【摘要】目的(de)探討靜脈(mo)(mo)用藥調(diao)配中(zhong)心(xin)開展(zhan)精(jing)(jing)(jing)細化(hua)管理對(dui)輸(shu)液質(zhi)量安(an)全的(de)影響。方(fang)法隨機選取2018-01至(zhi)2018-12濱州醫學院(yuan)附屬醫院(yuan)靜脈(mo)(mo)用藥調(diao)配科200張處方(fang)為對(dui)照(zhao)(zhao)組(zu)，對(dui)照(zhao)(zhao)組(zu)為靜脈(mo)(mo)用藥調(diao)配中(zhong)心(xin)精(jing)(jing)(jing)細化(hua)管理前階段；隨機選取2019-01至(zhi)2019-12我科200張處方(fang)為研(yan)究組(zu)，研(yan)究組(zu)為精(jing)(jing)(jing)細化(hua)管理后(hou)階段。比較兩組(zu)不(bu)合格(ge)處方(fang)檢出率(lv)、科室人員(yuan)專業知(zhi)(zhi)識與(yu)操作(zuo)(zuo)考(kao)核成績(ji)優良(liang)率(lv)、靜脈(mo)(mo)用藥調(diao)配中(zhong)心(xin)差(cha)錯(cuo)(cuo)事件發生率(lv)。結果(guo)研(yan)究組(zu)不(bu)合格(ge)處方(fang)檢出率(lv)低于對(dui)照(zhao)(zhao)組(zu)，差(cha)異有(you)統計(ji)學意義(yi)(yi)（P<0.05）；研(yan)究組(zu)科室人員(yuan)專業知(zhi)(zhi)識與(yu)操作(zuo)(zuo)考(kao)核優良(liang)率(lv)高于對(dui)照(zhao)(zhao)組(zu)，靜脈(mo)(mo)用藥調(diao)配中(zhong)心(xin)差(cha)錯(cuo)(cuo)事件發生率(lv)低于對(dui)照(zhao)(zhao)組(zu)，差(cha)異均有(you)統計(ji)學意義(yi)(yi)（P<0.05）。結論靜脈(mo)(mo)用藥調(diao)配中(zhong)心(xin)開展(zhan)精(jing)(jing)(jing)細化(hua)管理對(dui)輸(shu)液質(zhi)量安(an)全有(you)積極影響，可(ke)有(you)效提高科室人員(yuan)專業知(zhi)(zhi)識與(yu)操作(zuo)(zuo)水(shui)平，并降(jiang)低其(qi)靜脈(mo)(mo)用藥調(diao)配中(zhong)心(xin)差(cha)錯(cuo)(cuo)事件發生率(lv)，減少(shao)不(bu)合格(ge)處方(fang)，保證(zheng)輸(shu)液質(zhi)量與(yu)患者安(an)全。

【關鍵詞(ci)】靜脈用藥；精(jing)細化管理；輸液(ye)質量(liang)

近(jin)年來(lai)，隨著靜(jing)脈(mo)用(yong)藥調(diao)配中(zhong)(zhong)心在國(guo)內各級醫院的推廣，規范化(hua)(hua)、精(jing)細化(hua)(hua)管(guan)理(li)(li)(li)逐漸成為(wei)了(le)靜(jing)脈(mo)用(yong)藥調(diao)配中(zhong)(zhong)心工(gong)作的重要(yao)內容(rong)，而可(ke)行(xing)性(xing)(xing)高、合理(li)(li)(li)科學的管(guan)理(li)(li)(li)模式也是靜(jing)脈(mo)用(yong)藥調(diao)配中(zhong)(zhong)心正常運行(xing)的重要(yao)前(qian)提，因而制定(ding)出一套(tao)(tao)靜(jing)脈(mo)用(yong)藥調(diao)配中(zhong)(zhong)心精(jing)細化(hua)(hua)管(guan)理(li)(li)(li)模式十分(fen)(fen)必要(yao)，對于(yu)患(huan)者輸液(ye)質量及安(an)全性(xing)(xing)均(jun)有重要(yao)臨床意(yi)義[1]。為(wei)此，筆者在醫院靜(jing)脈(mo)用(yong)藥調(diao)配中(zhong)(zhong)心中(zhong)(zhong)即(ji)結合科室條件建立了(le)一套(tao)(tao)精(jing)細化(hua)(hua)管(guan)理(li)(li)(li)方案，取(qu)得良好效果。為(wei)證(zheng)明筆者靜(jing)脈(mo)用(yong)藥調(diao)配中(zhong)(zhong)心精(jing)細化(hua)(hua)管(guan)理(li)(li)(li)方案的可(ke)行(xing)性(xing)(xing)與優越性(xing)(xing)，以指導臨床應用(yong)，特(te)運用(yong)回顧性(xing)(xing)分(fen)(fen)析(xi)方法，對靜(jing)脈(mo)用(yong)藥調(diao)配中(zhong)(zhong)心精(jing)細化(hua)(hua)管(guan)理(li)(li)(li)前(qian)、后的輸液(ye)安(an)全性(xing)(xing)，以及科室人員專業(ye)水平變(bian)化(hua)(hua)進行(xing)自(zi)體對照分(fen)(fen)析(xi)，現報道如下。

