中国医疗机构住院患者自备药临床管理建议

<正>1背景自备药（patients’own medications,POM）是指患者从各级医疗机构或社区药店获得,带入当前住院就诊医院准备继续使用的药品,住院患者使用POM的常见情形包括：慢病患者自行带入的长期使用药品;从外院开具需要继续使用的药品;临床试验用药品;患者因就诊医院内未配备而需要外购的药品[如患者从医保定点药店购买的双通道药品,患者因临床急（抢）救、特殊临床治疗、突发公共卫生事件及自然灾害需要使用而就诊医院未配备的药品]。一项纳入中国3 896名患者的研究发现,     

基于JCI标准构建我院住院患者自备药安全管理模式

目的:为建立住院患者自备药管理模式提供参考。方法:基于美国医疗机构国际联合委员会(JCI)标准对患者自备药管理(鉴别、存储、使用)的相关要求,提出我院住院患者自备药管理的模式和方法,并以相关指标评价管理效果。结果与结论:参照JCI标准相关要求,我院建立的对患者自备药的管理方法包括制订制度、规范流程,医患知情、统一管理,严格审核、安全第一,定期监测、保证效果;自2011年起实行该管理模式后,我院住院患者自备药的存储合格率从2011年的70%左右升至2012年的90%左右。我院建立的住院患者自备药管理模式比较全面,促进了自备药的安全使用。     

某三甲专科医院住院患者自备药管理模式分析与探讨

目的 根据某三甲专科医院住院患者自备药的使用情况,探讨自备药安全管理模式,为住院患者自备药的临床应用管理提供参考.方法 收集整理某三甲专科医院2019年1～12月使用自备药的住院患者及其药品信息,分析药品种类及使用情况,归纳总结自备药安全管理模式要点.结果 归纳分析某三甲专科医院自备药品共17类547个,其中使用最多的...     

对我院住院患者退药情况的思考

目的调查我院住院患者退药情况并提出应对措施。方法收集我院各科病区2009年11-12月2 717份退药申请单退药数额,分析我院住院患者的退药特点。结果我院不同病区均有退药情况发生,主要集中在普外科和肿瘤科。结论应采取有效方法减少不合理退药情况的发生,保证患者用药安全,有效利用医院的人力资源。     

精神疾病住院患者抗精神病药使用分析

目的：了解长期住院精神疾病患者抗精神病药使用特点。方法：对我院2014年10月20日住院时间超过1个月的精神疾病患者处方进行调查分析。结果：1196例精神疾病患者,单一用药352例（29.4%）,其中利培酮142例（40.3%）、氯氮平68例（19.3%）;联合用药844例（70.6%）,常用联合方案为氯氮平+新型非典型抗精神病药、利培酮+丙戊酸盐、氯氮平+新型非典型抗精神病药+丙戊酸盐;氯氮平与其它精神药物联用时剂量低于单用,有显著性差异。结论：住院精神疾病患者使用利培酮比率最高,药物治疗以联合用药为主,联合用药方案基本合理。     

1457例住院患者抗感染药使用调查

目的：调查住院患者抗感染药使用情况，提高临床合理用药水平。方法：随机抽取某三级医院1998年11月－1999年5月中五天住院患者领药单1457份，对抗感染药的使用情况进行统计分析。结果：全院使用抗感染药的患者占36．9％，某些科室患者使用抗感染药比例高达50％以上。抗感染药的联合用药增多，但联合用药目的不明确，用药种类多达3－4种。结论：抗感染药使用基本合理，但应注意防止抗感染药的滥用，联合用药时应注意抗感染药种类的选择。     

精神病专科医院住院患者抗精神病药使用分析

目的：了解本院长期住院精神疾病患者抗精神病药使用特点。方法：对2014年10月20日住院时间超过1个月的精神疾病患者处方进行调查分析。结果：1196例精神疾病患者,单一用药352例（29.4%）,其中利培酮142例（40.3%）、氯氮平68例（19.3%）;联合用药844例（70.6%）,常用联合方案为氯氮平+新型非典型抗精神病药、利培酮+丙戊酸盐、氯氮平+新型非典型抗精神病药+丙戊酸盐;氯氮平与其它精神药物联用时剂量低于单用,有显著性差异。结论：住院精神疾病患者使用利培酮比率最高,药物治疗以联合用药为主,联合用药方案基本合理。     

住院精神疾病患者抗精神病药使用情况调查

目的:了解住院精神疾病患者抗精神病药的使用情况。方法:采用回顾性调查方法,对中山市第三人民医院2013年1月1日—12月31日出院的精神疾病患者的用药情况进行统计、分析。结果:在住院精神疾病患者的疾病构成中,以精神分裂症和心境障碍所占比例最多;抗精神病药使用最多的是利培酮;合并用药的治疗方式在住院患者中非常普遍;抗精神病药的使用剂量基本都在推荐的安全剂量范围之内。结论:该院抗精神病药以使用非典型抗精神药为主;各种抗精神病药临床用药多样化,用药安全不容忽视。     

