品管圈的应用对住院药房调剂差错率的影响分析

目的:探讨品管圈的应用对住院药房调剂差错率的影响. 方法:将品管圈应用于降低住院药房调剂差错率的管理中. 分别收集并统计本院住院药房品管圈应用前(2014年8月)、品管圈应用中(2014年9~10月)以及品管圈应用后(2014年11月)的药品调剂差错情况,评价品管圈应用的有形成果和无形成果.结果:有形成果:住院药房调剂差错率从2014年8月的0.556%降低至2014年11月的0.194%,P<0.01,差异具有统计学意义;无形成果:圈员在团队合作精神、工作积极性以及品质管理手法方面得到了显著提升. 结论:品管圈的应用能够显著降低住院药房调剂差错率,提高住院药房服务质量,值得推广.     

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.     

品管圈活动在降低武汉大学中南医院综合药房药品调剂差错率的效果分析

目的：探讨品管圈活动对降低武汉大学中南医院综合药房药品调剂差错率的作用。方法：通过成立品管圈,以"降低我院综合药房调剂差错"为主题,按照品管圈活动的10个步骤实施,评价该活动的有形成果和无形成果。结果：全员参与此次品管圈活动,针对容易发生差错的主要原因拟定对策。取得的有形成果：综合药房调剂差错件数由改善前的11件/周,降低至改善后的4件/周,降低率为63.6%;无形成果：药师在实施品管圈手法、团队精神、脑力开发、沟通协调、解决问题能力、责任心等方面均有所提高。结论：品管圈活动对降低差错、保障医疗安全效果显著;优化了工作流程,提高了药师发现问题、解决问题的能力。     

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。     

PDCA循环管理法在降低住院药房处方调配差错率中的应用效果分析

目的:分析PDCA循环管理法在降低住院药房处方调配差错率的应用效果。方法:采用回顾性分析法,抽取2015年1—6月间(实施PDCA循环管理法前)以及2016年1—6月间(实施PDCA循环管理法后)差错处方,统计和分析医院住院药房药品处方调配差错情况,并比较实施管理法前后的药品处方调配差错率以及患者和工作人员对药房药品处方调配的满意度情况。结果:实施PDCA循环管理法前药品调配差错率为0.973%;实施PDCA循环管理法后药品调配差错率为0.552%;管理前后药品调配差错率经组间比较其差异有统计学意义(P<0.05),并且患者和工作人员对药房药品处方调配的满意度均高于管理前(P<0.05)。结论:将PDCA循环管理法应用于住院药房药品处方调配差错管理中,产生了较理想的效果,减少了药品处方调配差错的发生,提高了住院药房的管理质量,保障了患者的用药安全性。     

品管圈活动在降低我院门诊药房发药差错率中的应用

目的:降低医院门诊药房发药差错率,促进药学服务质量提升。方法:以"降低门诊药房发药差错率"为主题,在我院门诊药房按照品管圈活动的10个步骤实施各项活动,并评价该活动的有形成果和无形成果。结果:通过开展品管圈活动,拟定了几方面的对策,如配方人员仔细核对打印标签,药品调配后摆放整齐;对同一成分不同规格、包装非常类似的2种药品,用其他品种的药品隔开,并贴上醒目图标等。有形成果方面,与改善前比较门诊药房发药差错率下降62.9%(29.25件vs.10.85件),目标达标率120.66%;无形成果方面,员工品管手法、解决问题的能力及责任心等方面的评分明显提高。结论:开展品管圈活动可以提升门诊药房药学服务质量,促进临床用药更加安全、有效。     

