品管圈在静脉用药调配中心排药环节的应用

目的 开展品管圈活动,对静脉用药调配中心(PIVAS)排药环节进行优化,降低排药差错率,提高工作质量,保证输液安全.方法 2013年4月PIVAS成立品管圈,并确定降低排药差错率为主题,分析PIVAS排药差错的原因,按品管圈实施步骤实施各项活动,并拟定和改善措施.结果 PIVAS排药差错率由活动前的0.12%改善到活动后的0.0512%,达成率88.9%.结论 开展品管圈活动不仅有效降低了PIVAS排药差错率,还提高了科室人员参与管理的意识以及发现和解决PIVAS内部问题的能力.     

品管圈在降低自动摆药机摆药差错率的应用研究

目的：探讨品管圈质量管理工具在降低自动摆药机摆药差错率中的作用研究。方法：成立品管圈，确定"降低中心摆药室自动摆药机摆药差错率"为主题，利用鱼骨图、80/20法则分析导致自动摆药机摆药差错的原因，拟定对策，进行对策实施与检讨，比较运用品管圈前后自动摆药机摆药差错的发生率。结果：自动摆药机摆药差错率从改善前的0.654%降至0.271%，低于目标值0.345%，改善前后对比差异具有显著性（P<0.05），目标达标率为123.95%，进步率为58.56%。结论：开展品管圈活动能够有效的降低自动摆药机摆药差错，同时临床药师从合理用药角度出发降低了不合理用药的发生率，提高患者的满意度。     

优化静脉药物配置中心流程对药学服务工作的影响

目的探讨静脉药物配置中心(PIVAS)运行模式的改变对提高工作效率和减少排药差错率的影响。方法根据该院自身实际情况,检讨原有流程的不足与存在问题,修改PIVAS系统程序,梳理人员配置,优化病区分组、标签打印等工作流程,采用分组标识配置,完善排药模式,平行采集PIVAS长期医嘱静脉药物的配置用时,对比优化流程前后药师平均排药时间和排药差错率。结果 PIVAS流程优化后药师平均排药时间及排药差错率均优于优化前,差异有统计学意义(P<0.05或0.01)。结论优化静脉药物配置中心流程,可明显减少排药差错率。     

品管圈活动对降低静脉输液配伍核对差错中的应用分析

目的:分析品管圈活动对降低静脉输液配伍核对差错中的应用,供合理用药参考。方法:在静脉药物配制中心(PIVAS)开展品管圈活动,分析差错类型及发生原因,提出对策,计算目标达标率,通过对比活动前、后平均每月成品输液配伍差错率,对结果进行检讨与改进。结果:开展品管圈活动后,成品输液配制过程中的差错率由活动前的平均每月0.24‰降至平均每月0.14‰,目标达标率为114.8%;同时,药师的责任心、自信心得到提升。结论:本次品管圈活动的开展,减少了静脉药物配制过程中的差错,提高了患者用药安全性。同时提升了药师的自信心与责任心,增加了团队凝聚力。     

品管圈活动在缩短PIVAS新生儿营养液调配时间的应用

目的：通过在静脉用药调配中心（PIVAS）开展品管圈活动,缩短新生儿营养液调配时间,提高工作效率,确保临床及时用药。方法：根据品管圈质量管理方法,以PIVAS新生儿营养液作为研究对象,通过记录每一个流程所用时间,分析我院PIVAS新生儿营养液调配较慢的原因,活动按照PDCA循环法的十大步骤进行。结果：药师调配每袋营养液时间、计算汇总单时间、药师摆药时间、药师审核时间是我院PIVAS新生儿营养液调配流程耗时长的原因。通过采取加强人员培训、信息化计算汇总单、更改摆药流程等措施,我院PIVAS新生儿营养液调配时间由原来的62.1min下降到28.5 min,目标值为52.81%,改善值54.11%,目标达成率102.4%。结论：我院PIVAS开展品管圈活动,通过改进流程,优化信息,不仅缩短了调配时间,还提高了工作效率,确保临床及时用药及用药安全     

