某院门诊药房药品调剂差错原因分析及其对策

目的:分析医院门诊药房药品调剂差错的原因,并对此提出相应的改进措施,为患者提供安全、满意、优质的医疗服务。方法:抽取医院门诊药房2017年1月—12月间药品调剂差错处方504张为实施措施前组;另抽取2018年1月—12月间药品调剂差错处方474张为实施措施后组,比较实施措施前后(2017年和2018年)药品调剂差错原因的发生率差异。结果:通过实施一系列改进措施后,2018年度门诊药房药品调剂差错率较2017年度得到整体下降,由原来的0.308‰下降到0.247‰,其中出门差错率由原来的0.019‰下降到0.011‰。结论:通过对门诊药房调剂差错原因的分析,从制度落实、规范流程、人员培训、环境整理、内部管理等方面实施改进,有效遏制了药品调剂差错的发生,确保了患者用药的安全性。     

品管圈在提升我院PIVAS质量管理中的实践

目的:提升静脉用药集中调配中心(PIVAS)质量管理水平,减少调剂差错,促进患者用药安全。方法:运用品管圈方法对我院PIVAS进行质量管理,以"降低冲配药品调剂内差率"为主题,分析调剂差错发生原因,确定改善重点;制订改进方案,通过PDCA(Plan,Do,Check,Action)循环管理确定有效对策;比较活动前(2016年2月)及活动后(2016年8月)的有形成果(调剂差错率)及无形成果,评价活动效果。结果:制订并实施了包括统一排班、引进PIVAS MATE流程管理软件、人员全岗培训、加强退药管理及目视管理等措施。取得的有形成果为调剂差错率由活动前的1.81‰下降为0.53‰、目标达成率达108.47%、目标进步率为70.72%;无形成果包括优化了药品调剂的工作流程,使退药制度、人员培训制度标准化,增进了圈员的自信心、责任心、合作意识、凝聚力等;另获得一项避光储药盒的实用新型专利。结论:运用品管圈方法可有效提升PIVAS工作流程中的管理质量,促进患者静脉用药安全。     

危害分析和关键控制点在急诊药房药品效期管理的应用

目的:探讨安全有效管理急诊药房药品效期的方法。 方法:选取 2021 年 1-6 月急诊药房效期药品 347 种作为运用危害 分析和关键控制点(HACCP)管理前的研究对象,2021 年 7-12 月急诊药房效期药品 353 种作为运用 HACCP 管理后的研究对 象,比较分析实施 HACCP 管理前后近效期药品在急诊药房的流通情况。 具体步骤包括成立工作组、建立工作流程图、分析危 害和评估风险、确定关键控制点(CCP)、建立关键限值(CL)、制定和实施 HACCP 计划、建立记录档案。 结果:实施 HACCP 管理 后,医院急诊药房近效期药品百分比降低,由 3. 09%下降到 0. 84%(P<0. 05);药品报损率降低,由 0. 94‰下降到 0. 19‰(P< 0. 05)。 结论:HACCP 法用于急诊药房药品效期管理成果显著, 值得推广应用。     

易混淆药品管理存在的问题与对策

目的:分析易混淆药品调配时差错率发生的原因,为保障患者用药安全提供参考。方法:建立易混淆药品的管理制度,比较实施制度前(2014年7—12月)与实施制度后(2015年1—6月)的易混淆药品调剂差错处方数,计算差错率和下降率,分析其差错原因。结果:实施制度后,易混淆药品调剂差错率明显下降,易混淆药品调剂差错率仅为0.005%,比实施制度前下降了57.65%。结论:实施易混淆药品管理制度后,易混淆药品调配差错率得到显著下降,提高了药学服务质量,保障了患者的用药安全。     

PDCA循环法在降低住院药房口服药品调剂差错中的应用

目的 降低住院药房口服药品调剂差错,保证患者用药安全.方法 应用PDCA循环法对住院药房口服药品调剂差错情况进行原因分析,制定相应对策并实施.结果 实施PDCA循环管理法后调剂差错率由原来的0.174%下降至0.084%,下降了51.8%.结论 运用PDCA循环法能明显降低住院药房口服药品调剂差错率,提高患者的用药安全.     

