我院对外药房分区间小范围盘点的实施方案介绍

目的:加强药房管理,提高药房盘点效率,降低药品盘点误差。方法:依托"军卫一号"库存管理系统,从中提取数据并应用Excel表格加以调整,设计对外药房分区间(按药柜划分)小范围盘点表,采用定人定药使库存盘点表药品排序与药品摆放顺序相符的方式进行盘点。结果:新方案实施误差率较传统的每月式盘点降低了3个百分点。结论:该盘点方法不仅减少了人力物力,而且使得盘点更为灵活、方便、快捷,账物相符率也有了明显的提高。     

医院门诊药房药品盘点工作质量改进措施

目的提高药品管理质量,加强门诊药房规范化管理。方法选取医院门诊药房2012年7月至2013年6月的药品盘点数据,从药品盘点数量符合率等方面进行统计分析。结果针对盘点中账物不符的原因,通过实施完善药品管理制度、编排药品货位码、合理设计盘点表、实行双盲盘点制度、充分利用计算机网络系统等措施,药房盘点数量符合率由60．59％上升到92．88％。结论通过完善药品管理制度,合理安排盘点工作的各个环节,借助信息系统的支持,可显著提高门诊药房的盘点效率和药品的数量符合率。     

利用药品电子监管码减少医院门诊药房相似药品调剂差错并实现门诊药品的可溯源性

目的:减少我院门诊药房相似药品调剂差错,实现门诊药品溯源。方法:在对医院信息系统(HIS)药品字典后台数据库中加入药品电子监管码字段的基础上,改进我院门诊药房处方调剂流程,在二次审核发药操作前增加药品电子监管码扫码审核操作,并据此实现药品终端溯源。通过对比改进前、后12个月的调剂外差率、盘点中发现的与相似药品调剂差错有关的"特殊异常数据"占比、患者候药时间等指标,评价改进前后门诊药房处方调剂质量。结果:增加药品电子监管码审核操作后,相似药品引起的调剂外差由22例降低为1例(占总处方数比例分别为0.019 7‰、0.010 3‰),"特殊异常数据"数量由836条下降为436条(占总异常数据比例分别为31.5%、16.8%),患者平均候药时间未见明显延长(分别为10.85、10.88 min),并实现了大部分门诊药品从药房到患者之间的溯源查询。结论:利用药品电子监管码可减少门诊药房相似药品调剂外差,有利于药品溯源链的建立、提升药学服务质量。     

药品实库存管理模式在门诊药房中的应用效果分析

目的:分析药品实库存管理模式在门诊药房中的应用效果。方法:应用医院信息系统(HIS),通过实施药品实库存管理模式分析门诊药房实施前后平均盘点时间、平均药品周转时间和药品药品盘点误差率等指标的变化情况。结果:门诊药房药品实库存管理实施后在平均盘点时间、平均药品周转时间和药品盘点误差率等方面均明显优于实施前(P<0.05)。结论:科学规范的管理,使门诊药房的工作效率和质量大大提升。     

我院药品进销存系统的应用及相关药品管理措施改进探讨

目的:提高门诊药房药品账物相符率,促进药品管理水平的提高。方法:介绍我院的药品进销存系统,同时分析引起药品账物不符的原因,采取有效措施加强相关药品管理。通过统计我院门诊药房2011年4～10月的药品月盘点的进、销、存数据总结系统应用及措施改进后的效果。结果:采取了完善各项制度、账物同步、加强药品拆零管理、改进盘点方法等措施加强相关的药品管理;门诊药房2011年4月、10月药品帐物相符率分别为60.25%、65.53%,其中儿科和妇科药房的盘点准确率分别升高6.52%、5.51%。结论:通过药品进销存系统应用以及一系列药品账目优化管理措施的实施,提高了药品账物相符率及药品管理水平。     