应用PDCA循环管理法提高门诊药房的药品调剂质量

目的适应医院的信息系统,减少门诊药房发药差错,提高门诊药房调剂工作质量。方法采用PDCA循环管理法对门诊药房的药品调剂工作进行管理,目标将药品调剂差错率控制在1％。以下。管理措施主要包括：解决计算机网络系统运行中存在的问题;提高药品调剂工作效率;减少药品调剂差错。每月检查药学人员执行PDCA管理措施的情况,计算药品调剂差错率,并进行分析和评定,检查整改的效果,提出新的计划和措施。结果运用PDCA循环管理后,门诊药房的药品调剂工作效率显著提高,药品调剂差错率降至0．89％。（223／251238）,达到本轮PDCA循环的目标。结论采用PDCA循环管理法可有效减少门诊药房药品调剂差错,提高门诊调剂工作质量。     

品管圈活动在降低我院门诊药房药品库存金额中的应用

目的:降低医院门诊药房药品库存金额,提高药房管理水平。方法:以"降低门诊药房药品库存金额"为主题,在我院门诊药房按照品管圈活动的10个步骤实施各项活动,并评价该活动的有形成果和无形成果。结果:通过开展品管圈活动,拟定了3个对策群组:一是设定领药周期与警戒线,二是完善领药制度,三是制定滞销药品管理制度;有形成果方面,门诊药房药品库存金额由改善前的1 147 503.89元降至509 571.16元,目标达成率为115.50%;无形成果方面,全体员工在品管手法运用、思维开拓能力等方面的评分有明显提升。结论:品管圈活动在门诊药房取得了良好效果,降低了药品库存金额,提高了工作效率。     

品管圈在降低住院药房差错件数中的应用及效果评价

目的:降低住院药房工作差错率,促进患者用药安全。方法:按品管圈理论的十大步骤进行计划、实施、确认和处置,分析导致住院药房工作差错(品项和数量差错)发生的真因并探讨解决的对策并实施,评价效果。结果:针对品项差错发生的主要原因如同一品名的药品多规格、多厂家,制订药品分开摆放及设计醒目标识等对策。取得的有形成果:差错件数从每周10.3件下降到0.7件(降低93.2%);无形成果:药师在品管圈手法运用、工作积极性、团队合作精神等方面得到显著提高。结论:品管圈用于降低住院药房工作差错是可行的、有效的,建议推广应用。     

品管圈的应用对住院药房调剂差错率的影响

目的:探讨分析品管圈的应用对住院药房调剂差错率的影响.方法:通过科室鼓励,工作人员自愿组成品管圈,通力合作,共同找出药房调剂差错原因;运用各种品管方法制定对策,并进行实施.结果:实施品管圈活动后,药房调剂差错率由0.556%降低为0.153%;同时参加品管圈的成员在工作积极性、品质管理手法以及团队合作精神上有了较大提高,带动了全科室的工作热情.结论:品管圈活动的开展能降低住院药房调剂差错率,有助于科室工作人员团队合作,提高服务质量.     

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.     

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.     

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。     

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.     

Comparison of in vitro cell models in predicting in vivo brain entry of drugs

Although several in vitro models have been reported to predict the ability of drug candidates to cross the blood-brain barrier, their real in vivo relevance has rarely been evaluated. The present study demonstrates the in vivo relevance of simple unidirectional permeability coefficient (P(app)) determined in three in vitro cell models (BBMEC, Caco-2 and MDCKII-MDR1) for nine model drugs (alprenolol, atenolol, metoprolol, pindolol, entacapone, tolcapone, baclofen, midazolam and ondansetron) by using dual probe microdialysis in the rat brain and blood as an in vivo measure. There was a clear correlation between the P(app) and the unbound brain/blood ratios determined by in vivo microdialysis (BBMEC r=0.99, Caco-2 r=0.91 and MDCKII-MDR1 r=0.85). Despite of the substantial differences in the absolute in vitro P(app) values and regardless of the method used (side-by-side vs. filter insert system), the capability of the in vitro models to rank order drugs was similar. By this approach, thus, the additional value offered by the true endothelial cell model (BBMEC) remains obscure. The present results also highlight the need of both in vitro as well as in vivo methods in characterization of blood-brain barrier passage of new drug candidates.