1資料與方法

1.1一(yi)般資(zi)料(liao)。隨機選取2018-01至(zhi)2018-12濱(bin)州(zhou)醫(yi)(yi)(yi)學院(yuan)附屬醫(yi)(yi)(yi)院(yuan)靜(jing)(jing)(jing)(jing)(jing)(jing)(jing)脈(mo)(mo)(mo)(mo)用(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)調(diao)(diao)配(pei)(pei)(pei)(pei)(pei)(pei)(pei)(pei)(pei)(pei)科(ke)(ke)200張處(chu)(chu)方(fang)(fang)(fang)為(wei)(wei)對(dui)(dui)照(zhao)(zhao)組，對(dui)(dui)照(zhao)(zhao)組為(wei)(wei)靜(jing)(jing)(jing)(jing)(jing)(jing)(jing)脈(mo)(mo)(mo)(mo)用(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)調(diao)(diao)配(pei)(pei)(pei)(pei)(pei)(pei)(pei)(pei)(pei)(pei)中(zhong)(zhong)(zhong)心(xin)(xin)(xin)(xin)精(jing)(jing)(jing)細(xi)化(hua)(hua)(hua)管(guan)理(li)(li)(li)(li)前(qian)階(jie)段(duan)；隨機選取2019-01至(zhi)2019-12我科(ke)(ke)200張處(chu)(chu)方(fang)(fang)(fang)為(wei)(wei)研究(jiu)組，研究(jiu)組為(wei)(wei)精(jing)(jing)(jing)細(xi)化(hua)(hua)(hua)管(guan)理(li)(li)(li)(li)后階(jie)段(duan)。根據科(ke)(ke)室條(tiao)件(jian)(jian)為(wei)(wei)靜(jing)(jing)(jing)(jing)(jing)(jing)(jing)脈(mo)(mo)(mo)(mo)用(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)調(diao)(diao)配(pei)(pei)(pei)(pei)(pei)(pei)(pei)(pei)(pei)(pei)中(zhong)(zhong)(zhong)心(xin)(xin)(xin)(xin)建立一(yi)套精(jing)(jing)(jing)細(xi)化(hua)(hua)(hua)管(guan)理(li)(li)(li)(li)方(fang)(fang)(fang)案。所有(you)患者均(jun)已簽(qian)署知(zhi)情同意(yi)書，同意(yi)參與(yu)(yu)(yu)本研究(jiu)。1.2納(na)入(ru)(ru)與(yu)(yu)(yu)排(pai)除標(biao)準(zhun)。納(na)入(ru)(ru)標(biao)準(zhun)：（1）精(jing)(jing)(jing)細(xi)化(hua)(hua)(hua)管(guan)理(li)(li)(li)(li)前(qian)后兩個(ge)(ge)(ge)(ge)時(shi)(shi)(shi)間(jian)(jian)(jian)段(duan)的(de)(de)(de)(de)(de)(de)氣(qi)候、季節(jie)等(deng)(deng)變(bian)化(hua)(hua)(hua)不(bu)大，誤(wu)差(cha)較小；（2）精(jing)(jing)(jing)細(xi)化(hua)(hua)(hua)管(guan)理(li)(li)(li)(li)前(qian)、管(guan)理(li)(li)(li)(li)后的(de)(de)(de)(de)(de)(de)科(ke)(ke)室工(gong)(gong)作(zuo)人(ren)員(yuan)(yuan)(yuan)(yuan)均(jun)為(wei)(wei)40名(ming)，前(qian)后無(wu)(wu)變(bian)化(hua)(hua)(hua)；（3）輸(shu)(shu)液(ye)(ye)(ye)(ye)處(chu)(chu)方(fang)(fang)(fang)以(yi)及(ji)(ji)差(cha)錯(cuo)記(ji)錄等(deng)(deng)相(xiang)關資(zi)料(liao)完整無(wu)(wu)缺。排(pai)除標(biao)準(zhun)：（1）抽選的(de)(de)(de)(de)(de)(de)處(chu)(chu)方(fang)(fang)(fang)資(zi)料(liao)不(bu)詳；（2）科(ke)(ke)室工(gong)(gong)作(zuo)人(ren)員(yuan)(yuan)(yuan)(yuan)有(you)變(bian)動；（3）靜(jing)(jing)(jing)(jing)(jing)(jing)(jing)脈(mo)(mo)(mo)(mo)用(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)調(diao)(diao)配(pei)(pei)(pei)(pei)(pei)(pei)(pei)(pei)(pei)(pei)中(zhong)(zhong)(zhong)心(xin)(xin)(xin)(xin)負責(ze)的(de)(de)(de)(de)(de)(de)病區(qu)(qu)有(you)變(bian)動。1.3方(fang)(fang)(fang)法(fa)。1.3.1精(jing)(jing)(jing)細(xi)化(hua)(hua)(hua)處(chu)(chu)方(fang)(fang)(fang)審核(he)(he)。（1）在科(ke)(ke)室靜(jing)(jing)(jing)(jing)(jing)(jing)(jing)脈(mo)(mo)(mo)(mo)用(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)調(diao)(diao)配(pei)(pei)(pei)(pei)(pei)(pei)(pei)(pei)(pei)(pei)中(zhong)(zhong)(zhong)心(xin)(xin)(xin)(xin)中(zhong)(zhong)(zhong)設(she)(she)計(ji)(ji)(ji)(ji)出(chu)合(he)理(li)(li)(li)(li)的(de)(de)(de)(de)(de)(de)輸(shu)(shu)液(ye)(ye)(ye)(ye)用(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)軟件(jian)(jian)，仔(zi)細(xi)查詢藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)物(wu)(wu)之間(jian)(jian)(jian)配(pei)(pei)(pei)(pei)(pei)(pei)(pei)(pei)(pei)(pei)伍禁忌、藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)物(wu)(wu)作(zuo)用(yong)(yong)、用(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)途徑等(deng)(deng)自動審核(he)(he)及(ji)(ji)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)物(wu)(wu)信息(xi)(xi)；（2）審核(he)(he)處(chu)(chu)方(fang)(fang)(fang)時(shi)(shi)(shi)，應(ying)根據個(ge)(ge)(ge)(ge)人(ren)臨(lin)床(chuang)(chuang)經驗(yan)、工(gong)(gong)具(ju)書與(yu)(yu)(yu)說明(ming)書，特別(bie)是主(zhu)管(guan)護(hu)師職稱以(yi)上工(gong)(gong)作(zuo)人(ren)員(yuan)(yuan)(yuan)(yuan)，應(ying)對(dui)(dui)靜(jing)(jing)(jing)(jing)(jing)(jing)(jing)脈(mo)(mo)(mo)(mo)用(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)具(ju)備多(duo)年、豐富的(de)(de)(de)(de)(de)(de)實踐(jian)經驗(yan)；（3）安(an)排(pai)主(zhu)管(guan)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)師與(yu)(yu)(yu)主(zhu)管(guan)護(hu)師聯合(he)審核(he)(he)處(chu)(chu)方(fang)(fang)(fang)，全面(mian)發(fa)(fa)(fa)揮藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)劑(ji)(ji)(ji)人(ren)員(yuan)(yuan)(yuan)(yuan)對(dui)(dui)于藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)物(wu)(wu)性狀(zhuang)、配(pei)(pei)(pei)(pei)(pei)(pei)(pei)(pei)(pei)(pei)伍、作(zuo)用(yong)(yong)的(de)(de)(de)(de)(de)(de)了解，明(ming)確(que)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)學法(fa)律優(you)勢，并(bing)(bing)能(neng)互相(xiang)取長補(bu)短(duan)，同醫(yi)(yi)(yi)護(hu)人(ren)員(yuan)(yuan)(yuan)(yuan)之間(jian)(jian)(jian)能(neng)夠快速、有(you)效(xiao)(xiao)溝通，降(jiang)低(di)差(cha)錯(cuo)事(shi)件(jian)(jian)發(fa)(fa)(fa)生(sheng)率(lv)(lv)，降(jiang)低(di)輸(shu)(shu)液(ye)(ye)(ye)(ye)處(chu)(chu)方(fang)(fang)(fang)不(bu)合(he)格(ge)情況發(fa)(fa)(fa)生(sheng)率(lv)(lv)。1.3.2精(jing)(jing)(jing)細(xi)化(hua)(hua)(hua)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)管(guan)理(li)(li)(li)(li)（1）對(dui)(dui)針劑(ji)(ji)(ji)及(ji)(ji)輸(shu)(shu)液(ye)(ye)(ye)(ye)體(ti)制(zhi)(zhi)(zhi)管(guan)理(li)(li)(li)(li)模式進(jin)(jin)(jin)(jin)(jin)(jin)行(xing)改(gai)革，實現開放式管(guan)理(li)(li)(li)(li)、分(fen)(fen)(fen)類上架、分(fen)(fen)(fen)區(qu)(qu)域管(guan)理(li)(li)(li)(li)，保(bao)(bao)證排(pai)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)更快捷(jie)、方(fang)(fang)(fang)便、準(zhun)確(que)。對(dui)(dui)于針劑(ji)(ji)(ji)則安(an)排(pai)專(zhuan)(zhuan)(zhuan)人(ren)管(guan)理(li)(li)(li)(li)，以(yi)科(ke)(ke)室為(wei)(wei)單位(wei)(wei)發(fa)(fa)(fa)放、擺置藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)，保(bao)(bao)證藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)物(wu)(wu)規格(ge)無(wu)(wu)誤(wu)，對(dui)(dui)醫(yi)(yi)(yi)院(yuan)、患者負責(ze)，并(bing)(bing)加入(ru)(ru)核(he)(he)對(dui)(dui)環(huan)(huan)節(jie)，降(jiang)低(di)差(cha)錯(cuo)事(shi)件(jian)(jian)發(fa)(fa)(fa)生(sheng)率(lv)(lv)；（2）可(ke)運(yun)用(yong)(yong)靜(jing)(jing)(jing)(jing)(jing)(jing)(jing)脈(mo)(mo)(mo)(mo)用(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)調(diao)(diao)配(pei)(pei)(pei)(pei)(pei)(pei)(pei)(pei)(pei)(pei)中(zhong)(zhong)(zhong)心(xin)(xin)(xin)(xin)的(de)(de)(de)(de)(de)(de)信息(xi)(xi)系統管(guan)理(li)(li)(li)(li)針劑(ji)(ji)(ji)，如(ru)按貨(huo)位(wei)(wei)號(hao)定(ding)(ding)位(wei)(wei)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)，可(ke)按照(zhao)(zhao)如(ru)下(xia)分(fen)(fen)(fen)類管(guan)理(li)(li)(li)(li)：貴(gui)重藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)、冷藏藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)、高(gao)(gao)危(wei)(wei)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)。