4M1E精细化管理法在优化我院门诊药房工作中的应用及效果评价

目的:探索门诊药房精细化管理模式,提高门诊药房工作效率和服务质量。方法:从我院医院信息与大数据中心调取门诊患者取药相关数据,对传统管理模式下的门诊药房处方数据进行统计,通过鱼骨分析法发现可能影响患者候药时间和药房工作效率及质量的因素,采用质量管理工具4M1E法对相关问题进行改进并实施精细化管理。选择改进前、精细化管理第1阶段及第2阶段各10个工作日的处方数据,对改进前后的药师工作效率、患者平均候药时间、调配差错和盘点错误等进行对比分析,以评价精细化管理的实施效果。结果:通过鱼骨图分析发现,影响患者候药时间和我院门诊药房工作效率及质量的因素包括人员因素、机器因素、物料因素、方法因素、环境因素等,如人员上岗人数和时间分配不合理、机器老化等。实施精细化管理后,我院门诊药房采取了调整人员上岗时间并细化绩效奖励方案、维护自动发药机并更新处方扫描设备、设立临时药柜并优化货位号、加强药品管理和相关人员培训、开设特色单品种发药窗口等多种措施。统计结果表明,在实施精细化管理的第1阶段,我院门诊药房10个工作日的调剂处方数和处方条目数均有小幅上涨,门诊药房因上岗人数减少且开放窗口数量和时间有所变化,上岗人员累计工作时长由1680 h减少至1440 h;人均每小时调剂处方数和处方条目数分别由52.0张、58.7个增加至65.1张、69.6个(P<0.05);收集到的调配差错数量由30条减少为5条,患者候药时间和盘点错误数未见有明显变化。在第2阶段,在我院门诊药房调剂处方量相近的情况下,药师人均每小时调剂处方数和处方条目数分别由改进前的52.0张、58.7个增加至59.9张、67.3个(P<0.05),患者的平均候药时间由9.30 min缩短到7.32 min(P<0.05);经进一步细化差错数据收集方式和调整绩效激励方案后,门诊药房调配差错上报数增加至75条,盘点错误由5条降为0条。结论:我院门诊药房通过4M1E法进行精细化管理,实现了工作效率和质量的提升,缩短了患者的候药时间。     

门诊药房差额动态盘点体系的建立与评估

目的：通过对差额动态盘点方法完善与评估,拟对门诊药房实行动态盘点。方法：利用即时微机库存数量与实际数量的差额来确定药品准确数量,对盘点表进行对比分析和评估。结果：该方法有效克服了因药品销售而造成的影响,比较准确地反映帐物相符情况。结论：经过2年多的实践,该方法在不影响盘点准确率的情况下,能有效减少盘点用时,提高劳动效率,可在门诊药房推广应用。     

订单分析方法在自动化药房建设中的应用

目的:了解订单分析方法在医院药房处方分析中的作用,为改善药品管理和建设自动化药房提供理论依据。方法:利用EIQ(Entry,Item,Quantity)分析结合ABC分类分析、订单频次分析等对某"三甲"医院门诊药房的发药处方进行分析,获得医院药房日常发药量的大小及其一定周期内的波动规律等相关数据。结果:分析数据可知,该门诊药房应按发药处方顺序依次进行分拣;可将门诊药房盒装药品按单个品项发药量的大小分类,A类药品76种,B类药品184种,C类药品332种,并引入相应的自动化分拣设备;1天之内发药高峰时段在上午9:00-11:30和下午2:00-4:30,1周之内周二至周五发药数量较多。结论:订单分析方法适用于医院处方的分析,可为自动化药房的规划和建设提供有价值的参考数据。     

我院门诊中药房盘点模式探讨

目的为提升医院门诊中药房的管理水平提供参考。方法依托"军卫一号"医院信息管理系统,借助Excel软件,采用按类分时段盘点法进行药品盘点工作。结果与结论门诊中药房药品盘点实现了"每月帐物相符率在90%以上"的目标,并且提高了盘点的工作效率。     

门诊药房麻醉药品管理系统的研发与使用

目的:编制麻醉药品管理系统,管理门诊药房麻醉药品。方法:利用Visual Basic编程语言和Access数据库编制门诊药房麻醉药品管理系统,进行麻醉药品的处方登记以及患者资料、空安瓿回收和剩余药品回收等管理工作,通过查询导出Excel表,生成麻醉药品相关管理文件。结果:该系统完善了门诊药房麻醉药品管理的各个环节,简化了操作步骤,数据准确可靠,提高了管理质量和工作效率。结论:门诊药房麻醉药品管理系统是一个比较实用的麻醉药品管理工具。     

Drug compatibility with new polyolefin infusion solution containers.