我院住院患者退药情况分析

目的 探讨本院住院患者的退药情况与退药原因,为患者合理用药与降低退药量提供参考.方法 统计本院2013年7～9月退药的住院患者共1562例,对其退药原因与退药情况进行分析.结果 内科退药现象较普遍,因医嘱变更退药所占比例最高,退药品种以抗微生物药物居多.结论 应采取针对性措施减少不合理退药情况,以保障患者安全、有效用药,减少医院不必要的资源消耗.     

住院患者退药管理规定实施前后住院药房退药统计分析

目的评价我院住院患者退药管理规定对住院药房退药的影响。方法收集我院住院药房2011年12月与2012年12月退药登记表,调取同期病案室各病区住院人数,对收集数据进行分析。结果我院住院药房退药管理规定实施后（2012年12月）,退药人数占同期住院人数比例下降了23．5％,退药金额占同期药品销售金额的比例下降了3．9％,退药笔次减少了3617笔,退药单医生职称变化不大,根据药敏调整抗菌药物和死亡原因退药比例分别升高了12．3％、0．9％,其他原因退药比例均呈下降趋势。结论完善的退药管理制度,可有效遏制住院患者随意退药现象。但医务人员对特殊储存药品、高危药品保管不当导致药效的降低,甚至用药差错相关知识不足,需要临床药师加强对医务人员药品质量与药效知识的培训和宣传。     

Anti-infectives-induced adverse drug reactions in hospitalized patients

OBJECTIVES: To assess the rate and seriousness of adverse drug reactions (ADRs) attributable to anti-infective agents in hospitalized patients; to estimate the likelihood of experiencing anti-infectives-induced ADRs at different length of drug usage in the hospital; to compare different classes of anti-infectives in inducing ADRs; to determine the impact of age and sex on anti-infectives-induced ADRs. DESIGN: Prospective cohort study. PARTICIPANTS: Patients admitted to the infectious diseases department at a university teaching hospital, on Sunday to Wednesday, over a 9 months period, who received at least one anti-infective agent were eligible to enter the study. MAIN OUTCOME MEASURES: Any suspected noxious and untoward medical events, including laboratory tests abnormalities following anti-infective therapy. METHODS: All patients admitted have received at least one anti-infective drug. Anti-infective agents induced ADRs were detected by interviewing patients and daily chart review. The seriousness, causality, and type of reactions were classified based on World Health Organization (WHO) definitions. Chi-square analysis was performed to assess the influence of sex and age on occurring ADRs. Both Kaplan-Meier and life table method were used to estimate the time to occur the ADR in anti-infective users. To compare the estimated risk of ADRs induced by different classes of anti-infectives, odds ratios were estimated. In all classes of anti-infectives, the odds ratio of each class was estimated with regard to anti-tuberculosis agents, which had the highest prevalence of ADRs. RESULTS: During the study period, 460 patients were entered the study. During the same period, 38 ADRs were recognized of which 20 (42%) were serious. The most recognized ADRs were suspected to be induced by anti-tuberculosis agents (29.8%). However in comparing with anti-tuberculosis agents, anti-fungal agents were associated with the highest ADR rate (odds ratio [OR], 4.21; 95% confidence interval [CI], 1.41-1.256) whereas cephalosporines were associated with the lowest rate, (OR, 0.1; 95%CI, 0.04-0.26). The survival analysis shows that the likelihood of experiencing an ADR was increased at first 14 days of drug therapy. Also Chi-square analysis shows that greater risk of anti-infectives-induced ADRs was observed in women. CONCLUSION: The rate of ADRs induced by anti-infective agents in this study was 8.2%. This is higher than a standard (5%) which has been reported in other studies. This study also shows that some of the classes of anti-infective agents like anti-fungals need more attention.     

A prospective study of adverse drug reactions in hospitalized children

AIMS: There are few publications of adverse drug reactions (ADRs) among paediatric patients, though ADR incidence is usually stated to be higher during the first year of life and in male patients. We have carried out a prospective study to assess the extent, pattern and profile risk for ADRs in hospitalized patients between 1 and 24 months of age. METHODS: An intensive events monitoring scheme was used. A total of 512 successive admissions to two medical paediatric wards (47 beds) were analysed. The hospital records were screened daily during two periods (summer, 105 days and winter, 99 days), and adverse clinical events observed were recorded. RESULTS: A total of 282 events were detected; of these, 112 were considered to be manifestations of ADRs. The cumulative incidence was 16.6%, no differences being observed between periods. Although there were no differences between patients under and over 12 months of age, risk was found to be significantly higher among girls compared with boys (RR=1.66, 95% CI 1.03-2.52). The gastro-intestinal system was most frequently affected. The therapeutic group most commonly implicated was anti-infective drugs and vaccines (41.5%). The ADRs were mild or moderate in over 90% of cases. A consistent relationship was noted between the number of drugs administered and the incidence of ADRs. CONCLUSIONS: Hospitalized patients exhibited an ADR risk profile that included female sex and the number of drugs administered. No particular age predisposition was observed. The most commonly prescribed drugs are those most often implicated in ADRs in paediatric patients.     

