122种注射用无菌粉末集中调配溶媒的选择

目的:探讨静脉用药集中调配中心(pharmacy intravenous admixture service,PIVAS)无菌粉末溶媒的选择,以期提高成品输液质量,保证静脉用药治疗效果。方法:收集河北省人民医院PIVAS当前在用的122种无菌粉末药品说明书,以“药品名称+溶媒选择”为主题词,检索CNKI、万方等数据库,并参考相关专业书籍,整理溶解溶媒、稀释溶媒及成品输液浓度限制等资料,并综合分析。建立并不断完善PIVAS无菌粉末溶媒选择数据库,统计PIVAS近7年存在溶媒选择不适宜的医嘱占比。结果:122种无菌粉末中有120种对溶解溶媒有特殊要求;120种对稀释溶媒有特殊要求。无菌粉末溶媒选择数据库的建立有效减少了溶媒选择不适宜医嘱占比(从0.48%减少到0.13%),保证了静脉用药安全。结论:溶解溶媒和稀释溶媒的选择是提高成品输液质量、保证静脉用药治疗效果的重要环节。随着DIP付费方式的全面铺开,探索新的稀释溶媒在临床应用的可能性,同时开展多种无菌粉末混合调配的相容性研究,有可能成为PIVAS今后工作的主要内容。

Selection of solvents in the centralized dispension of 122 sterile powders for injection

OBJECTIVE To explore the selection of solvent of sterile powder for injection in pharmacy intravenous admixture service(PIVAS),in order to improve the quality of finished infusion,and ensure the therapeutic effect of intravenous medication.METHODS Collect 122 kinds of sterile powders’ drug instructions currently in use by PIVAS in Hebei Provincial People’s Hospital,with the subject heading of "drug name+solvent selection",databases such as CNKI and Wanfang were searched,and related professional books were referenced to sort out dissolving solvent,diluting solvent and concentration limit of finished infusion and other data,and comprehensive analysis.Establish and continuously improve the selection database of solvent for sterile powder for injection in PIVAS,statistics on the proportion of doctor’s orders with inappropriate selection of solvent in PIVAS in the past 7 years.RESULTS Among the 122 sterile powders for injection,120 had special requirements for dissolving solvent;120 had special requirements for diluting solvent.Establishment of the selection database of solvent for sterile powder,effectively reduce the proportion of doctor’s orders with inappropriate selection of solvent(reduced from 0.48% to 0.13%),to ensure the safety of intravenous medication.CONCLUSION The selection of dissolving and diluting solvents is an important link to improve the quality of finished infusion and ensure the therapeutic effect of intravenous medication.With the full spread of DIP payment method,exploring the possibility of new diluting solvent in clinical application,and carrying out the compatibility study of multiple sterile powder mixtures,may become the main content of PIVAS in the future.