PDCA循环法在门诊药房调剂工作持续质量改进中的应用

目的:应用PDCA循环法从调配中发现问题,通过质量持续改进,减少用药错误、提高用药安全,使门诊药房的安全质量、服务质量持续提高.方法:按照PDCA循环的计划、实施、检查、总结程序,根据门诊中西药处方调剂流程设计门诊药房差错检查表,统计本院2014年3-5月门诊药房普通处方错误差错情况,分析差错产生的原因并提出相应措施,不断提高门诊工作质量.结果:经过相关对策与措施的实施,调配差错明显减少.实施改善措施前差错率为1.76‰,实施措施后差错率为0.83‰,差错率降低了52.84％,达到预期目标.结论:差错发生的主要原因是工作人员的主观疏忽,其次是药品因素和环境因素.通过PDCA循环法制定的对策、方案的实施有效地减少了调配差错,确保病人用药安全.     

某“三甲医院”病区药房药品调剂差错原因分析及其对策

目的:通过对医院病区药房药品调剂差错的回顾性分析,寻求发生药品调剂差错的原因及其防治对策,确保患者用药的安全性。方法:汇总和分析医院2014年1月—2016年12月间病区药房的药品调剂医嘱条数及调配出现差错的原因。结果:在这3年中,医院病区药房调配差错的发生率呈逐年下降趋势(2014年差错发生率为0.065‰,2015年差错发生率为0.052‰,2016年差错发生率为0.026‰);引起调剂差错前4位药品的原因分别是数量差错、邻位差错、药品名称相似差错和规格差错。结论:定期举办差错分享会和专业知识培训,加强5 S管理目标,以优化工作环境、结合奖惩制度和提高员工的责任感是降低差错率的主要防治对策。     

PDCA循环模式的品管圈活动对我院门诊西药房处方调配差错率的影响

门诊西药房为医院重要部门,为药品调剂终端,在保障用药安全方面责任重大,然而,门诊西药房工作量较大,处方数量、种类多,处方调剂过程中难免因各种原因发生差错,处方调配差错可影响患者疾病治疗,严重者可危害患者生命安全[1]。因此,采取有效措施降低门诊西药房处方调配差错率,对保障患者用药安全具有重要意义。计划-实施-检查-处理(PDCA)循环模式的品管圈活动为近年来临床常用有效管理模式,在提高工作效果及工作人员积极性方面具有良好效果[2]。本研究于2018年10月至2018年12月对我院门诊西药房医开展PDCA循环模式的品管圈活动,旨在探究其对门诊西药房处方调配差错率、药学人员工作能力及状态的影响。报告如下。     

新调剂模式下儿科门诊药房内部调剂差错分析与防范

目的:评价我院儿科门诊药房"一对一"新调剂模式在减少内部调剂差错事件方面的成效。方法:新调剂模式即将前台发药药师与后台配方药师固定搭配,在医院信息系统支持下按照智能标签进行预配药。汇总该模式运行前1年的调剂差错事件,分析发生差错的原因并归类,制订相应的措施干预调剂差错事件的发生,1年后再对差错事件进行汇总分析,并与运行前比较。结果:通过采取优化人员分工、优化药品位置、增加硬件设备和更新调剂操作规范等干预措施后,调剂差错由343例降低为236例,差错率由0.584‰降为0.367‰,且各类别差错发生率均有下降。结论:"一对一"调剂模式有效减少了儿科门诊药房内部调剂差错事件,保障了儿童用药安全,提升了药学服务质量。     

西药房调剂差错处方分析及防范对策

目的:探讨茂名市人民医院(以下简称"我院")西药房处方调剂差错发生的原因及相关预防措施。方法:收集2012—2014年我院西药房所调剂的处方共2 205张,对其中存在差错处方的数量、类型及原因等进行统计与分析,并制订相应的防范措施。结果:我院西药房处方调剂差错类型主要有药品品种差错、药品数量差错、错发患者、用法与用量差错及用药禁忌差错。调剂差错原因类型主要有同种药品不同规格、药品包装相似、药品名称相似、药师或医师对于用药禁忌不熟知及患者和环境因素等。从总体看来,我院西药房近3年的处方调剂差错发生率呈逐年下降趋势。结论:针对我院近年来在西药房调剂处方方面出现的问题,应加强门诊药房管理,增强医师、药师的专业素养与工作责任心,完善处方审核制度,提高处方调剂的质量,降低调剂差错发生率,以保障患者用药安全。     

Role of glutathione in reduction of arsenate and of gamma-glutamyltranspeptidase in disposition of arsenite in rats

