某院肾功能不全患者用药监测系统及其数据分析

目的：通过某院肾功能不全患者用药监测系统及其数据分析，为肾功能不全患者合理用药提供参考。方法：进行肾功能不全用药建档，而后医院信息系统自动抓取相关数据，临床药师根据具体临床情况，参考相关资料，评估用药合理性，及时给出建议。结果：筛选分析2015年度873例成年慢性肾功能不全案例，抗菌药物占比最多；临床药师介入成效显著，包括建议调整用法用量164例，更换药品34例，停药6例，监测生化值40例，密切监测不良反应20例，监测血药浓度9例等。结论：通过肾功能不全患者用药监测，临床药师及时介入，进一步保障了肾功能不全患者合理用药。

Drug monitoring system and data analysis for patients with renal impairment in a hospital

OBJECTIVE To provide a reference for reasonable drug use in patients with renal impairment through renal drug monitoring and data analysis in a hospital.METHODS Records were established for medication against renal impairment, then relevant data were captured automatically by the hospital information system. According to the specific clinical situations, by referring to related data, evaluating the rationality of drug use, advise would be proposed timely by clinical pharmacists.RESULTS Totally 873 adult cases of chronic renal failure were screened and analyzed in 2015, antibacterial agents accounted for the highest proportion of drugs used. Clinical pharmacist intervention showed remarkable results, including recommending adjustment of usage and dosage (164 cases), replacing drugs (34 cases), withdrawing drugs (6 cases), monitoring biochemical values (40 cases), monitoring the adverse drug reactions closely (20 cases), monitoring the plasma concentration (9 cases), etc.CONCLUSION Through drug monitoring for patients with renal impairment, clinical pharmacists intervene timely to further guarantee the rational drug use in patients with renal impairment.