浅谈我院药房麻醉药品的规范化管理

随着麻醉药品使用量的与日俱增，如何合理使用和管理好麻醉药品是医院药房工作的重中之重，也是医院目标责任制考核的重要内容，为此，我院针对本院是处于本地州最大医院，就诊的晚期癌症患者较多的特点。严格执行《麻醉药品精神药品管理条例》、《麻醉药品，第一类精神药品管理规定》，加强了对本院麻醉药品的管理，在具体的工作中通过不断学习，改进，总结了一些规范化管理的经验。     

病区麻醉药品信息化管理系统的构建及应用

目的分析病区麻醉药品信息化管理系统在加强麻醉药品规范化管理中的应用效果。方法以病区麻醉药品传统管理系统为基础,从问题出发,构建并应用麻醉药品信息化管理系统来规范病区护士执行麻醉药品医嘱,实行院科两级麻醉药品监管,并定期进行数据分析和改进,比较新系统实施前后的效果。结果实施麻醉药品信息化管理后,病区麻醉药品使用管理质量得分明显高于实施前,每次麻醉药品登记用时缩短,病区麻醉药品各种近似错误发生率降低,护士工作满意度提高,差异有统计学意义(P<0.01或P<0.05)。结论麻醉药品信息化管理系统有助于推动病区护理单元麻醉药品管理规范化,促进医院护理质量管理信息化水平的提升,保障麻醉药品使用安全,提高护士工作满意度,值得临床推广使用。     

大规模手术室高流量使用麻醉药品和精神药品的安全管理

目的探讨大规模手术室高流量使用麻醉药品和精神药品的规范化管理方法。方法运用流程精细化管理措施,对药品使用和管理各个环节进行逐一完善。通过定期质量控制,不断优化管理制度。结果我中心麻醉药品和精神药品实现了安全管理,在医院、全军各级检查中得到了肯定和好评。结论运用流程精细化管理措施能有效实现大规模手术室高流量使用麻醉药品和精神药品的规范化管理。     

麻醉科麻醉药品安全管理实践

麻醉药品安全管理与使用是医院麻醉科药品管理工作的重要内容之一。我院麻醉与围术期医学科结合国家颁布的法律法规,制定了符合医院要求及临床科室使用的麻醉药品管理流程和制度,尤其是麻醉药品发放与回收、麻醉药品库存维护、麻醉药品每日盘库、麻醉药品交接班管理、麻醉药品自查等环节,实现了麻醉药品的闭环管理,保障了麻醉药品合法、合理、安全使用。     

病区麻醉药品管理存在的问题及对策

麻醉药品是指连续使用后易产生生理依赖性、能成瘾的药品，是临床应用中比较特殊的一类药品。病区因病人需要可备少量麻醉药品，但因其有潜在的成瘾性，容易滥用，因此加强麻醉药品的管理尤其重要，其管理面临的形势也越来越严峻。2005年11月1日实施《麻醉药品和精神药品管理条例》中对麻醉药品的使用和储存有严格的要求和规定。为了解我院麻醉药品的管理状况，对我院22个病区麻醉药品的管理情况进行了调查。现将存在的问题及应对措施介绍如下。     

手术室麻醉药品管理办法介绍

麻醉药品是指使用后易产生依赖性、易成瘾的药品.麻醉药品具有双重性,合理的管理和使用,有利于病人的疼痛治疗,不严格的管理与不合理的滥用往往会导致人格丧失,道德沦落,危害社会的稳定.为防止麻醉药品外流与滥用,加强麻醉药物安全管理尤为重要.     

手术室麻醉药品管理

麻醉药品是指连续使用后身体易产生依赖性的药品[1-3],临床上用量使用恰当可以治病救人,反之,则会带来严重的公共问题,危害病人健康.手术室是医疗机构麻醉用药种类最多、数量最大的科室之一,加强手术室麻醉药品的管理是落实医院特殊药品管理制度的关键[4].我院为了保证麻醉药品的正确使用和管理,建立了麻醉药品管理制度,取得良好效果.现将体会总结如下.     

浅谈病区麻醉药和精神Ⅱ类药管理的体会

为规范麻醉药品及精神Ⅱ类药品的病区临床管理,保证临床用药安全。根据我院麻醉药品及精神Ⅱ类药品的管理条例,实施各项管理措施及质量控制,规范麻醉药品及精神Ⅱ类药品的临床使用,使药品得以安全有效使用,提高病区的工作效率及管理水平。     

病区麻醉药品管理存在的问题及对策

麻醉药品是指连续使用后易产生生理依赖性、能成瘾的药品,是临床应用中比较特殊的一类药品[1]。病区因病人需要可备少量麻醉药品,但因其有潜在的成瘾性,容易滥用,因此加强麻醉药品的管理尤其重要,其管理面临的形势也越来越严峻。2005年11月1日实施《麻醉药品和精神药品管理条例》中对麻醉药品的使用和储存有严格的要求和规定。为了解我院麻醉药品的管理状况,对我院22个病区麻醉药品的管理情况进行了调查。现将存在的问题及应对措施介绍如下。1存在的问题1.1管理制度不健全病区未制定切实可行的管理制度或制定制度简单,造成麻醉药品管理混乱…     