對(dui)(dui)于高(gao)(gao)危(wei)(wei)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)以(yi)及(ji)(ji)外(wai)觀(guan)相(xiang)似容易混淆(xiao)的(de)(de)(de)(de)(de)(de)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)進(jin)(jin)(jin)(jin)(jin)(jin)行(xing)定(ding)(ding)位(wei)(wei)防(fang)治，并(bing)(bing)予以(yi)“雙標(biao)識”作(zuo)為(wei)(wei)特殊記(ji)號(hao)，實現“前(qian)饋控(kong)制(zhi)(zhi)(zhi)”，降(jiang)低(di)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)輸(shu)(shu)錯(cuo)等(deng)(deng)差(cha)錯(cuo)事(shi)件(jian)(jian)發(fa)(fa)(fa)生(sheng)率(lv)(lv)。在醫(yi)(yi)(yi)院(yuan)建立低(di)溫保(bao)(bao)存(cun)(cun)(cun)區(qu)(qu)，靜(jing)(jing)(jing)(jing)(jing)(jing)(jing)脈(mo)(mo)(mo)(mo)用(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)調(diao)(diao)配(pei)(pei)(pei)(pei)(pei)(pei)(pei)(pei)(pei)(pei)中(zhong)(zhong)(zhong)心(xin)(xin)(xin)(xin)中(zhong)(zhong)(zhong)需要(yao)低(di)溫保(bao)(bao)存(cun)(cun)(cun)的(de)(de)(de)(de)(de)(de)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)物(wu)(wu)有(you)20余種(zhong)，可(ke)設(she)(she)置低(di)溫保(bao)(bao)存(cun)(cun)(cun)區(qu)(qu)域，購(gou)買冷藏箱，以(yi)實時(shi)(shi)(shi)監控(kong)溫度(du)(du)(du)，及(ji)(ji)時(shi)(shi)(shi)調(diao)(diao)整，保(bao)(bao)證低(di)溫保(bao)(bao)存(cun)(cun)(cun)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)的(de)(de)(de)(de)(de)(de)質量(liang)，最大限度(du)(du)(du)地(di)預防(fang)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)效(xiao)(xiao)受(shou)損；（3）設(she)(she)置高(gao)(gao)危(wei)(wei)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)標(biao)識十分(fen)(fen)(fen)必要(yao)，可(ke)分(fen)(fen)(fen)類為(wei)(wei)A級、B級、C級，設(she)(she)置醒目識貼(tie)，擺藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)時(shi)(shi)(shi)設(she)(she)置擺藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)貼(tie)，并(bing)(bing)保(bao)(bao)證專(zhuan)(zhuan)(zhuan)袋(dai)包(bao)裝(zhuang)、專(zhuan)(zhuan)(zhuan)箱配(pei)(pei)(pei)(pei)(pei)(pei)(pei)(pei)(pei)(pei)送(song)(song)。1.3.3精(jing)(jing)(jing)細(xi)化(hua)(hua)(hua)調(diao)(diao)配(pei)(pei)(pei)(pei)(pei)(pei)(pei)(pei)(pei)(pei)管(guan)理(li)(li)(li)(li)。（1）醫(yi)(yi)(yi)院(yuan)感(gan)染預防(fang)管(guan)理(li)(li)(li)(li)。成(cheng)立領導管(guan)理(li)(li)(li)(li)小組，完善靜(jing)(jing)(jing)(jing)(jing)(jing)(jing)脈(mo)(mo)(mo)(mo)用(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)相(xiang)關制(zhi)(zhi)(zhi)度(du)(du)(du)，落實領導小組各個(ge)(ge)(ge)(ge)成(cheng)員(yuan)(yuan)(yuan)(yuan)的(de)(de)(de)(de)(de)(de)職責(ze)，并(bing)(bing)檢(jian)(jian)(jian)查醫(yi)(yi)(yi)院(yuan)感(gan)染管(guan)理(li)(li)(li)(li)工(gong)(gong)作(zuo)落實各項(xiang)(xiang)預防(fang)院(yuan)內感(gan)染的(de)(de)(de)(de)(de)(de)制(zhi)(zhi)(zhi)度(du)(du)(du)，包(bao)括規范無(wu)(wu)菌化(hua)(hua)(hua)操(cao)(cao)作(zuo)流(liu)程(cheng)、各級層流(liu)環(huan)(huan)境(jing)清潔(jie)度(du)(du)(du)達標(biao)、每日(ri)消毒層流(liu)操(cao)(cao)作(zuo)臺與(yu)(yu)(yu)配(pei)(pei)(pei)(pei)(pei)(pei)(pei)(pei)(pei)(pei)制(zhi)(zhi)(zhi)間(jian)(jian)(jian)物(wu)(wu)品(pin)(pin)(pin)(pin)、每日(ri)清潔(jie)地(di)面(mian)、記(ji)錄紫外(wai)線燈管(guan)更換日(ri)期以(yi)及(ji)(ji)輻射(she)強度(du)(du)(du)。同時(shi)(shi)(shi)，注(zhu)意(yi)每個(ge)(ge)(ge)(ge)月進(jin)(jin)(jin)(jin)(jin)(jin)行(xing)一(yi)次醫(yi)(yi)(yi)務人(ren)員(yuan)(yuan)(yuan)(yuan)手衛生(sheng)檢(jian)(jian)(jian)測(ce)、物(wu)(wu)體(ti)表(biao)面(mian)細(xi)菌檢(jian)(jian)(jian)測(ce)和空氣(qi)細(xi)菌檢(jian)(jian)(jian)測(ce)，一(yi)旦(dan)超標(biao)則立即查找原因(yin)(yin)，解決問(wen)(wen)題(ti)后再次進(jin)(jin)(jin)(jin)(jin)(jin)行(xing)檢(jian)(jian)(jian)測(ce)，并(bing)(bing)做(zuo)好(hao)記(ji)錄工(gong)(gong)作(zuo)。（2）藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)配(pei)(pei)(pei)(pei)(pei)(pei)(pei)(pei)(pei)(pei)置精(jing)(jing)(jing)細(xi)化(hua)(hua)(hua)管(guan)理(li)(li)(li)(li)。首先，工(gong)(gong)作(zuo)人(ren)員(yuan)(yuan)(yuan)(yuan)應(ying)注(zhu)意(yi)配(pei)(pei)(pei)(pei)(pei)(pei)(pei)(pei)(pei)(pei)制(zhi)(zhi)(zhi)時(shi)(shi)(shi)間(jian)(jian)(jian)、順序(xu)等(deng)(deng)問(wen)(wen)題(ti)，輸(shu)(shu)液(ye)(ye)(ye)(ye)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)物(wu)(wu)溶解后不(bu)穩(wen)定(ding)(ding)或(huo)(huo)存(cun)(cun)(cun)在時(shi)(shi)(shi)間(jian)(jian)(jian)要(yao)求(qiu)，如(ru)抗腫瘤藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)物(wu)(wu)、注(zhu)射(she)用(yong)(yong)中(zhong)(zhong)(zhong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)制(zhi)(zhi)(zhi)劑(ji)(ji)(ji)、質子泵抑制(zhi)(zhi)(zhi)劑(ji)(ji)(ji)等(deng)(deng)，需要(yao)在限定(ding)(ding)時(shi)(shi)(shi)間(jian)(jian)(jian)內應(ying)用(yong)(yong)或(huo)(huo)現配(pei)(pei)(pei)(pei)(pei)(pei)(pei)(pei)(pei)(pei)用(yong)(yong)，因(yin)(yin)而輸(shu)(shu)液(ye)(ye)(ye)(ye)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)對(dui)(dui)于配(pei)(pei)(pei)(pei)(pei)(pei)(pei)(pei)(pei)(pei)送(song)(song)時(shi)(shi)(shi)間(jian)(jian)(jian)與(yu)(yu)(yu)配(pei)(pei)(pei)(pei)(pei)(pei)(pei)(pei)(pei)(pei)制(zhi)(zhi)(zhi)時(shi)(shi)(shi)間(jian)(jian)(jian)均(jun)有(you)嚴格(ge)要(yao)求(qiu)。工(gong)(gong)作(zuo)人(ren)員(yuan)(yuan)(yuan)(yuan)與(yu)(yu)(yu)各個(ge)(ge)(ge)(ge)網(wang)絡中(zhong)(zhong)(zhong)心(xin)(xin)(xin)(xin)、臨(lin)床(chuang)(chuang)科(ke)(ke)室部門充(chong)分(fen)(fen)(fen)討論與(yu)(yu)(yu)協調(diao)(diao)，為(wei)(wei)有(you)特殊要(yao)求(qiu)的(de)(de)(de)(de)(de)(de)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)設(she)(she)計(ji)(ji)(ji)(ji)一(yi)套管(guan)理(li)(li)(li)(li)流(liu)程(cheng)，保(bao)(bao)證藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)物(wu)(wu)配(pei)(pei)(pei)(pei)(pei)(pei)(pei)(pei)(pei)(pei)制(zhi)(zhi)(zhi)、靜(jing)(jing)(jing)(jing)(jing)(jing)(jing)脈(mo)(mo)(mo)(mo)用(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)時(shi)(shi)(shi)間(jian)(jian)(jian)均(jun)合(he)理(li)(li)(li)(li)。