PURPOSE: The compatibility of new polyolefin (VISIV) containers with seven drugs that have exhibited sorption to polyvinyl chloride (PVC) containers and sets and an additional four drugs that have exhibited leaching of plasticizer or other polymer matrix components from PVC containers and sets was studied. METHODS: For the sorption portion of the study, amiodarone hydrochloride, carmustine, regular human insulin, lorazepam, nitroglycerin, sufentanil citrate, and thiopental sodium and their respective reference standards were used. For the leaching portion of the study, docetaxel, paclitaxel, tacrolimus, teniposide, and diethylhexyl phthalate (DEHP) reference standard, were used. A 350-mL quantity of each test admixture was prepared, and 100-mL aliquots were transferred into three of the VISIV containers. The containers were stored at ambient temperature and exposed to fluorescent light. Samples for analysis were taken initially and after 24 hours for all drugs except carmustine, which was evaluated for only 6 hours because of its limited stability. High-performance liquid chromatography was used to evaluate each test solution. RESULTS: Of the seven drugs subject to sorption to PVC, only insulin showed a substantial loss in the VISIV containers. Carmustine exhibited a loss consistent with the drug's known chemical stability. None of the drugs that are known to leach plastic components, such as DEHP plasticizer, from PVC equipment exhibited any leached components in the VISIV containers. CONCLUSION: Of the drugs tested, only insulin exhibited sorption to the new VISIV polyolefin containers. No leaching of plastic components, such as plasticizer, from the containers was found with any of the surfactant-containing drugs.     

Quality and comprehensiveness of the National Drug Code Directory on magnetic tape

The quality and comprehensiveness of the FDA's National Drug Code Directory (NDCD) in magnetic tape form was evaluated. The internal quality of the tape was measured by performing cross-checks of the four record types found on the tape and by checking for the presence of "illegal" characters. The comprehensiveness of the tape was evaluated by determining the extent to which a sample of items from nine community and hospital pharmacies could be matched with code numbers on the NDCD tape. A second test of comprehensiveness measured the match rate between the shelf stock sample and National Drug Code (NDC) numbers in a magnetic tape supplied by a regional wholesaler. External quality was measured by comparing the NDC numbers on the containers of items from the shelf sample with the corresponding information in the NDCD tape. More than 300 discrepancies among the four types of records were discovered, and more than 100 "illegal" characters were present in each of the four record types. Matches on the NDCD tape could be found for 80% of the items in the shelf stock sample and 69.5% of the items in the tape supplied by the wholesaler. A total of 156 errors were discovered when the codes on containers in the shelf sample were matched with the NDCD tape information, yielding an error rate of 6.5%. Because of the 6.5% error rate, the usefulness of the NDCD tape is questionable. Since only 80% of an off-the-shelf sample of drugs had matches on the NDCD tape, about 20% of drug products would have to be matched with some other information source. How these figures for the NDCD tape compare with figures for proprietary tapes is not known.     

我院药品调配“条形码校验程序”介绍

目的:为减少药品调配差错,提高用药准确性提供参考。方法:概述国内、外药学领域条形码技术的应用情况,介绍我院开发的药品调配“条形码校验程序”的工作流程和主要功能。结果与结论:将“条形码校验程序”与医院信息系统连接并应用于药品调配过程,增加计算机判断步骤,有利于减少差错,提高药品调配质量。     

3种材质输液容器对药物的相容性及吸附性考察

目的:考察非聚氯乙烯(PVC)多层共挤复合膜输液袋、PVC输液袋和玻璃瓶与大输液的相容性及3种材质输液容器对6种药物的吸附性。方法:将5%葡萄糖注射液(5%GS)、0.9%氯化钠注射液(0.9%NaCl)分别置于3种材质输液容器中存放1y,观察、测定并比较5%GS、0.9%NaCl各质量控制指标及其变化;将一定量6种药品加入3种包装材质输液中,与输液混合均匀后分别于0、1、24h时测定药物浓度,并与0h时比较。结果:与玻璃瓶比较非PVC和PVC材质输液容器中5%GS、0.9%NaCl多数检测指标结果无显著性差异(P>0.05),但PVC材质中2种大输液含量下降(P<0.05);在PVC输液袋中,胰岛素、硝酸异山梨酯和硝酸甘油含量在34.44%～80.80%之间,含量下降百分比与玻璃瓶比较具有统计学差异(P<0.05);在玻璃瓶中,硝酸异山梨酯和硝酸甘油含量为72.83%～81.86%,含量下降百分比与非PVC比较具有统计学差异(P<0.05)。结论:PVC及玻璃瓶材质对部分药物有吸附性,应引起临床注意;非PVC材质与大输液相容性良好,对药物吸附性较小。     

