品管圈缩短门诊药房高峰时段取药时间实践

目的缩短门诊药房高峰时段患者取药时间,提高药学服务质量。方法通过开展品管圈(QCC)活动,找出影响门诊药房高峰时段患者取药时间的因素,提出改进措施,确认活动效果。结果有形成果,取药高峰时段每百人取药时间超过10 min的人次从活动前(2019年6月)的43人次降为活动后(2019年12月)的24人次,基本达到目标值(23人次);高峰时段患者平均取药时间从活动前的9.6 min缩短为6.4 min,降幅达33.33%。无形成果,提高了圈员的综合素质,有助于进一步提高药学服务质量。结论通过开展QCC活动,缩短了门诊药房高峰时段患者取药时间,提高了患者的满意度。     

门诊药房配药取号机的设置及其实施前后的调配效率分析

目的:分析门诊药房配药取号机的设置及其实施前后的调配效率,以缩短患者取药等候时间,减轻发药药师工作强度。方法:实施取消处方付费时分配药房取药窗口号,等候区增设取号机,由取号机取号时分配窗口取药的方法。结果:实施后的新院区门诊患者缴费后到取药的等候时间为9.2 min,实施前的老院区患者缴费后到取药等候时间为25.5 min;实施后比实施前缩短等候时间的效率节省了63.92%。结论:实施门诊药房取药环节增加取号机,患者取号后药师再配合自动化设备进行处方调配的模式,门诊收费处多点设置流程缩短了患者取药等候时间,提高了患者对取药的满意率。     

我院门诊药房取药等候时间抽样分析

目的:了解我院门诊药房的取药等候情况,为缩短患者取药等候时间和优化药房服务提供量化依据.方法:通过药房信息系统(PIS)和纸质处方获取2010年某日的门诊处方时间信息,计算取药等候时间,对不同院区和不同时段的取药等候时间进行统计学处理.结果:东院和西院门诊药房患者的取药等候时间的中位数(最小值～最大值)分别为9.32( 1.75 ～27.87) min和5.82(1.20～ 17.45)min,两个院区差异有统计学意义(P＜0.05).东院门诊药房的高峰时段分别为10:01 ～12:00和13:31 ～ 15:30,西院的为10:01 ～ 12:00和14:31 ～ 16:30.上午高峰时段的取药等候时间长于非高峰时段(P＜0.05),但差值小于0.8 min.下午高峰时段与非高峰时段的取药等侯时间差异无统计学意义(P＞0.05).结论:从抽样日的数据看,门诊药房取药等候时间中位数小于10 min.可进一步优化取药流程,缩短取药等候时间.     

基于闭环管理改造模式下的门诊药房管理系统对提高患者取药高峰时间段发药质量与缩短等候时间的影响

目的:探究基于闭环管理改造模式下的门诊药房管理系统对提高患者取药高峰时间段发药质量,以及缩短等候时间的影响.方法:选取医院2020年1月门诊药房实施闭环管理改造模式后(2020年1月-3月)门诊患者72例为实施后组,另选2019年10月-12月门诊患者63例为实施前组;调查与比较2组患者高峰时间段(9:40 am-11:40 am与15:10 pm-16:40 pm)内药房发药差错率、平均取药等候时间、处方合格率和患者对药学服务的满意度差异,分析其发生的原因与对策.结果:实施后组患者9:40 am-11:40am与15:10 pm-16:40 pm时间段内药房发药差错率均低于实施前组(P＜0.05),平均取药等候时间均短于实施前组(P＜0.01),处方合格率和患者对药学服务满意度均高于实施前组(P＜0.05).结论:采用闭环管理改造模式的门诊药房系统可降低取药高峰时间段发药差错率、缩短患者取药等候时间,提高处方合格率和患者满意度.     