同時(shi)(shi)(shi)，危(wei)(wei)害性高(gao)(gao)、需要(yao)避光或(huo)(huo)者冷藏儲(chu)存(cun)(cun)(cun)的(de)(de)(de)(de)(de)(de)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)，以(yi)及(ji)(ji)非整袋(dai)或(huo)(huo)整只(zhi)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)，應(ying)利用(yong)(yong)靜(jing)(jing)(jing)(jing)(jing)(jing)(jing)脈(mo)(mo)(mo)(mo)用(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)調(diao)(diao)配(pei)(pei)(pei)(pei)(pei)(pei)(pei)(pei)(pei)(pei)中(zhong)(zhong)(zhong)心(xin)(xin)(xin)(xin)網(wang)絡系統，在輸(shu)(shu)液(ye)(ye)(ye)(ye)卡標(biao)簽(qian)下(xia)方(fang)(fang)(fang)標(biao)注(zhu)漢(han)字，在提示(shi)靜(jing)(jing)(jing)(jing)(jing)(jing)(jing)脈(mo)(mo)(mo)(mo)用(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)調(diao)(diao)配(pei)(pei)(pei)(pei)(pei)(pei)(pei)(pei)(pei)(pei)中(zhong)(zhong)(zhong)心(xin)(xin)(xin)(xin)各個(ge)(ge)(ge)(ge)工(gong)(gong)作(zuo)環(huan)(huan)節(jie)的(de)(de)(de)(de)(de)(de)同時(shi)(shi)(shi)，提醒醫(yi)(yi)(yi)護(hu)人(ren)員(yuan)(yuan)(yuan)(yuan)合(he)理(li)(li)(li)(li)用(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)，做(zuo)好(hao)防(fang)護(hu)工(gong)(gong)作(zuo)。（3）藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)配(pei)(pei)(pei)(pei)(pei)(pei)(pei)(pei)(pei)(pei)制(zhi)(zhi)(zhi)質量(liang)管(guan)理(li)(li)(li)(li)。對(dui)(dui)于兒(er)科(ke)(ke)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)物(wu)(wu)，應(ying)參考藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)物(wu)(wu)劑(ji)(ji)(ji)量(liang)換算表(biao)進(jin)(jin)(jin)(jin)(jin)(jin)行(xing)配(pei)(pei)(pei)(pei)(pei)(pei)(pei)(pei)(pei)(pei)制(zhi)(zhi)(zhi)，且工(gong)(gong)作(zuo)人(ren)員(yuan)(yuan)(yuan)(yuan)應(ying)經過培(pei)訓后上崗，且可(ke)設(she)(she)定(ding)(ding)“專(zhuan)(zhuan)(zhuan)人(ren)配(pei)(pei)(pei)(pei)(pei)(pei)(pei)(pei)(pei)(pei)制(zhi)(zhi)(zhi)”管(guan)理(li)(li)(li)(li)方(fang)(fang)(fang)法(fa)；對(dui)(dui)于抗腫瘤藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)物(wu)(wu)，應(ying)對(dui)(dui)醫(yi)(yi)(yi)院(yuan)常用(yong)(yong)的(de)(de)(de)(de)(de)(de)化(hua)(hua)(hua)療藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)物(wu)(wu)方(fang)(fang)(fang)案進(jin)(jin)(jin)(jin)(jin)(jin)行(xing)總結，并(bing)(bing)將(jiang)每一(yi)項(xiang)(xiang)化(hua)(hua)(hua)療藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)物(wu)(wu)方(fang)(fang)(fang)案的(de)(de)(de)(de)(de)(de)用(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)時(shi)(shi)(shi)間(jian)(jian)(jian)、藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)、用(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)順序(xu)、溶媒、配(pei)(pei)(pei)(pei)(pei)(pei)(pei)(pei)(pei)(pei)制(zhi)(zhi)(zhi)方(fang)(fang)(fang)法(fa)等(deng)(deng)打印成(cheng)稿(gao)，便于工(gong)(gong)作(zuo)人(ren)員(yuan)(yuan)(yuan)(yuan)隨時(shi)(shi)(shi)查閱，保(bao)(bao)證藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)物(wu)(wu)配(pei)(pei)(pei)(pei)(pei)(pei)(pei)(pei)(pei)(pei)制(zhi)(zhi)(zhi)準(zhun)確(que)性、一(yi)致性，提升靜(jing)(jing)(jing)(jing)(jing)(jing)(jing)脈(mo)(mo)(mo)(mo)用(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)調(diao)(diao)配(pei)(pei)(pei)(pei)(pei)(pei)(pei)(pei)(pei)(pei)中(zhong)(zhong)(zhong)心(xin)(xin)(xin)(xin)誠信度(du)(du)(du)。（4）包(bao)裝(zhuang)與(yu)(yu)(yu)配(pei)(pei)(pei)(pei)(pei)(pei)(pei)(pei)(pei)(pei)送(song)(song)管(guan)理(li)(li)(li)(li)。將(jiang)輸(shu)(shu)液(ye)(ye)(ye)(ye)成(cheng)品(pin)(pin)(pin)(pin)裝(zhuang)入(ru)(ru)規格(ge)病區(qu)(qu)專(zhuan)(zhuan)(zhuan)用(yong)(yong)的(de)(de)(de)(de)(de)(de)、密封良(liang)(liang)好(hao)的(de)(de)(de)(de)(de)(de)送(song)(song)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)車，且在加封條(tiao)后安(an)排(pai)工(gong)(gong)人(ren)遞送(song)(song)。送(song)(song)達時(shi)(shi)(shi)應(ying)與(yu)(yu)(yu)病區(qu)(qu)的(de)(de)(de)(de)(de)(de)醫(yi)(yi)(yi)療護(hu)士進(jin)(jin)(jin)(jin)(jin)(jin)行(xing)書面(mian)性交(jiao)接，注(zhu)明(ming)送(song)(song)達時(shi)(shi)(shi)間(jian)(jian)(jian)后簽(qian)名(ming)，將(jiang)問(wen)(wen)題(ti)發(fa)(fa)(fa)生(sheng)原因(yin)(yin)、處(chu)(chu)理(li)(li)(li)(li)方(fang)(fang)(fang)法(fa)與(yu)(yu)(yu)協調(diao)(diao)時(shi)(shi)(shi)間(jian)(jian)(jian)等(deng)(deng)以(yi)書面(mian)形式發(fa)(fa)(fa)送(song)(song)至(zhi)各個(ge)(ge)(ge)(ge)病區(qu)(qu)。1.4觀(guan)察指標(biao)。（1）不(bu)合(he)格(ge)處(chu)(chu)方(fang)(fang)(fang)：統計(ji)(ji)(ji)(ji)兩組不(bu)合(he)格(ge)處(chu)(chu)方(fang)(fang)(fang)檢(jian)(jian)(jian)出(chu)率(lv)(lv)。（2）科(ke)(ke)室人(ren)員(yuan)(yuan)(yuan)(yuan)專(zhuan)(zhuan)(zhuan)業(ye)知(zhi)識與(yu)(yu)(yu)操(cao)(cao)作(zuo)考核(he)(he)成(cheng)績：對(dui)(dui)研究(jiu)組、對(dui)(dui)照(zhao)(zhao)組兩個(ge)(ge)(ge)(ge)時(shi)(shi)(shi)期的(de)(de)(de)(de)(de)(de)科(ke)(ke)室人(ren)員(yuan)(yuan)(yuan)(yuan)進(jin)(jin)(jin)(jin)(jin)(jin)行(xing)專(zhuan)(zhuan)(zhuan)業(ye)知(zhi)識、操(cao)(cao)作(zuo)水平(ping)考核(he)(he)，總分(fen)(fen)(fen)采用(yong)(yong)百分(fen)(fen)(fen)制(zhi)(zhi)(zhi)，得分(fen)(fen)(fen)越高(gao)(gao)表(biao)示(shi)水平(ping)越高(gao)(gao)，其中(zhong)(zhong)(zhong)≥90分(fen)(fen)(fen)為(wei)(wei)優(you)秀，80~89分(fen)(fen)(fen)為(wei)(wei)良(liang)(liang)好(hao)，60~79分(fen)(fen)(fen)為(wei)(wei)及(ji)(ji)格(ge)，<60分(fen)(fen)(fen)為(wei)(wei)不(bu)及(ji)(ji)格(ge)。科(ke)(ke)室人(ren)員(yuan)(yuan)(yuan)(yuan)專(zhuan)(zhuan)(zhuan)業(ye)知(zhi)識與(yu)(yu)(yu)操(cao)(cao)作(zuo)考核(he)(he)優(you)良(liang)(liang)率(lv)(lv)=（優(you)秀+良(liang)(liang)好(hao)）/40×100.0%。（3）靜(jing)(jing)(jing)(jing)(jing)(jing)(jing)脈(mo)(mo)(mo)(mo)用(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)調(diao)(diao)配(pei)(pei)(pei)(pei)(pei)(pei)(pei)(pei)(pei)(pei)中(zhong)(zhong)(zhong)心(xin)(xin)(xin)(xin)差(cha)錯(cuo)事(shi)件(jian)(jian)發(fa)(fa)(fa)生(sheng)率(lv)(lv)：搜集兩組審方(fang)(fang)(fang)、貼(tie)簽(qian)、擺藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)、調(diao)(diao)配(pei)(pei)(pei)(pei)(pei)(pei)(pei)(pei)(pei)(pei)、停醫(yi)(yi)(yi)囑退(tui)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)、成(cheng)品(pin)(pin)(pin)(pin)輸(shu)(shu)液(ye)(ye)(ye)(ye)發(fa)(fa)(fa)放等(deng)(deng)差(cha)錯(cuo)事(shi)件(jian)(jian)相(xiang)關數據，統計(ji)(ji)(ji)(ji)靜(jing)(jing)(jing)(jing)(jing)(jing)(jing)脈(mo)(mo)(mo)(mo)用(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)調(diao)(diao)配(pei)(pei)(pei)(pei)(pei)(pei)(pei)(pei)(pei)(pei)中(zhong)(zhong)(zhong)心(xin)(xin)(xin)(xin)差(cha)錯(cuo)事(shi)件(jian)(jian)發(fa)(fa)(fa)生(sheng)率(lv)(lv)。1.5統計(ji)(ji)(ji)(ji)學處(chu)(chu)理(li)(li)(li)(li)。采用(yong)(yong)SPSS22.0軟件(jian)(jian)進(jin)(jin)(jin)(jin)(jin)(jin)行(xing)統計(ji)(ji)(ji)(ji)分(fen)(fen)(fen)析，計(ji)(ji)(ji)(ji)數資(zi)料(liao)用(yong)(yong)率(lv)(lv)表(biao)示(shi)，組間(jian)(jian)(jian)比較采用(yong)(yong)Pearsonχ2檢(jian)(jian)(jian)驗(yan)，以(yi)P<0.05為(wei)(wei)差(cha)異有(you)統計(ji)(ji)(ji)(ji)學意(yi)義。