利用"e药通"软件分析1704例住院患者用药情况

目的：应用“e药通”用药指南软件系统审查住院患者用药医嘱,评估临床合理用药水平,为临床合理用药提供参考。方法：抽取2004年1—12月定点科室固定时间段全部住院患者的用药医嘱,利用“e药通”软件进行用药合理性监测,再通过系统中的Microsoft Excel进行分析。结果：本次调查监测病例l704例,共23072条医嘱,涉及药物559种,平均每例医嘱达13．5条;存在药物相互作用医嘱l789条,发生率为7．75％。结论：本次调查住院患者的用药情况基本正常,但仍存在不足;“e药通”系统软件符合临床药学及医务人员的工作需要,但仍存在一些缺陷,有待继续完善。     

Low colonic absorption drugs: risks and opportunities in the development of oral extended release products

Introduction: Currently numerous drugs have been observed with lower colonic absorption than small intestine absorption, which can significantly impact in vivo performance of their oral extended release (ER) products.

Areas covered: We reviewed over 300 publications, patents, book chapters, and commercial reports of drug products from regulatory agencies for low colonic absorption (LCA) drugs and critical findings are discussed. The focuses of this article are (1) current findings on the causes of low colonic absorption to support early assessment of LCA candidates, and (2) current knowledge on successful ER strategies and technical platforms used for LCA drugs in commercial drug products to facilitate oral ER product development.

Expert opinion: Colonic drug absorption is one of the critical considerations in successful development of oral ER products. The root causes of low colonic absorption in many LCA drugs are still unclear. It is recommended to evaluate colonic drug absorption of drug candidate at early stage of oral ER product development. After evaluation, the selection of a formulation platform to develop an oral ER product needs to be carefully considered for LCA drugs. Based on the current commercial oral ER formulation platforms for LCA drugs, compounds are first divided into five types (I-V) and different ER formulation approaches with higher success rate are recommended for each type.     

Development and evaluation of an individuals-oriented information-provision system for outpatients--utility of "drug Usage sheets" and "Drug Information Cards" for patient consultation

We have implemented an information-provision system for outpatients at the department of pharmacy, University of Tokyo Hospital, in order to comply with the revised Pharmacists' Law by which pharmacists have been obliged to provide patients with information necessary for rational usage of medicine at the time they receive dispensed drugs. This system is linked on-line with the order entry system to print "Drug Usage Sheets" containing important drug information such as therapeutic effects and adverse reactions, as well as photographic color views of drugs. We prepared the sheets by extracting and classifying the original information, and by converting medical terms into lay expressions. Moreover, we developed "Drug Information Cards" to inform each patient of severe side effects and drug interactions, which should affect drug compliance, and implemented an individuals-oriented information system using both the "Drug Usage Sheets" and "Drug Information Cards." In this study, we evaluated the usefulness of this system from the viewpoint of patients' recognition and understanding on necessary drug information. It was indicated from questionnaires to patients that the "Drug Usage Sheets" help most patients understand the names, usage, effects, and general cautions including slight adverse reactions (i.e. grade 1), and that the use of colored letters for important parts and pictograms is a useful method to attract more attention from patients as compared with a conventional method using only letters. Most patients answered that the "Drug Usage Sheets" can be utilized in many ways and valuable in taking drugs with assurance. We formulated the "Drug Information Cards" by information processing: separation of early symptoms of adverse effects into subjective and objective ones and their classification into related organs. Moreover, the brand names of drugs which may cause drug interactions have been listed on the cards so that worsening of adverse reactions and drug interactions can be avoided. Although 14% of the patients answered that they became unsecured when informed on side effects, the percentage of such patients was significantly higher with those who received caution-required drugs for the first time or who have experienced drug side effects before, suggesting the need for combining oral explanation based on each patient's background and understanding on drug adverse effects. In conclusion, an efficient provision of drug information became possible through our integration of necessary drug information in this study, and the individuals-oriented system of drug information was established, which was demonstrated to contribute to the rational usage of medicine.     

多剂量包装口服药品分析

目的:探讨口服药品多剂量包装的合理性。方法:对我院目前使用的西药口服制剂按是否单剂量包装进行分类调查,并对多剂量包装情况、分布情况等进行分析。结果:在调查所涉及的460种西药口服制剂中,单剂量包装药品222种,多剂量包装药品138种,而在多剂量包装药品中,有87种药品的包装存在问题。结论:提倡单剂量包装,完善合理的多剂量包装。     

A brief overview of the clinical pharmacology of "club drugs"

Four different "club drugs" are reviewed: MDMA (methylenedioxymethamphetamine, "Ecstasy"), GHB (gamma-hydroxybutyrate), ketamine, and Rohypnol (flunitrazepam). The neurobiology, clinical pharmacology, and treatment issues for each are discussed.