规范医院麻醉药品和一类精神药品管理探讨

目的 评价医院麻醉、一类精神药品使用管理各环节.方法 阐述东台妇幼保健院麻醉药品和精神药品管理模式和方法,分析2007-2009年该类药品使用情况.结果 医院麻醉药品和精神药品管理体系日趋完善,但还存在特殊情况下身份确认、处方限量难以掌握等问题.结论 我院麻醉药品和精神药品使用流程合理、管理规范.     

门急诊麻醉药品的处方分析

目的分析宜宾市第二人民医院2009年门、急诊麻醉药品的使用情况,促进麻醉药品使用的合理化和规范化。方法对2009年门急诊1 420张麻醉药品处方进行统计,统计处方总数,麻醉药品临床使用分布情况,根据药品分类分别统计麻醉药品的用药总量,各种麻醉药品的处方所占的比例,实际用药总天数等。对非癌症处方以用药频率及药物利用指数（DUI）为指标,癌症处方以用药天数及平均日用药量为指标进行进行统计、分析、评价。结果门急诊的麻醉药品有8种,盐酸吗啡缓释片的总用量居首位,盐酸哌替啶针在急诊处方中出现频率较高,芬太尼透皮贴剂的用药频度较小,药物利用指数均≤1。结论宜宾市第二人民医院的急诊麻醉药品使用基本合理。     

60例癌症患者麻醉药品应用及管理情况分析

目的分析60例癌症患者麻醉药品应用及管理情况。方法纳入我院癌症患者60例,收集麻醉药品处方79张。记录患者麻醉药品处方不合理率,分析患者麻醉药品用药情况,比较不同麻醉药品的用药频度(DDDs)。结果 79张麻醉药品处方中,不合理处方3张,处方不合理率为3.80%。麻醉药品中,吗啡缓释片的销售金额占比最高(44.02%),其次为羟考酮控释片(28.73%)和芬太尼透皮贴剂(9.72%)。我院麻醉药品中,吗啡缓释片DDDs最高,其次为芬太尼注射液和哌替啶注射液,吗啡注射液DDDs最低。第三阶梯药物的DDDs高于第二阶梯药物。结论我院麻醉药品应用较为合理,临床应根据患者个体情况,选择合理的麻醉药品。     

对5所军队医院护理工作中存在问题的调查与分析

目的了解军队医院护理工作中存在的问题,为护理质量管理提供依据。方法抽查5所军队医院的护理质量,包括护理质量管理、人力资源、危重病人护理、急救器材和毒麻药品管理。结果各医院床位数增加,护理工作量加大,护士完成了超负荷的护理工作任务,但护理质量部分指标下降。结论应科学筹划人力资源,保留护理技术骨干,体现护理专业价值,注重ICU专科护士队伍建设、护士持证上岗和护理安全问题。     

The role of ketorolac tromethamine in a clinical care pathway for men undergoing radical retropubic prostatectomy

The use of ketorolac in managing postoperative pain after a variety of surgical procedures has potential advantages over the use of narcotic analgesics alone. The purpose of this study was to determine whether the addition of ketorolac influenced the time to resumption of a full diet, hospital discharge, and postoperative complication rates, compared to a group of patients receiving only narcotic analgesics whose postoperative management was otherwise similar. The group receiving ketorolac had an earlier return to full diet than those receiving narcotics alone. Similarly, the median length of hospital stay was shorter in the ketorolac group then the group treated with narcotics alone. The inclusion of ketorolac in the postoperative pain management of patients after radical retropubic prostatectomy appears to be a safe and effective strategy.     

上海市奉贤区中心医院2008年-2010年门急诊麻醉药品处方分析

目的分析上海市奉贤区中心医院2008年-2010年门、急诊麻醉药品的使用情况,促进麻醉药品使用的合理化和规范化。方法对2008年-2010年门急诊麻醉药品处方共5 461张进行统计分析,包括不合理处方比例及存在的问题、各年度处方总数、临床使用分布、各类麻醉药品的用药总量、各类麻醉药品的处方比例和等。对非癌痛处方以用药频率、药物利用指数为指标,癌症处方以用药天数和平均日剂量为指标进行分析、评价。结果门急诊的麻醉药品有9种,盐酸吗啡缓释片的总用量居首位,盐酸吗啡针在急诊处方中比例最高,药物利用指数<1,不合理处方共770张,占14.10%。结论该院门急诊麻醉药品使用基本合理,但需对部分医师加强麻醉药品使用培训。     

The effect of aminophylline on renal colic: a randomized double blind controlled trial