我院静脉用药集中调配中心自动化智能建设与实践

目的:探讨我院静脉用药集中调配中心(PIVAS)的自动化智能建设及效果。方法:介绍我院PIVAS自动化智能建设的主要情况,收集我院PIVAS自动化智能建设前(2016年7-9月)、后(2016年10-12月)相关工作环节的用时和差错率,评价建设效果。结果:我院在PIVAS的摆药、贴签、分拣以及配送环节进行了自动化智能建设,并进行了相关的制度和流程建设。自动化智能建设后,每张医嘱摆药用时由建设前的(6.78±0.87)s缩短至(2.65±0.71)s,贴签用时由(3.24±0.71)s缩短至(1.41±0.55)s,分拣每袋输液成品用时由(13.37±2.84)s缩短至(5.33±1.72)s,配送相同数量的输液用时由(35.64±4.33)min缩短至(18.12±3.57)min(P<0.05);摆药差错率由(2.35±0.59)‰降至(0.26±0.21)‰,贴签差错率由(1.51±0.45)‰降至(0.22±0.10)‰,分错病区差错率由(3.47±1.02)‰降至(0.17±0.10)‰,配送差错率由(1.33±0.55)‰降至(0.13±0.11)‰(P<0.05)。结论:我院PIVAS自动化智能建设后工作效率提高、差错率降低,降低了潜在的用药风险,提升了PIVAS管理水平。     

PDCA循环在提高静脉用药调配中心排药质量和速度的应用

目的 提高静脉用药调配中心(PIVAS)排药工作的质量及速度，保障临床静脉用药安全。方法 运用PDCA循环对影响排药工作质量和速度的原因进行分析、设定目标、拟定对策并逐项实施。统计并比较2021年3月至2021年6月PIVAS实施PDCA管理前后排药工作的速度和差错率。结果 经过3个月的PDCA循环管理，平均排药速度从(18.22±1.96)组/min提高至(27.10±2.84)组/min,差异具有统计学意义(P<0.01)。排药差错率从0.29%降低至0.14%,差异具有统计学意义(P<0.01),各类型差错例数均有所减少。结论 PDCA循环管理方法可有效提升PIVAS排药工作速度，减少排药差错，提高药学服务质量。     

我院静脉用药调配中心细节化控制对提高调配安全性的作用

目的通过发掘静脉用药调配中心(PIVAS)工作中的细节问题并加以控制,以减少差错。方法我院PIVAS通过设计药品批号的目视标识、物品定位标识、规章制度壁挂式,按类别、分步骤医嘱审核,细化批次调整,并设计高危药品成品输液标识、非整支用量标识、退药标识,细化药品管理以及采取信息化交互手段等举措,以提高工作质量。比较实施细节化控制前(2014年7-12月)与实施细节化控制后(2015年1-6月)调配差错率的变化,评价相关措施的成效。结果 PIVAS工作中细节化的控制,使差错率由实施前的0.497/10 000降低到实施后的0.128/10 000。结论关注PIVAS工作中的细节问题,可以优化PIVAS工作中某些环节,降低调配差错率,确保患者静脉用药安全。     

分类安排医嘱标签在降低静脉药物调配中心摆药差错的效果分析

目的：分析静脉用药调配中心（PIVAS）出现摆药差错的情况及原因,对各工作环节进行梳理,制定相应标签安排及摆药复核措施,降低摆药差错率,提高PIVAS药品调配质量。方法：将2016年1-12月未实行分类安排医嘱标签出现的摆药差错和2017年1-12月分类安排医嘱标签出现的摆药差错作为对照比较,通过改进前后的摆药差错率降低比例,评价相关措施的效果。结果：实施后摆药差错率由0.032‰下降到0.004‰,降幅达86.67%。摆药人员由原来的8人减到4人。结论：分类安排医嘱标签,既减少了摆药人员的工作压力,有效减少了摆药差错发生率,又保障了药品调配质量,节约了人力成本,提高了PIVAS工作效率     

静脉用药集中调配中心智能一体化设备设计与应用

目的 介绍静脉用药集中调配中心(PIVAS)智能一体化设备设计思路及应用情况,评价其在降低人力成本、减少差错发生及提升工作效率等方面的实践效果。方法 针对PIVAS工作环节中的输液出入库、贴标签、发筐、针剂摆药及成品输液分拣进行模块化硬件设计,通过医院内部局域网对各模块可编程逻辑控制器进行互通控制及数据交互,实现PIVAS智能输液出入库、智能贴标签、智能发筐、智能针剂摆药、智能分拣及数据追溯等功能,比较使用该设备前后工作指标,评估其应用价值。结果 应用该设备后,PIVAS贴签及摆药人数由每天4人降至1人;单个医嘱贴签及摆药平均耗时由(7.01±0.56) s缩短至(6.54±0.44) s;应用前后人工贴签与智能贴签均未发生差错,单月医嘱针剂摆药差错由6件降低至1件,单月成品输液分拣差错由12件降低至2件;成品输液分拣时间由(1.22±0.08) h缩短至(0.91±0.06) h,平均每袋分拣时间由(4.24±0.34) s缩短至(2.92±0.21) s,均差异有统计学意义(P<0.01)。结论 PIVAS智能一体化设备降低了医院人力资源投入及差错发生率,提高了工作效率并减轻...     

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.