医院门诊药房调剂模式及效率调查分析

目的优化医院门诊药房调剂模式,改进调剂程序,缩短患者候药时间,提高工作效率。方法现场考察省内医院门诊药房高峰时段患者候药时间,咨询查阅相关资料,了解人员配备管理、人均处方量等。结果13家三甲医院门诊药房调剂模式不尽相同,有刷卡语音叫号模式、预配候取模式及传统取药模式。患者等候取药时间及药师调配的处方量有显著差异,人均处方量最多330张,最少100张,平均207张;患者候药时间最短3.40 min,最长20.22 min,平均10.15 min。结论调剂模式、发药设备和人员管理直接影响患者候药时间及药师的发药质量和工作效率。先进的发药设备及人员绩效管理等优化调剂模式值得在门诊药房推广。     

浅析智能药架对我院西院门诊药房服务流程改进的效果

目的：门诊药房使用智能药架改进服务流程,为新流程的服务效果提供数据支持。方法：分析智能药架服务流程下药师调配时间和患者取药等候时间的数据,并比较流程改造前、后的患者取药等候时间等数据之间的差异。结果：智能药架流程下药师调配时间在5 min之内的占71.52%,在10 min之内的占95%以上;在9个时段中,2013-10-21患者取药等候时间中位数比2010-10-18均有不同程度的缩短。结论：智能药架服务流程提高门诊药房工作效率,缩短患者取药等候时间,提升门诊药房服务水平。     

品管圈在缩短门诊药房高峰期患者取药等候时间的应用和效果评价

目的:分析品管圈活动在缩短门诊药房高峰期患者取药等候时间的应用效果,以期提升药学人员药学服务质量和患者满意度.方法:通过系统后台和现场查检相结合的方式采集2021年1月20日—2月28日患者取药等候时间为改善前数据(未采取任何干预措施),采集2021年2月28日至今患者取药等候时间为改善后数据(采取品管圈活动干预措施)...     

品管圈在减少门诊药房患者候药时间中的应用与效果分析

目的:减少门诊药房患者候药时间,提高患者满意度,提升药学服务质量。方法:以减少门诊药房患者候药时间为主题,根据品管圈的十大步骤开展品管圈活动,并评价有形成果和无形成果。结果:针对改善重点即缩短调配时间和审方时间,制订了包括修订绩效考核方案、加强情绪管理、增加审方软件、加强设备维护、优化药房布局、简化调配流程等措施。经过6个月的品管圈活动,患者平均候药时间由11.03 min缩短至5.79 min,目标达成率为91.61%,且圈员们的品管手法、团队凝聚力、愉悦感、积极性等无形成果均得到提高。结论:品管圈活动基本达到了预期目标,用于药房的管理有效、可行。     

由多个分药房组成的门诊药房管理模式介绍

目的:建立由多个药房组成的门诊药房管理模式。方法:在我院由1个门诊药房改为4个楼层药房的要求下,分析药房原有流程的缺点,建立门诊药房新流程,利用信息化管理手段,建立新型分药房发药模式。结果:原有的1个门诊药房无法满足患者就近取药的需求,原有的收方、发药流程致患者的排队时间较长,且易致发药差错、工作量分配不均;新建的门诊分药房采用取药刷条码报到及预摆药模式,患者可自主选择取药楼层,可合理分流患者,改善取药环境,简化收方发药流程,系统自动判断皮试处方。与旧模式相比,采用新模式患者取药等候时间从原来的平均10~15 min缩短为5 min(占90%),减少了取药差错,各窗口工作量相对平均等。结论:建立的门诊分药房发药模式提高了药房管理水平。     

我院门诊药房药品发放流程的改进

目的:缩短门诊患者取药等候时间,提高门诊药房工作效率及患者满意度。方法:通过数据收集(统计2013年每月药师摆药后患者未领取即无效摆药的高、低处方量)、现场测试和问卷调查(患者200份和药房工作人员50份)的方法分析引致高峰时段患者取药等候时间较长的原因,改进门诊药房发药流程及制订相关措施,并评价改进后效果。结果与结论:引起取药时间长的原因主要是无效摆药处方量大(65¹12张)、患者不知晓取药流程、取药大厅秩序混乱等,为此采取了流程改进(患者缴费后取药信息延迟3 min再传入药房后台摆药)及完善配套设施、明确流程标识、优化等候环境等相关措施。结果无效摆药处方量由每日最高量112张减少至8张;患者取药时间由30112张)、患者不知晓取药流程、取药大厅秩序混乱等,为此采取了流程改进(患者缴费后取药信息延迟3 min再传入药房后台摆药)及完善配套设施、明确流程标识、优化等候环境等相关措施。结果无效摆药处方量由每日最高量112张减少至8张;患者取药时间由30⁶0 min缩短到260 min缩短到2⁸ min;药师每人每天发放处方量由原来114张增加至134张;患者满意度从88.6%提高到97%,取得了良好效果。     

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.     

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.     

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。