Arsenate (AsV), the environmentally prevalent form of arsenic, is converted sequentially in the body to arsenite (AsIII), monomethylarsonic acid (MMAsV), monomethylarsonous acid (MMAsIII), and dimethylarsinic acid (DMAsV) and some trimethylated metabolites. Although the biliary excretion of arsenic in rats is known to be glutathione (GSH)-dependent, involving transport of arsenic-GSH conjugates, the role of GSH in the reduction of AsV to the more toxic AsIII in vivo has not been defined. Therefore, we studied how the fate of AsV is influenced by buthionine sulfoximine (BSO), which depletes GSH in tissues. Control and BSO-treated rats were given AsV (50 micromol/kg, i.v.) and arsenic metabolites in bile, urine, blood and tissues were analysed by HPLC-HG-AFS. BSO increased retention of AsV in blood and tissues and decreased appearance of AsIII in blood, bile (by 96%) and urine (by 63%). The biliary excretion of MMAsIII was also nearly abolished, the appearance of MMAsIII and MMAsV in the blood was delayed and the renal concentrations of these monomethylated arsenicals were decreased by BSO. Interestingly, appearance of DMAsV in blood and urine remained unchanged and the concentrations of this metabolite in the kidneys and muscle were even increased in response to BSO. To test the role of gamma-glutamyltranspeptidase (GGT) in arsenic disposition, the effect of the of the GGT inhibitor acivicin was investigated in rats injected with AsIII (50 micromol/kg, i.v.). Acivicin lowered the hepatic and renal GGT activities and increased the biliary as well as urinary excretion of GSH, but failed to alter the disposition (i.e. blood and tissue concentrations, biliary and urinary excretion) of AsIII and its metabolites. In conclusion, shortage of GSH decreases not only the hepatobiliary transport of arsenic, but also reduction of AsV and the formation of monomethylated arsenic, while not hindering the production of dimethylated arsenic. While GSH plays an important role in the disposition and toxicity of arsenic, GGT, which hydrolyses GSH and GSH conjugates, apparently does not influence the fate of the GSH-reactive trivalent arsenicals in rats.     

微透析取样技术在中药体内分析中的应用研究进展

本文综述了微透析取样技术在中药体内分析中的应用,介绍微透析取样技术的原理、组成、探针类型、特点,重点阐述了微透析取样技术在测定脑、血液、皮肤等组织器官中中药有效成分浓度的应用实例。表明微透析取样技术在中药药效研究中具有广阔的前景。     

应用PASS系统对我院2008年住院医嘱的分析

目的监测分析2008年我院住院患者用药情况。方法将PASS系统嵌入医生工作站、临床药学工作站等子系统,构建合理用药计算机网络系统,对住院医嘱进行及时监测,将监测结果向医生反馈,并对其进行统计、分析。结果2008年共监测医嘱3 620 241条,不合理医嘱908条,占0.02%。不合理医嘱中,配伍禁忌(381条)占41.96%,用法用量(381条)占41.96%,药物相互作用(108条)占11.89%,儿童用药(38条)占4.19%。经与医生沟通后,更改不合理医嘱856条,占94.27%。结论PASS系统可有效监测医嘱中的不合理用药,通过与医生交流,大大减少药物不良事件的发生,值得临床推广应用,也为临床药师开展工作带来了极大的便利。但PASS系统尚存在局限性,有待进一步完善。     

Role of desacetylation in the detoxification of cephalothin in renal cells in culture

The toxicity of three cephalosporin antibiotics to rabbit kidney cells in culture was compared to their known nephrotoxic potential in vivo (cephaloridine greater than cefazolin greater than cephalothin). While cephalothin is considered to be a relatively nonnephrotoxic cephalosporin when administered to many species including humans and rabbits, in several in vitro systems involving rabbit renal tissue, cephalothin was comparatively more toxic than anticipated based on in vivo data. Cephalothin is extensively desacetylated in rabbits to a less microbiologically active metabolite, desacetylcephalothin. When a microsomal S9 fraction from rabbit kidney was added to the in vitro assay in cultured rabbit renal cells, cephalothin was desacetylated and its toxicity to kidney cells was reduced. The addition of S9 in vitro provided a toxicity ranking of the cephalosporins that correlated with their known in vivo nephrotoxic potentials (cephaloridine greater than cefazolin greater than cephalothin). The in vitro detoxification of cephalothin by S9 was blocked by the coadministration of the esterase inhibitor, aminocarb. Desacetylcephalothin was relatively nontoxic to rabbit renal tissue in vitro. These results suggest that the desacetylation of cephalothin in vivo represents a previously unrecognized mechanism of detoxification of this cephalosporin antibiotic. Furthermore, this mechanism of detoxification may be applicable to other acetylated cephalosporins.     