2結果

2011年3月(yue)1日國家頒(ban)布(bu)新(xin)的(de)《醫(yi)(yi)療機(ji)構(gou)藥(yao)(yao)(yao)事(shi)管理(li)規定(ding)》中明確規定(ding)醫(yi)(yi)療機(ji)構(gou)應當(dang)建立臨(lin)床(chuang)(chuang)藥(yao)(yao)(yao)師(shi)制(zhi)度，配備專職(zhi)(zhi)臨(lin)床(chuang)(chuang)藥(yao)(yao)(yao)師(shi)，參與(yu)臨(lin)床(chuang)(chuang)藥(yao)(yao)(yao)物(wu)治療方案設計(ji);對(dui)病人進(jin)(jin)行(xing)安全用(yong)藥(yao)(yao)(yao)指導(dao)，實(shi)施治療藥(yao)(yao)(yao)物(wu)監測，指導(dao)合理(li)用(yong)藥(yao)(yao)(yao);對(dui)處方和用(yong)藥(yao)(yao)(yao)醫(yi)(yi)囑進(jin)(jin)行(xing)適宜性審核(he);收集藥(yao)(yao)(yao)物(wu)安全性和有效性等信息，建立臨(lin)床(chuang)(chuang)藥(yao)(yao)(yao)學(xue)(xue)信息系統，提(ti)供用(yong)藥(yao)(yao)(yao)咨詢(xun)服(fu)務等〔1－2〕。我(wo)院是一所(suo)有400張床(chuang)(chuang)位的(de)二級(ji)甲等醫(yi)(yi)院，從2006年開(kai)始(shi)，我(wo)們抽(chou)出1名具有高級(ji)技術職(zhi)(zhi)稱的(de)藥(yao)(yao)(yao)師(shi)專職(zhi)(zhi)開(kai)展臨(lin)床(chuang)(chuang)藥(yao)(yao)(yao)學(xue)(xue)工作，并且將該藥(yao)(yao)(yao)師(shi)身(shen)份明確為醫(yi)(yi)院臨(lin)床(chuang)(chuang)藥(yao)(yao)(yao)師(shi)，負責檢查、督導(dao)全院各科室的(de)用(yong)藥(yao)(yao)(yao)情況(kuang);2008年，又確定(ding)3名具有中級(ji)技術職(zhi)(zhi)稱的(de)藥(yao)(yao)(yao)師(shi)協助臨(lin)床(chuang)(chuang)藥(yao)(yao)(yao)師(shi)進(jin)(jin)行(xing)臨(lin)床(chuang)(chuang)藥(yao)(yao)(yao)學(xue)(xue)工作。現將開(kai)展情況(kuang)總結(jie)如下(xia)。

1臨床(chuang)藥師工作的內容及方法

1．1檢查處(chu)方(fang)(fang)臨(lin)床藥(yao)(yao)師每周至少隨機抽查1d的(de)門診處(chu)方(fang)(fang)(處(chu)方(fang)(fang)數(shu)量不得低于500張)，先將處(chu)方(fang)(fang)按(an)照科(ke)室(shi)進行(xing)(xing)分類，然后(hou)(hou)逐科(ke)開始檢查。檢查內容包(bao)括(kuo):書(shu)寫項目(mu)是否齊全、簽(qian)名(ming)是否完整(zheng)規范、藥(yao)(yao)品名(ming)稱是否準確、有無使(shi)用(yong)(yong)商(shang)品名(ming)、用(yong)(yong)藥(yao)(yao)與臨(lin)床診斷(duan)是否相(xiang)符(fu)、用(yong)(yong)法用(yong)(yong)量是否正確、有無重復用(yong)(yong)藥(yao)(yao)和(he)(he)配伍禁忌、有無超(chao)級(ji)別或超(chao)檔次(ci)用(yong)(yong)藥(yao)(yao)以及其他(ta)不符(fu)合處(chu)方(fang)(fang)規定的(de)事項等〔1〕。最后(hou)(hou)將問題進行(xing)(xing)歸(gui)類、匯總、統計，計算各科(ke)室(shi)的(de)處(chu)方(fang)(fang)合格(ge)率，上報醫院職(zhi)能部門，由職(zhi)能部門按(an)月對科(ke)室(shi)進行(xing)(xing)考(kao)核，考(kao)核對象為處(chu)方(fang)(fang)當事人和(he)(he)科(ke)室(shi)主任。

1．2終(zhong)(zhong)末病(bing)(bing)歷(li)檢查臨(lin)床藥(yao)(yao)師每月隨機(ji)抽查50份歸檔病(bing)(bing)歷(li)，仔細閱讀病(bing)(bing)歷(li)，掌握患(huan)者的基本情況，如臨(lin)床診斷(duan)、現(xian)病(bing)(bing)史(shi)、既(ji)往史(shi)、醫囑信息、各種(zhong)檢查結果、患(huan)者體溫、體質(zhi)量等(deng)，結合查閱相關資料，從以(yi)下幾(ji)個方(fang)面(mian)對終(zhong)(zhong)末病(bing)(bing)歷(li)用(yong)藥(yao)(yao)情況給予評價:(1)適應證是否(fou)明確;(2)選藥(yao)(yao)是否(fou)恰當;(3)用(yong)藥(yao)(yao)劑量和用(yong)藥(yao)(yao)方(fang)法是否(fou)正確;(4)是否(fou)有禁忌證;(5)是否(fou)存在危險的藥(yao)(yao)物相互作用(yong)。對檢查到的問題(ti)進(jin)行(xing)記錄，甚(shen)至(zhi)拍(pai)照，以(yi)書面(mian)形式下發整(zheng)改意見，責令科室(shi)主任負責限期整(zheng)改。

