本文選題：聯(lián)用　切入點(diǎn)：六西格瑪　出處：《北京中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：目的:目前,臨床中藥注射劑的聯(lián)合使用十分普遍,聯(lián)用的合理性關(guān)系到患者的生命安全。因此,必須加強(qiáng)對(duì)中藥注射劑合理用藥的監(jiān)管,避免由于不合理聯(lián)用引發(fā)的藥物不良事件的發(fā)生。本研究以門診處方點(diǎn)評(píng)為切入點(diǎn),對(duì)中藥注射劑臨床用藥過程實(shí)施監(jiān)測(cè)、評(píng)價(jià)和超常預(yù)警,以初步建立符合臨床實(shí)際、便于操作的藥學(xué)監(jiān)護(hù)范式,確保臨床用藥安全。方法:本研究采用以下2種方法:(1)文獻(xiàn)研究法:查閱相關(guān)文獻(xiàn)及藥品說明書,全面的了解中藥注射劑的配伍禁忌(相互作用)。(2)六西格瑪管理法:通過對(duì)我院門診處方的分析,引入六西格瑪管理理念,制定相應(yīng)的藥學(xué)監(jiān)護(hù)策略。結(jié)果:本研究共抽查門診中藥注射劑處方1487張,干預(yù)前處方合格率97.70%,干預(yù)前不合理聯(lián)用的主要科室是急診、神經(jīng)內(nèi)科。不合理聯(lián)用主要問題是藥品超劑量、溶媒選擇及用量錯(cuò)誤、無間隔液體、同類中藥聯(lián)用。因此,重點(diǎn)針對(duì)這些科室的問題實(shí)施監(jiān)控。通過六西格瑪模式對(duì)我院處方進(jìn)行點(diǎn)評(píng)及干預(yù),使干預(yù)后的處方合格率達(dá)到99.73%。結(jié)論:本研究立足于醫(yī)院中藥注射劑的合理應(yīng)用,開展了醫(yī)院中藥注射劑聯(lián)用的藥學(xué)監(jiān)護(hù)探索工作。通過文獻(xiàn)研究及院內(nèi)的用藥情況調(diào)查,制定了符合臨床實(shí)際、可操作的藥學(xué)監(jiān)護(hù)措施,用于實(shí)踐取得了良好的干預(yù)效果,不僅提高了臨床醫(yī)生安全合理用藥的認(rèn)識(shí),同時(shí)提高了醫(yī)院合理用藥的水平,降低了不良反應(yīng)發(fā)生的風(fēng)險(xiǎn)。由于目前中藥注射劑聯(lián)合應(yīng)用的藥學(xué)監(jiān)護(hù)尚在初始階段,所以本次研究引入六西格瑪管理理念參與制定中藥注射劑臨床聯(lián)用的藥學(xué)監(jiān)護(hù)策略具有創(chuàng)新性。本研究受多種條件限制,存在一定的局限性。今后,隨著我院信息系統(tǒng)的完善,進(jìn)一步深入系統(tǒng)的研究有待繼續(xù)。同時(shí),中藥注射劑的說明書存在諸多問題,這就需要臨床藥師必須對(duì)相關(guān)文獻(xiàn)進(jìn)行實(shí)時(shí)追蹤,確保藥學(xué)監(jiān)護(hù)的實(shí)用性、有效性。
[Abstract]:Objective: at present, the combined use of traditional Chinese medicine injection is very common, and the rationality of the combination is related to the life safety of patients. Therefore, it is necessary to strengthen the supervision on the rational use of traditional Chinese medicine injection. To avoid the occurrence of adverse drug events caused by irrational combination of drugs, this study, based on the outpatient prescription evaluation, carried out monitoring, evaluation and abnormal early warning of the clinical drug use process of traditional Chinese medicine injection, so as to establish a preliminary clinical reality. A convenient pharmacological monitoring paradigm to ensure the safety of clinical drug use. Methods: in this study, the following two methods were used: literature research method: consulting related literature and drug instructions, Comprehensive understanding of traditional Chinese medicine injection compatibility taboo (interaction. 2) six Sigma management method: through the analysis of outpatient prescriptions in our hospital, the introduction of six Sigma management concept, Results: a total of 1487 prescriptions of traditional Chinese medicine injection were randomly checked in this study. The qualified rate of prescriptions before intervention was 97.70. The main department of irrational combination before intervention was emergency department. Department of Neurology. The main problems of irrational combination use are overdose of drugs, wrong choice and dosage of solvent, no interval liquid, combined use of the same kind of traditional Chinese medicine. Through the six Sigma model, the prescription qualification rate of our hospital reached 99.733.Conclusion: this study is based on the rational application of traditional Chinese medicine injection in hospital. Through the literature study and the investigation of the drug use in the hospital, the pharmaceutical monitoring measures which accord with the clinical practice and can be operated have been formulated, and the good intervention effect has been obtained in the practice. It not only improves the understanding of safe and rational use of drugs by clinicians, but also raises the level of rational use of drugs in hospitals and reduces the risk of adverse reactions. At present, the pharmaceutical monitoring of the combined application of traditional Chinese medicine injections is still in the initial stage. Therefore, this study introduces six Sigma management concept to participate in the formulation of traditional Chinese medicine injection clinical combined pharmaceutical monitoring strategy is innovative. This study is limited by a variety of conditions, there are certain limitations. In the future, with the improvement of information system in our hospital, At the same time, there are many problems in the specification of traditional Chinese medicine injection, which requires clinical pharmacists to track the relevant documents in real time to ensure the practicability and effectiveness of pharmaceutical monitoring.
【學(xué)位授予單位】：北京中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R288

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