单中心儿科呼吸病房住院医嘱超说明书用药横断面调查

发布时间：2018-03-16 05:20

本文选题：超说明书用药　切入点：小儿呼吸　出处：《中国循证儿科杂志》2017年01期 　论文类型：期刊论文

【摘要】：目的调查吉林大学第一医院(我院)儿科呼吸病房住院病历医嘱的超说明书用药情况,分析超说明书用药的影响因素。方法以横断面研究设计试验方案,采用等距抽样原则,从2014年9月至2015年9月我院HIS系统儿科呼吸病房的连续的0~18岁连续住院病历中抽取500份病历,提取与用药有关的全部医嘱,排除嘱托医嘱、退药医嘱、领药医嘱和0.9%氯化钠注射液等类似的医嘱。采集病历的一般信息和医嘱信息,判断每条医嘱的超说明用药情况,从年龄、药品种类、疾病和医嘱类型等方面行分层分析,采用Logistic回归法分析超说明书用药的影响因素。结果进入本文分析的500份病历包括465例患儿,共提取18 082条医嘱,住院用药医嘱16 618条,出院带药医嘱1 464条;涉及196种药物,主要为呼吸系统用药和系统抗感染药医嘱。(1)500份病历的超说明书用药率为100%,超说明书用药医嘱4 717条(26.1%),平均每份病历超说明书用药9.4条医嘱,平均每份病历每日超说明书用药1.4条医嘱。(2)无儿童用法和用量超说明书用药的发生率(17.4%)是其他类型超说明书用药发生率总和的2倍。(3)不同年龄阶段:总体超说明书用药发生率差异有统计学意义,年龄越小超说明书用药发生率越高(P=0.000)。(4)不同药物品种:总体超说明书用药发生率,系统抗感染药(35.7%)、呼吸系统用药(32.1%)和心血管系统用药(21.8%)较高;抗病毒药物高于抗细菌药物(P=0.000),均主要集中于无儿童用法用量;抗哮喘药高于镇咳祛痰药(P=0.020),前者主要集中于无儿童用法用量,后者主要集中于无给药途径和无儿童用法用量;超禁忌用药见于消化系统用药和其他药物。(5)不同疾病类型:总体超说明书用药发生率由高到低依次为肺炎、重症肺炎、支气管炎、支气管哮喘、其他疾病、咽炎和支气管异物。(6)不同医嘱类型:总体超说明书发生率出院带药医嘱高于住院用药医嘱。(7)Logistic回归分析:与婴儿相比,学龄期+青春期超说明书用药风险降低了20%;与系统抗感染药相比,呼吸系统超说明书用药风险降低了15%;与肺炎相比,其余疾病的超说明书用药风险均有所降低;与高级职称相比,中级职称和初级职称超说明书用药风险降低86%和84%。结论儿科呼吸病房超说明书用药现象普遍存在,无儿童用法用量是最主要的超说明书用药类型,其次为超给药途径。
[Abstract]:Objective to investigate the drug usage of the medical records of pediatric respiratory ward in the first Hospital of Jilin University, and analyze the influencing factors of the drug use. Methods the experimental scheme was designed by cross-sectional study and the principle of equidistant sampling was adopted. From September 2014 to September 2015, 500 consecutive medical records of 18 years old hospitalized in the pediatric respiratory ward of HIS system of our hospital were collected, and all medical orders related to the use of drugs were extracted. The general information of medical records and the information of doctors' orders were collected to judge the overstatement of the medication of each doctor's order, and the analysis was carried out in terms of age, type of drug, disease and type of doctor's order, and so on. Logistic regression analysis was used to analyze the influencing factors of drug use. Results #number0# medical records, including 465 children, were analyzed in this paper. A total of 18 082 medical orders were extracted, 16 618 medical orders in hospital, 1 464 medical orders in hospital and 1 464 medical orders in hospital, involving 196 kinds of drugs. The overdose rate of 500 medical records of respiratory system drugs and systemic antiinfective drugs was 100, and the average medical record was 9.4 prescriptions per patient with 4 717 prescriptions. An average of 1.4 prescriptions per medical record per day. 2) the incidence of overuse and overdose in children was 17.4) twice as high as the total incidence of other types of over-prescriptions. 3) different age periods: total overstatement. There was significant difference in the incidence of drug use in books. The incidence of drug use was higher with age (P < 0. 000). (4) different drug varieties: total drug overdose rate, systemic antiinfective drug 35. 7am, respiratory system drug 32.1) and cardiovascular system medication 21. 8). The antiviral drug was higher than that of the bacteriological drug Pu 0.000, and the antiasthmatic drug was higher than that of the antitussive and expectorant drug (P0. 020), the former was mainly concentrated on the usage of no children, and the latter was mainly concentrated on the route of no administration and the dosage of no children. Supercontraindications are found in digestive system drugs and other drugs.) different types of diseases: the incidence of total superprescriptions from high to low is pneumonia, severe pneumonia, bronchitis, bronchial asthma, and other diseases. Pharyngitis and bronchial foreign body. 6) different types of doctors' orders: the incidence of total overstatement was higher than that of inpatients. Logistic regression analysis: compared with infants, the incidence of total overstatement was higher than that of inpatients. Compared with systemic anti-infective drugs, the risk of over-instruction of respiratory system was reduced by 15 times, compared with pneumonia, the risk of over-specification of other diseases was decreased. Compared with the senior professional titles, the risk of drug use in the intermediate and junior titles was reduced by 86% and 84. Conclusion the phenomenon of drug use in the pediatric respiratory ward is common, and the use of no children is the most important type of drug use. The next is the way of super-administration.
【作者单位】：吉林大学第一医院药学部;
【分类号】：R985

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