1．3參與查(cha)(cha)房和危重病(bing)人(ren)討(tao)論臨(lin)床藥(yao)師參與查(cha)(cha)房了(le)解(jie)(jie)患(huan)者(zhe)(zhe)的(de)(de)(de)基本情況，如(ru)臨(lin)床診(zhen)斷、各種檢(jian)查(cha)(cha)報告、患(huan)者(zhe)(zhe)體溫、個體狀況等，重點對藥(yao)物治(zhi)(zhi)療(liao)方(fang)案(an)進行分析、評估，對不(bu)當(dang)的(de)(de)(de)用藥(yao)方(fang)案(an)及時(shi)與主管醫師進行溝通，力爭達到最佳(jia)治(zhi)(zhi)療(liao)方(fang)案(an)。另(ling)外，通過藥(yao)師查(cha)(cha)房為(wei)患(huan)者(zhe)(zhe)提供(gong)用藥(yao)教育與咨詢，使患(huan)者(zhe)(zhe)具有良(liang)好的(de)(de)(de)依從性，從而更好地提高治(zhi)(zhi)療(liao)效(xiao)(xiao)果。臨(lin)床藥(yao)師參與危重患(huan)者(zhe)(zhe)的(de)(de)(de)病(bing)例(li)討(tao)論，了(le)解(jie)(jie)醫師進行藥(yao)物治(zhi)(zhi)療(liao)的(de)(de)(de)思路和目(mu)的(de)(de)(de)，與醫師“相互監督、相互彌補(bu)”，共同制(zhi)定患(huan)者(zhe)(zhe)的(de)(de)(de)治(zhi)(zhi)療(liao)方(fang)案(an)，以達到最佳(jia)的(de)(de)(de)治(zhi)(zhi)療(liao)效(xiao)(xiao)果。

1．4對(dui)特殊病人(ren)(ren)建立藥(yao)(yao)(yao)(yao)歷(li)我院(yuan)臨床(chuang)藥(yao)(yao)(yao)(yao)師(shi)(shi)堅持對(dui)危重病例、疑難病例、典型病例建立規范化藥(yao)(yao)(yao)(yao)歷(li)，對(dui)以上幾種特殊病人(ren)(ren)的(de)(de)(de)(de)藥(yao)(yao)(yao)(yao)物治療給予(yu)評(ping)價(jia)，從而(er)促(cu)進(jin)臨床(chuang)醫師(shi)(shi)合(he)理用(yong)藥(yao)(yao)(yao)(yao)。藥(yao)(yao)(yao)(yao)歷(li)是臨床(chuang)醫師(shi)(shi)通過收(shou)集、分析、整(zheng)理患(huan)者(zhe)的(de)(de)(de)(de)臨床(chuang)用(yong)藥(yao)(yao)(yao)(yao)信息歸納、書寫而(er)成的(de)(de)(de)(de)完整(zheng)的(de)(de)(de)(de)技(ji)術檔案資(zi)料(liao)〔3〕。藥(yao)(yao)(yao)(yao)歷(li)記錄了(le)藥(yao)(yao)(yao)(yao)學監護的(de)(de)(de)(de)全過程，是臨床(chuang)藥(yao)(yao)(yao)(yao)師(shi)(shi)為患(huan)者(zhe)開展藥(yao)(yao)(yao)(yao)學服務的(de)(de)(de)(de)必備資(zi)料(liao)，也是設(she)計最佳治療方案的(de)(de)(de)(de)重要(yao)依據(ju)，臨床(chuang)藥(yao)(yao)(yao)(yao)師(shi)(shi)可(ke)通過藥(yao)(yao)(yao)(yao)歷(li)了(le)解患(huan)者(zhe)的(de)(de)(de)(de)臨床(chuang)診(zhen)斷(duan)結(jie)果，住院(yuan)期間使用(yong)的(de)(de)(de)(de)所有(you)藥(yao)(yao)(yao)(yao)物，用(yong)藥(yao)(yao)(yao)(yao)前后的(de)(de)(de)(de)病情變化，根據(ju)檢查結(jie)果對(dui)治療方案調(diao)整(zheng)情況(kuang)，以便(bian)及時(shi)發現問(wen)題，積極主(zhu)動地(di)與主(zhu)管醫師(shi)(shi)或科室(shi)負責人(ren)(ren)協商(shang)解決方案，提高(gao)用(yong)藥(yao)(yao)(yao)(yao)的(de)(de)(de)(de)合(he)理性。同(tong)時(shi)也可(ke)促(cu)使臨床(chuang)藥(yao)(yao)(yao)(yao)師(shi)(shi)在工作中積累業務和臨床(chuang)知識(shi)，體現藥(yao)(yao)(yao)(yao)學人(ren)(ren)員的(de)(de)(de)(de)專(zhuan)業技(ji)能，使患(huan)者(zhe)得到良好(hao)的(de)(de)(de)(de)藥(yao)(yao)(yao)(yao)學服務。

1資料與方法

1.1一般資料

收集并(bing)分析2012年(nian)(nian)1月(yue)~2013年(nian)(nian)6月(yue)本院(yuan)護(hu)理(li)(li)質量管理(li)(li)小組(zu)對21個(ge)臨(lin)床科(ke)室的(de)檢(jian)查(cha)資料,發現(xian)與(yu)藥(yao)(yao)(yao)物有(you)關的(de)缺陷(xian)31起(qi)(qi),其中與(yu)新(xin)藥(yao)(yao)(yao)物有(you)關的(de)16起(qi)(qi),占(zhan)(zhan)(zhan)(zhan)51.61%；護(hu)理(li)(li)不(bu)良事(shi)(shi)件報表中,與(yu)給藥(yao)(yao)(yao)護(hu)理(li)(li)有(you)關的(de)142起(qi)(qi),與(yu)新(xin)藥(yao)(yao)(yao)物有(you)關的(de)49起(qi)(qi),占(zhan)(zhan)(zhan)(zhan)34.51%。具(ju)體表現(xian)為：查(cha)對不(bu)清6起(qi)(qi),占(zhan)(zhan)(zhan)(zhan)12.24%；給藥(yao)(yao)(yao)速度不(bu)正(zheng)確(que)9起(qi)(qi),占(zhan)(zhan)(zhan)(zhan)18.37%；藥(yao)(yao)(yao)物常用劑量不(bu)清4起(qi)(qi),占(zhan)(zhan)(zhan)(zhan)8.16%；違反(fan)藥(yao)(yao)(yao)物配伍(wu)(wu)禁(jin)忌9起(qi)(qi),占(zhan)(zhan)(zhan)(zhan)18.37%；未告知藥(yao)(yao)(yao)物副(fu)作(zuo)用18起(qi)(qi),占(zhan)(zhan)(zhan)(zhan)36.73%；過敏(min)反(fan)應處理(li)(li)不(bu)及時(shi)(shi)起(qi)(qi)2起(qi)(qi),占(zhan)(zhan)(zhan)(zhan)4.08%。2013年(nian)(nian)6月(yue)隨機抽查(cha)21個(ge)病區護(hu)理(li)(li)人員對3種新(xin)藥(yao)(yao)(yao)物的(de)掌握情(qing)況,提問護(hu)士84名(ming)(ming),對新(xin)藥(yao)(yao)(yao)的(de)主(zhu)要藥(yao)(yao)(yao)理(li)(li)作(zuo)用知曉(xiao)者32名(ming)(ming),占(zhan)(zhan)(zhan)(zhan)38.10%,能回答(da)(da)用法41名(ming)(ming),占(zhan)(zhan)(zhan)(zhan)48.81%；能準確(que)回答(da)(da)常用量47名(ming)(ming),占(zhan)(zhan)(zhan)(zhan)55.95%；配藥(yao)(yao)(yao)注(zhu)意(yi)事(shi)(shi)項及配伍(wu)(wu)禁(jin)忌知曉(xiao)者24名(ming)(ming),占(zhan)(zhan)(zhan)(zhan)28.57%；不(bu)良反(fan)應19名(ming)(ming),22.62%；藥(yao)(yao)(yao)物的(de)時(shi)(shi)間(jian)藥(yao)(yao)(yao)理(li)(li)學掌知曉(xiao)者12名(ming)(ming),占(zhan)(zhan)(zhan)(zhan)14.29%；較準確(que)回答(da)(da)觀察要點17名(ming)(ming),占(zhan)(zhan)(zhan)(zhan)20.24%；自(zi)身防護(hu)問題知曉(xiao)者22名(ming)(ming),占(zhan)(zhan)(zhan)(zhan)22.19%。