2009年某院住院患者抗真菌药用药调查

目的:分析讨论某院抗真菌药使用的合理性,为临床安全有效地使用抗真菌药提供参考。方法:回顾性统计分析某院2009年住院患者抗真菌药用药信息。结果:2009年某院住院患者抗真菌药DDDs排名前3名分别为:氟康唑、制霉菌素和伊曲康唑;使用金额排名前3名分别为:氟康唑、米卡芬净及卡泊芬净;更换一种抗真菌药进行治疗的患者数为176人,在全部患者中占13.4%。结论:应进一步强化用药指征的意识,提高标本送检率,同时改善某些抗真菌用药不合理更换的现象,以避免耐药性发生,从而更好更长远地体现抗真菌药的治疗价值。     

Changes in levels of dependency and predictors of mortality in elderly people in institutional care in Dunedin

The 1983 study of dependency of subjects in institutional care in Dunedin was repeated two years later. A significant increase in levels of dependency in residential homes, particularly in the Religious and Welfare sector was found. In 1983 there were 29 high dependency residents and 73 medium dependency residents in residential homes. In 1985 these numbers had increased to 55 and 86 respectively. There was no change in the number of low dependency residents. In 1983, 6 high dependency residents had been admitted to residential home care in the year prior to the study. In 1985 the number of high dependency residents recently admitted had increased to 23. There had also been a significant increase in the dependency of patients in Religious and Welfare continuing care hospitals. Of the 933 subjects in institutional care in 1983 who were able to be followed, 354 (37.9%) died in the following 2 years. Mortality rate was higher for those in hospital care (48.1%) than for those in residential home care (29.6%). Mortality rates were higher in more dependent subjects and this was evident for each measure of dependency.     

Kinetics of in vitro metabolism of methoxyphenamine in rats

1. Methoxyphenamine (MP) was metabolized in vitro by rat liver preparations to O-desmethylmethoxyphenamine (O-desmethyl-MP), N-desmethylmethoxyphenamine (N-desmethyl-MP) and 5-hydroxymethoxyphenamine (5-hydroxy-MP). These metabolic pathways were inhibited by SKF 525-A and carbon monoxide, which indicates that these reactions were mediated at least partly by an NADPH-dependent cytochrome P-450 system. 2. Strain differences in the metabolism of this drug in vitro were observed in female Lewis and Dark Agouti (DA) rats, which are proposed models for human debrisoquine phenotypes. Methoxyphenamine O-demethylase and 5-hydroxylase activity in DA rats were lower than those in Lewis rats. 3. The metabolic transformation of methoxyphenamine in vitro to O-desmethyl-MP was inhibited competitively by debrisoquine and sparteine. This indicates that the cytochrome P-450 isoenzyme mediating the metabolism of MP to O-desmethyl-MP is similar to that mediating metabolism of debrisoquine and sparteine. However, no inhibition was observed with methenytoin.     

应用PASS系统分析我院2010年住院医嘱

目的:了解我院2010年住院患者的合理用药情况,探讨如何利用合理用药监测系统( PASS)提高合理用药水平.方法:利用PASS对我院2010年15 966例住院患者的1 184 997条用药医嘱进行监测,以黑色警示医嘱为依据,收集不合理用药信息,并对监测结果进行统计、分析.结果:不合理用药医嘱50 261条,发生率为4.24％.绝对禁止黑色医嘱5441条,主要为药物相互作用(66.54％)、注射液体外配伍(17.86％)、用法用量(15.46％)、儿童警告(1.14％).结论:应用PASS系统能有效监测医嘱中的不合理用药情况,有利于提高临床合理用药水平,但PASS系统尚存在局限性,有待进一步完善.     

基层医院护士在临床合理用药中的作用

目的充分利用护士在医师和患者间的特殊地位和作用,促进基层临床合理用药。方法从护士的工作性质出发,论述护士参与促进合理用药的方便和优势。结果通过实践,护士在促进合理用药中的作用得到有效发挥,基层合理用药环境得到极大改善。结论充分利用护士与医师和患者间的特殊桥梁作用,在基层医院促进合理用药,规范医师用药行为,防止药物滥用,引导患者安全用药,降低药源性疾病。