OBJECTIVE: To evaluate the efficacy of aminophylline infusion as a painkiller compared with placebo in patients with acute renal colic. PATIENTS AND METHODS: From March to August 2005, 141 patients with clinical renal colic, who were under 60 years of age, had no history of heart or hepatic failure, asthma, theophylline or beta blocker use, reaction to methylxantines, pregnancy or breast feeding, and were not prescribed spasmolytic or analgesics, entered our study. They were randomly assigned to receive either 375 mg of aminophylline or placebo infusion under double blind conditions. Pain intensity was recorded using a visual analog scale (VAS), before drug administration and 30 and 60 minutes afterwards. The drug effectiveness was defined as > or =40% decrease in pain intensity 60 minutes after the onset of infusion, without exacerbation during the following 4 hours. RESULTS: Seventy patients received aminophylline; it was effective in 45 (64%; 95% confidence interval 52-75%). Alternatively, placebo was effective in 12 of 71 control patients (17%; 95% confidence interval 9-28%); (P < 0.001). Thirty and 60 minutes after administration, aminophylline reduced pain by 24% and 39% respectively, as compared with 6% and 8% pain reduction in the placebo group. CONCLUSION: This prospective study provides remarkable information about the efficacy of aminophylline on pain relief and decreasing narcotic usage in symptomatic urinary calculi. It is safe, inexpensive, with minute side effects and can be considered a good alternative or additive to narcotic analgesics in the management of renal colic.     

A process approach to improving pain management in the emergency department: development and evaluation

AIM:(1) To describe a process approach to the improvement of pain management in emergency departments. (2) To compare analgesia ordering and administration practices for patients with acute fractures before and after implementation of a nurse managed, titrated intravenous narcotic policy. METHOD: Retrospective chart review of patients with long bone fractures for the years 1993 and 1997. RESULTS: There was a dramatic change in analgesia administration practices away from the intramuscular route in favour of the intravenous route (p<0.001). For long bone fractures, in 1993, 53% of patients received intramuscular narcotic analgesia compared with 5% in 1997. In contrast, in 1993, 6% of the patients received intravenous narcotic analgesia compared with 54% in 1997. CONCLUSION: This study demonstrates that a process approach to improving pain management that resulted in both changes in drug administration and pain assessment and management processes made a significant and sustained change to analgesia ordering and administration practices for patients with long bone fractures in an emergency department.     

临床用药中的安全管理

目的：探讨在临床用药中所存在的安全隐患及如何规避,达到安全用药。方法：采取全院大查房的形式讨论药物在使用中存在的安全隐患,各科在临床工作中安全用药经验。结果：促进了医护及临床药剂师人员之间的沟通及对药物知识的掌握,药品的规范管理,安全用药。结论：严格的药物使用、保管制度及对药物使用知识的掌握是保证临床安全用药的关键。     

Optimization of anesthetic maintenance of a facial dermabrasion operation

Facial dermabrasion requires the preservation of natural mimic muscle tone, adequate spontaneous respiration, and contact with a patient. By taking into account the commercial pattern of surgical interventions, anesthesia should be as safe and comfortable as possible. For these purposes, the standard procedure of intravenous anesthesia with spontaneous respiration being preserved is optimized on the anticipatory analgesia principle, by using analgesics having the non-opiate mechanism of action: the kininogenesis inhibitor transamine and the nonsteroidal anti-inflammatory drug ketonal. This makes it possible to provide the adequacy of anesthesia and a good cardiovascular response with the doses of narcotic analgesics, hypnotics, and an anxiolytics, which do not cause respiratory distress, and to avoid using narcotic analgesics. The use of the antiemetics tropisetron and dexamethasone at the induction stage of anesthesia has been ascertained to be a reliable preventive measure against postoperative nausea and vomiting, by substantially enhancing its comfortability.     

Hydromorphone levels and pain control in patients with severe chronic pain

To better understand the use of narcotic analgesics, the hydromorphone concentration was measured in serum samples from 43 patients with chronic severe pain who were receiving this drug. At the time of blood sampling, pain intensity, mood, and cognitive performance were assessed. There was large individual variation in the dose-drug level relationship. Seven patients with bone or soft tissue pain and drug levels of greater than or equal to 4 ng/ml had good pain control, whereas 10 did not. None of 15 patients with levels less than 4 ng/ml had pain control, despite drug doses similar to those given patients with higher levels. Thus 60% of the patients without control of their pain had hydromorphone levels below the lowest level that produced pain control. No patient with pain from nerve infiltration or compression had good pain control, irrespective of the drug level or dose. Poor mood correlated with high pain intensity and low drug level. Impaired cognitive performance was not related to drug level. Knowing that there is a low concentration of narcotic in the blood of a patient with chronic severe pain who is receiving high drug doses and who shows lack of both efficacy and side effects may reassure health care professionals that further narcotic dosage escalation is appropriate.