1.2管理方法

1.2.1建立(li)病區新藥(yao)品管理組(zu)織

1.2.1.1成立病區(qu)新藥品管理小組

摘(zhai)要(yao)：目的(de)(de)探討臨床藥(yao)(yao)師基于(yu)(yu)疾病診斷相關分(fen)組(zu)（DRGs）數(shu)(shu)(shu)據參與消(xiao)(xiao)化內(nei)科(ke)藥(yao)(yao)事(shi)精(jing)細(xi)化管理的(de)(de)實施效(xiao)果(guo)，為促進(jin)(jin)臨床合理用(yong)(yong)藥(yao)(yao)提供參考(kao)。方法收集(ji)本院(yuan)(yuan)(yuan)消(xiao)(xiao)化內(nei)科(ke)進(jin)(jin)入DRGs分(fen)組(zu)的(de)(de)出院(yuan)(yuan)(yuan)患者作(zuo)為研究(jiu)對象。比(bi)較(jiao)臨床藥(yao)(yao)師參與藥(yao)(yao)事(shi)精(jing)細(xi)化管理干(gan)預(yu)(yu)(yu)前(qian)(qian)（2018年4～9月）、干(gan)預(yu)(yu)(yu)后（2019年4～9月）消(xiao)(xiao)化內(nei)科(ke)住院(yuan)(yuan)(yuan)患者的(de)(de)基本情況及主(zhu)要(yao)藥(yao)(yao)事(shi)管理指標情況，并選取(qu)排名(ming)靠(kao)前(qian)(qian)的(de)(de)DRGs組(zu)進(jin)(jin)行入組(zu)例(li)數(shu)(shu)(shu)、次(ci)均費(fei)(fei)用(yong)(yong)和藥(yao)(yao)品(pin)費(fei)(fei)用(yong)(yong)等(deng)進(jin)(jin)行統(tong)(tong)計學(xue)分(fen)析，比(bi)較(jiao)干(gan)預(yu)(yu)(yu)前(qian)(qian)后的(de)(de)費(fei)(fei)用(yong)(yong)差異。結(jie)(jie)果(guo)干(gan)預(yu)(yu)(yu)后，消(xiao)(xiao)化內(nei)科(ke)總權重、CMI值均明顯升高，時間消(xiao)(xiao)耗指數(shu)(shu)(shu)、費(fei)(fei)用(yong)(yong)消(xiao)(xiao)耗指數(shu)(shu)(shu)、住院(yuan)(yuan)(yuan)天數(shu)(shu)(shu)均有所(suo)降低(di)；藥(yao)(yao)品(pin)結(jie)(jie)構比(bi)、輔(fu)助藥(yao)(yao)品(pin)結(jie)(jie)構比(bi)、次(ci)均藥(yao)(yao)費(fei)(fei)、次(ci)均輔(fu)助藥(yao)(yao)費(fei)(fei)均有所(suo)下降；DRGs為GU15、GK23、GK25組(zu)，干(gan)預(yu)(yu)(yu)后藥(yao)(yao)品(pin)費(fei)(fei)用(yong)(yong)均較(jiao)干(gan)預(yu)(yu)(yu)前(qian)(qian)有所(suo)下降，GK23組(zu)差異有統(tong)(tong)計學(xue)意(yi)義（P＜0.01）。結(jie)(jie)論臨床藥(yao)(yao)師基于(yu)(yu)DRGs數(shu)(shu)(shu)據參與消(xiao)(xiao)化內(nei)科(ke)藥(yao)(yao)事(shi)精(jing)細(xi)化管理的(de)(de)實踐，在一定程(cheng)度規(gui)范了本院(yuan)(yuan)(yuan)消(xiao)(xiao)化內(nei)科(ke)的(de)(de)用(yong)(yong)藥(yao)(yao)合理性，確(que)保消(xiao)(xiao)化內(nei)科(ke)用(yong)(yong)藥(yao)(yao)安全、有效(xiao)、經濟(ji)。

關(guan)鍵(jian)詞：疾病診斷相關(guan)分(fen)組；臨床藥師；藥事(shi)精(jing)細化管理

隨著醫(yi)(yi)(yi)改(gai)的(de)(de)不斷(duan)深(shen)入，全(quan)面取消(xiao)藥(yao)(yao)(yao)(yao)品加(jia)成(cheng)，推進(jin)醫(yi)(yi)(yi)療(liao)價格、人事(shi)(shi)薪酬(chou)、藥(yao)(yao)(yao)(yao)品流(liu)通(tong)、醫(yi)(yi)(yi)保支(zhi)付(fu)方(fang)(fang)式等(deng)改(gai)革(ge)(ge)，控制醫(yi)(yi)(yi)療(liao)成(cheng)本(ben)(ben)，減輕醫(yi)(yi)(yi)療(liao)負(fu)擔，加(jia)強藥(yao)(yao)(yao)(yao)品管(guan)理(li)，推進(jin)合(he)(he)理(li)用(yong)藥(yao)(yao)(yao)(yao)，成(cheng)為醫(yi)(yi)(yi)院(yuan)(yuan)管(guan)理(li)工(gong)作(zuo)的(de)(de)重中之重[1]。DRGs（diagnosisrelatedgroups），即疾(ji)病(bing)診斷(duan)相(xiang)關分組(zu)，它(ta)綜合(he)(he)考(kao)慮患(huan)者的(de)(de)年齡、性(xing)(xing)別、住院(yuan)(yuan)天數(shu)、臨(lin)(lin)床(chuang)(chuang)診斷(duan)、病(bing)癥、手術、疾(ji)病(bing)嚴重程(cheng)度(du)(du)、合(he)(he)并(bing)(bing)癥與并(bing)(bing)發(fa)癥及(ji)轉歸等(deng)諸多因素的(de)(de)影響，把患(huan)者納入不同(tong)的(de)(de)DRGs，每一組(zu)都有較高的(de)(de)同(tong)質性(xing)(xing)和相(xiang)近的(de)(de)衛生(sheng)資源消(xiao)耗[2]。為了控制日益增長的(de)(de)醫(yi)(yi)(yi)療(liao)費(fei)(fei)用(yong)，1983年美國政府在(zai)全(quan)國實(shi)施了DRGs預付(fu)費(fei)(fei)制度(du)(du)（diagnosisrelatedgroups-prospectivepaymentsystem，DRGs-PPS）的(de)(de)改(gai)革(ge)(ge)方(fang)(fang)案[3]。我國從20世紀80年代(dai)末開始(shi)進(jin)行(xing)DRGs的(de)(de)相(xiang)關研(yan)究(jiu)，隨著公(gong)立醫(yi)(yi)(yi)院(yuan)(yuan)改(gai)革(ge)(ge)的(de)(de)不斷(duan)深(shen)入，北京(jing)市(shi)部(bu)分三甲(jia)醫(yi)(yi)(yi)院(yuan)(yuan)已經(jing)啟(qi)動DRGs-PPS。DRGs最(zui)初主要應(ying)用(yong)于醫(yi)(yi)(yi)療(liao)保險支(zhi)付(fu)，隨后應(ying)用(yong)到醫(yi)(yi)(yi)療(liao)費(fei)(fei)用(yong)、醫(yi)(yi)(yi)療(liao)質量、病(bing)案管(guan)理(li)、績效評(ping)價、成(cheng)本(ben)(ben)管(guan)理(li)等(deng)領域(yu)[4]。以“diagnosisrelatedgroups、DRGs、pharmacymanagement、pharmacist、pharmacy”等(deng)為檢索詞，并(bing)(bing)進(jin)行(xing)相(xiang)應(ying)組(zu)合(he)(he)，檢索結果顯示國外藥(yao)(yao)(yao)(yao)師在(zai)DRGs中的(de)(de)作(zuo)用(yong)主要體(ti)現在(zai)兩個(ge)方(fang)(fang)面：經(jing)濟性(xing)(xing)和安(an)全(quan)性(xing)(xing)，而國內文獻關于藥(yao)(yao)(yao)(yao)師在(zai)DRGs支(zhi)付(fu)方(fang)(fang)式改(gai)革(ge)(ge)中的(de)(de)實(shi)踐(jian)研(yan)究(jiu)相(xiang)對較少，易(yi)湛(zhan)苗等(deng)[5]提(ti)出建議及(ji)設想，國內藥(yao)(yao)(yao)(yao)師可以通(tong)過藥(yao)(yao)(yao)(yao)學服(fu)務(wu)節約(yue)費(fei)(fei)用(yong)，優化(hua)(hua)DRGs用(yong)藥(yao)(yao)(yao)(yao)方(fang)(fang)案、直(zhi)接(jie)控制不合(he)(he)理(li)的(de)(de)藥(yao)(yao)(yao)(yao)品費(fei)(fei)用(yong)、結合(he)(he)藥(yao)(yao)(yao)(yao)品分類/限定日劑量系統進(jin)行(xing)醫(yi)(yi)(yi)院(yuan)(yuan)藥(yao)(yao)(yao)(yao)品目錄遴選(xuan)等(deng)。本(ben)(ben)研(yan)究(jiu)旨(zhi)在(zai)介紹本(ben)(ben)院(yuan)(yuan)臨(lin)(lin)床(chuang)(chuang)藥(yao)(yao)(yao)(yao)師基(ji)于DRGs數(shu)據(ju)參(can)與消(xiao)化(hua)(hua)內科藥(yao)(yao)(yao)(yao)事(shi)(shi)精(jing)細化(hua)(hua)管(guan)理(li)的(de)(de)實(shi)踐(jian)效果，并(bing)(bing)就應(ying)用(yong)現狀進(jin)行(xing)分析，以期將DRGs更好地(di)應(ying)用(yong)于醫(yi)(yi)(yi)院(yuan)(yuan)精(jing)細化(hua)(hua)管(guan)理(li)中，促進(jin)臨(lin)(lin)床(chuang)(chuang)合(he)(he)理(li)用(yong)藥(yao)(yao)(yao)(yao)。

