计。结果不合理医嘱所占比例1.0%,药物相互作用与配伍禁忌(3328例,占22.9%),用药剂量不合理(2647例,占18.2%),儿童用药不合理(858例,占5.9%),重复用药(607例,占4.2%),给药途径不适宜(409例,占2.8%)。主要集中科室儿科、心血管内科、保健病房、肿瘤内科、呼吸内科,主要涉及药物去乙酰毛花苷、地塞米松、胺碘酮、氨茶碱、地西泮注射液。结论对不合理的医嘱单及时采取措施进行干预,有效降低临床上不合理医嘱率,及时纠正,减少差错的发生,提高全院合理用药水平

我院抗肿瘤药物和全静脉营养液不合理医嘱原因分析

收集我院静脉用药调配中心2013年1月至2014年3月间药师审核的抗肿瘤药物和全静脉营养液的医嘱,对其中不合理用药问题进行整理、归纳和总结,并提出合理化建议。审核的17683组医嘱中,存在不合理用药的医嘱有163组,占0.922%。不合理用药主要表现为:不合理的溶媒使用量、不合理的药物剂量、医生疏忽导致的用药错误、不合理的用药持续时间、不合理的给药途径、不合理的用药配伍和选择、肠外营养液组方中能量配比不合理

Necessity of treating subclinical hypothyroidism in early pregnant women

目的评估早孕妇女亚临床甲状腺功能减退症(subclinical hypothyroidism,SCH)对妊娠结局的影响及药物治疗的必要性。方法收集18 243例在厦门大学附属第一医院产前检查直至分娩的病例,诊断标准为妊娠10~12周产前检查时TT4与FT4正常而TSH≥2.5 m IU/L为SCH,甲状腺过氧化物酶抗体(thyroid peroxidase antibody,TPOAb)≥34 U/L为阳性。根据TSH的升高程度不同、TPOAb情况、能否遵医嘱按时按量服用L-T4使TSH控制在正常范围内进行分组:2.5 m IU/L≤TSH≤5.0 m IU/L且TPOAb阳性且能遵医嘱者为A组,不能遵医嘱者为B组;TSH>5 m IU/L且TPOAb阳性且能遵医嘱者为C组,不能遵医嘱者为D组;2.5 m IU/L≤TSH≤5.0 m IU/L且TPOAb阴性且能遵医嘱者为F组,不能遵医嘱者为G组;TSH>5 m IU/L且TPOAb阴性且能遵医嘱者为H组,不能遵医嘱者为K组。并随机抽取200例同期甲状腺功能正常的病例作为对照组(E组),回顾分析早孕妇女甲状腺功能异常的发生率、SCH对妊娠结局的影响、早孕妇女SCH行左旋甲状腺素片(L-T4)替代治疗的剂量及影响因素。结果早孕妇女SCH检出率为5.20%,甲状腺功能正常率为79.00%。A组早产3.31%(8/242)、妊娠期高血压7.02%(17/242)、胎儿生长受限7.02%(17/242)、出生低体质量儿6.61%(16/242)的发生率均低于B组的8.79%(8/91)、14.29%(13/91)、15.38(14/91)、14.29(13/91)(P均 5 m IU / L,TPOAb was positive and had good compliance; Group D: TSH and TPOAb as Group C but not have good compliance; Group F: 2. 5 m IU / L≤TSH≤5. 0 m IU / L,TPOAb was negative and had good compliance; Group G: as Group F,but not have good compliance; Group H: TSH > 5 m IU / L,TPOAb was negative and had good compliance; Group K: as Group H,but not have good compliance. Randomly selected 200 cases with normal thyroid function at the same period as the control group( Group E). Retrospective analysis the occurrence rate of thyroid gland dysfunction,the influence of SCH to pregnancy outcome,the doses and influencing factors of replacement therapy by L-T4 to SCH of early pregnant women. Results Relevance ratio of SCH in early pregnant women was5. 20%,the ratio of normal thyroid function was 79. 00%. In group A,premature birth 3. 31%( 8 /242),gestational hypertension 7. 02%( 17 /242),fetal growth restriction 7. 02%( 17 /242),low birth weight infant 6. 61%( 16 /242),were lower than that in group B 8. 79%( 8 /91),14. 29%( 13 /91),15. 38( 14 /91),14. 29( 13 /91) respectively( P < 0. 05). In group C,spontaneous abortion 3. 31%( 6 /181),premature birth 3. 89%( 7 /181),gestational hypertension 8. 29%( 15 /181),gestational diabetes mellitus 3. 89%( 7 /181),fetal growth restriction 7. 73%( 14 /181),low birth weight infant 6. 63%( 12 /181),were lower than that in group D 11. 54%( 6 /52),11. 54%( 6 /52),19. 23%( 10 /52),11. 54%( 6 /52),17. 31( 9 /52),15. 38( 8 /52)( P < 0. 05). No significant statistical difference were found in multiple comparison of the above six indexes of group A,B,C. And just the same as the multiple comparison of group F,G,H,K,E. When TSH reach the standard,the dosage of L-T4 in group A and C had significant difference [( 0. 757 ± 0. 378 vs. 1. 106 ± 0. 454) μg / kg,t = 8. 39,P < 0. 001]. There were also significant differences of group F compared with group H[( 0. 443 ± 0. 198 vs. 0. 813 ± 0. 378) μg/kg,t = 8. 22,P < 0. 001],group( A + F) compared with group( C + H) [( 0. 634 ± 0. 358 and 1. 017 ±0. 427) μg / kg,t = 11. 77,P < 0. 001],group A compared with group F [( 0. 757 ± 0. 378 vs. 0. 443 ± 0. 198) μg / kg,t = 9. 85,P < 0. 001 ],group C compared with group H [( 1. 106 ± 0. 45 vs. 0. 813 ± 0. 378) μg / kg,t = 5. 59,P < 0. 001],group( A + C) compared with group( F + H) [( 0. 932 ±0. 463 vs. 0. 693 ± 0. 388) μg / kg,t = 6. 53,P < 0. 001]. Conclusion The early pregnant women with SCH and TPOAb positive could increase the occurrence rate of spontaneous abortion,premature birth,gestational hypertension,gestational diabetes mellitus,fetal growth restriction and low birth weight infant. The early intervening treatment of L-T4 could efficiently decrease the adverse event occurrence ratio of pregnant woman with SCH and positive TPOAb,but no effect for that with SCH and TPOAb negative. The TSH level and condition of TPOAb could affect the replacement therapy dosage of early pregnancy with SCH