257例住院精神病患者精神药物一日使用的调查

目的调查北京市石景山区五里坨医院257例精神病住院患者精神药物的一日使用情况。方法选取2013年12月20日所有住院精神患者的用药资料并进行统计分析。结果本院住院精神患者使用药物频度最高的是利培酮[134例（52．1％）],抗抑郁药使用频度最高的是曲唑酮[38例（14．8％）]。结论本院多数用药方案合理。应防止滥用苯二氮革类、盐酸苯海索等药物。     

某医院老年住院患者抗生素使用情况调查分析

目的了解该院老年住院患者抗菌药物的使用情况,评价其用药合理性。方法采用回顾性调查分析,随机抽取2011年1月—6月该院老年住院患者的住院病历276份,统计分析抗菌药物的使用情况。结果 276份病历中,使用抗菌药物病历186份,抗生素使用率为67.39%,一联用药46.23%,二联用药47.31%,三联用药4.84%,抗菌药物以青霉素、喹诺酮类为主。结论该院老年住院患者抗菌药物使用合理性期待进一步加强,应引起重视。     

住院患者药品不良反应报告分析

目的:了解住院患者发生药品不良反应(ADRs)的情况。方法:按患者的年龄、性别、用药情况及ADRs的主要表现、严重程度等进行统计分析。结果:185例报表中,男性87例,女性98例,涉及药品82种,主要为抗感染药物(46.49%),其次为中药制剂(16.76%),ADRs主要表现是皮肤及附件损害,其次是循环系统、消化系统。结论:应加强对住院患者ADRs的监测工作,以保证用药安全性。     

社区住院患者胃管留置时间研究

目的：为减轻留置胃管患者的痛苦和经济负担，探索社区卫生服务中心留置胃管的合适时间。方法：观察对象为留置硅胶胃管的住院患者80例，按留置胃管时间分为4、5、6、7周4组，每组各20例，比较胃管堵塞、鼻咽部黏膜损伤等情况。结果：7周组患者的鼻咽部黏膜充血和胃管堵塞较4、5、6组差异有统计学意义（P＜0.05），6周组与4、5周组间差异无统计学意义（P＞0.05）。结论：建议社区卫生服务中心留置硅胶胃管患者的胃管更换时间为6周。     

Risk factors for the development of adverse drug events in hospitalized patients

Adverse drug events in hospitalized patients lead to increased morbidity, mortality and costs. Early detection of adverse drug events could aid in the prevention of these adverse outcomes. A costeffective system for the early detection of adverse drug events should focus on high risk patients. A study was set up with the primary aim to identify characteristics that are associated with the development of adverse drug events (ADEs) in hospitalized patients.ADE reports were gathered from physicians and nurses (spontaneous reports) and from patients after intensive ward interviews by hospital pharmacists. All patients admitted to the internal medicine wards of two Dutch hospitals, during a two month period, were included.The following characteristics were analyzed for their potential relationship to the occurence of ADEs: age (categorized), gender, number of drugs prescribed during hospital stay, types of drugs used and changes in drug use on admission.Age was found to be inversely associated with the development of ADEs (OR 0.36, CI 0.210.61 for age category > 80 years; OR 0.56; CI 0.311.02 for age category 7580 years and OR 0.69; CI 0.421.11 for age category 6074 years). Furthermore, statistically significant associations were found for the number of drugs prescribed per hospitalized patient (for the class of 46 drugs per patient OR 2.61, CI 1.325.18), for newly prescribed drugs (OR 6.65, CI 2.6316.81) and for the cessation of drugs on hospital admission (OR 1.50, CI 1.022.20). The use of gastrointestinal drugs (OR 2.13, CI 1.323.45), central nervous system drugs (OR 1.66, CI 1.072.57) and antibiotics (OR 2.44, CI 1.653.60) were associated with the development of ADEs, when compared to all other drugs taken by the patients.In this study, the most important risk factors are the number of drugs used per patient and the starting of a new drug during hospitalization. As most hospitalized patients start new drug therapies while in hospital, this seems an inappropriate focus. However, careful monitoring of patients using more than 7 drugs at a time may be possible in a costeffective system for the early detection of ADEs.