Analysis and Improvement Measures of Key Factors in the Speed Limit of Drug Distrbution in Pharmacy Intravenous Admixture Service

目的缩短我院静脉药物配置中心首批临床输液送达科室时间。方法通过我院计算机中心收集并整理分析我院自2015年8月首批临床输液到达科室的时间,通过临床输液配置流程改进、临床输液医嘱批次管理、静配中心员工绩效考核、临床输液配送管理等措施,优化临床输液送达时间。结果临床输液配置流程改进后平均时间缩短（30.0±5.5）min,临床输液医嘱批次管理后平均时间缩短（8.0±4.2）min,静配中心员工绩效考核优化后平均时间缩短（14.0±3.5）min,临床输液配送管理后平均时间缩短（7.0±2.1）min,我院首批临床输液平均送达科室时间缩短（50.0±2.0）min。结论通过对我院静脉药物配置中心的有效管理,确保临床及时有效的合理用药。Objective To shorten the delivery time of the first infusion clinic in the intravenous drug allocation center of our hospital. Methods Through the hospital computer center to collect and organize the data of the first batch of clinical infusion to reach the clinical department time of our hospital from August 2015, through the clinical infusion configuration process improvement, clinical infusion doctor batch management, static center staff performance appraisal, clinical infusion delivery management and other measures to optimize the delivery time of clinical infusion. Results The average time was shortened（30.0 ± 5.5） min after improvement of clinical infusion configuration, the average time was shortened（8.0 ± 4.2） min after improvement of clinical infusion by doctoral management, and the average time was shortened（14.0 ± 3.5） min after improvement ofstatic center staff performance appraisal, the average time was shortened（7.0 ± 2.1） min after improvement of clinical infusion delivery, and the average time of delivery of the first batch of clinical infusion was shortened（50.0 ± 2.0） min. Conclusion Through the effective management of the PIVAS in our hospital, it is necessary to ensure the timely and effective use of medicine

运用品管圈改进医疗服务计费工作质量

Objective: To investigate the application of QCC management tools in improving the work quality of medical service pricing. Methods： To retrospectively analyze the effect of quality control circle on the work quality of medical service pricing. Results: Using the QCC circle management tool, can charge and accurately to guide clinical price project link, reduce the error rate, guarantee both doctors and win-win. Conclusions: QCC management tool, can improve the accuracy of the medical fees prices, transparency, is advantageous to the hospital economic operations and the interest of the patient, is today's medical institutions to adapt to the market economy and an effective regulatory tool.目的 探讨运用品管圈管理工具，改进医疗服务计费工作质量的方法。方法 回顾分析我院运用品管圈改进医疗服务计费工作质量的方法和效果。结果 运用品管圈管理工具，能够规范、准确地指导临床物价项目收费环节，降低差错率，保障医患双方共赢。结论 品管圈管理工具，能够改进医疗物价收费项目的准确性、透明性，有利于医院经济运营和维护患者利益，是当今医疗机构适应市场经济的又一有效监管工具