1資料與方法

1.1本(ben)(ben)院(yuan)(yuan)(yuan)(yuan)(yuan)基于。從2016年(nian)(nian)8月(yue)份以(yi)(yi)來(lai)，本(ben)(ben)院(yuan)(yuan)(yuan)(yuan)(yuan)成立了院(yuan)(yuan)(yuan)(yuan)(yuan)長(chang)親自(zi)主抓，分(fen)(fen)管(guan)院(yuan)(yuan)(yuan)(yuan)(yuan)長(chang)直接督辦(ban)的(de)“DRGs工(gong)作(zuo)領(ling)導(dao)小組(zu)(zu)(zu)(zu)”，成員由醫(yi)(yi)務(wu)處(chu)、病(bing)(bing)案(an)統(tong)計(ji)(ji)(ji)室、信息中心及(ji)醫(yi)(yi)保辦(ban)等相關職能部門(men)(men)負責人組(zu)(zu)(zu)(zu)成，各部門(men)(men)通(tong)力協作(zuo)，認真做(zuo)好各自(zi)的(de)分(fen)(fen)管(guan)工(gong)作(zuo)，將DRGs工(gong)作(zuo)穩步推進(jin)。2018年(nian)(nian)下半年(nian)(nian)本(ben)(ben)院(yuan)(yuan)(yuan)(yuan)(yuan)開始探索基于DRGs的(de)藥事(shi)精(jing)細化(hua)(hua)管(guan)理(li)，各專科(ke)臨床(chuang)藥師針對不同病(bing)(bing)區(qu)進(jin)行(xing)(xing)合理(li)用(yong)(yong)(yong)(yong)藥溝通(tong)會，通(tong)過對費(fei)用(yong)(yong)(yong)(yong)消耗指(zhi)數(shu)(shu)(shu)(shu)較(jiao)高(gao)的(de)病(bing)(bing)區(qu)及(ji)醫(yi)(yi)師的(de)分(fen)(fen)析，找(zhao)(zhao)出規范診療(liao)行(xing)(xing)為(wei)的(de)重點。以(yi)(yi)“均次(ci)藥品(pin)費(fei)用(yong)(yong)(yong)(yong)/DRGs組(zu)(zu)(zu)(zu)標(biao)(biao)(biao)住院(yuan)(yuan)(yuan)(yuan)(yuan)桿費(fei)用(yong)(yong)(yong)(yong)”找(zhao)(zhao)到靶向病(bing)(bing)例，評價(jia)某(mou)一病(bing)(bing)組(zu)(zu)(zu)(zu)內(nei)(nei)病(bing)(bing)例的(de)用(yong)(yong)(yong)(yong)藥合理(li)性。1.2資料來(lai)源(yuan)。本(ben)(ben)次(ci)研(yan)究(jiu)所選數(shu)(shu)(shu)(shu)據(ju)為(wei)本(ben)(ben)院(yuan)(yuan)(yuan)(yuan)(yuan)2018年(nian)(nian)4～9月(yue)、2019年(nian)(nian)4～9月(yue)消化(hua)(hua)內(nei)(nei)科(ke)出院(yuan)(yuan)(yuan)(yuan)(yuan)患(huan)(huan)者(zhe)(zhe)記(ji)錄。病(bing)(bing)案(an)的(de)數(shu)(shu)(shu)(shu)據(ju)來(lai)源(yuan)于醫(yi)(yi)院(yuan)(yuan)(yuan)(yuan)(yuan)信息系統(tong)（HIS）病(bing)(bing)案(an)首(shou)(shou)頁相關數(shu)(shu)(shu)(shu)據(ju)，數(shu)(shu)(shu)(shu)據(ju)格(ge)式與國家(jia)衛生統(tong)計(ji)(ji)(ji)網絡直報系統(tong)要求保持(chi)一致。DRGs分(fen)(fen)組(zu)(zu)(zu)(zu)以(yi)(yi)CN-DRGs國標(biao)(biao)(biao)版(ban)為(wei)分(fen)(fen)組(zu)(zu)(zu)(zu)方式，DRGs權重計(ji)(ji)(ji)算及(ji)參(can)照標(biao)(biao)(biao)準為(wei)北京市市屬三(san)級醫(yi)(yi)院(yuan)(yuan)(yuan)(yuan)(yuan)平均水平。1.3研(yan)究(jiu)方法(fa)。將2018年(nian)(nian)4～9月(yue)消化(hua)(hua)內(nei)(nei)科(ke)出院(yuan)(yuan)(yuan)(yuan)(yuan)患(huan)(huan)者(zhe)(zhe)記(ji)錄數(shu)(shu)(shu)(shu)據(ju)作(zuo)為(wei)干(gan)(gan)預前(qian)組(zu)(zu)(zu)(zu)，2019年(nian)(nian)4～9月(yue)消化(hua)(hua)內(nei)(nei)科(ke)出院(yuan)(yuan)(yuan)(yuan)(yuan)患(huan)(huan)者(zhe)(zhe)記(ji)錄數(shu)(shu)(shu)(shu)據(ju)作(zuo)為(wei)干(gan)(gan)預后組(zu)(zu)(zu)(zu)，利用(yong)(yong)(yong)(yong)CN-DRGs分(fen)(fen)組(zu)(zu)(zu)(zu)器處(chu)理(li)數(shu)(shu)(shu)(shu)據(ju)的(de)反饋結果，使(shi)用(yong)(yong)(yong)(yong)Excel2016軟件將DRGs分(fen)(fen)組(zu)(zu)(zu)(zu)信息與醫(yi)(yi)院(yuan)(yuan)(yuan)(yuan)(yuan)病(bing)(bing)案(an)首(shou)(shou)頁信息進(jin)行(xing)(xing)匹配，比(bi)較(jiao)臨床(chuang)藥師基于DRGs數(shu)(shu)(shu)(shu)據(ju)參(can)與本(ben)(ben)院(yuan)(yuan)(yuan)(yuan)(yuan)消化(hua)(hua)內(nei)(nei)科(ke)藥事(shi)精(jing)細化(hua)(hua)管(guan)理(li)前(qian)后住院(yuan)(yuan)(yuan)(yuan)(yuan)患(huan)(huan)者(zhe)(zhe)基本(ben)(ben)情況(kuang)，主要藥事(shi)管(guan)理(li)指(zhi)標(biao)(biao)(biao)情況(kuang)。并根(gen)據(ju)DRGs分(fen)(fen)組(zu)(zu)(zu)(zu)，選取排名靠前(qian)的(de)DRGs組(zu)(zu)(zu)(zu)進(jin)行(xing)(xing)入組(zu)(zu)(zu)(zu)例數(shu)(shu)(shu)(shu)、次(ci)均費(fei)用(yong)(yong)(yong)(yong)和藥品(pin)費(fei)用(yong)(yong)(yong)(yong)等進(jin)行(xing)(xing)統(tong)計(ji)(ji)(ji)學分(fen)(fen)析，比(bi)較(jiao)干(gan)(gan)預前(qian)后的(de)費(fei)用(yong)(yong)(yong)(yong)差(cha)異。1.4統(tong)計(ji)(ji)(ji)學方法(fa)采用(yong)(yong)(yong)(yong)SPSS25.0軟件對數(shu)(shu)(shu)(shu)據(ju)進(jin)行(xing)(xing)統(tong)計(ji)(ji)(ji)分(fen)(fen)析。計(ji)(ji)(ji)量資料以(yi)(yi)x±s表示(shi)，組(zu)(zu)(zu)(zu)間比(bi)較(jiao)采用(yong)(yong)(yong)(yong)t檢驗(yan)；計(ji)(ji)(ji)數(shu)(shu)(shu)(shu)資料以(yi)(yi)例數(shu)(shu)(shu)(shu)或率表示(shi)，組(zu)(zu)(zu)(zu)間比(bi)較(jiao)采用(yong)(yong)(yong)(yong)χ2檢驗(yan)；P＜0.05為(wei)差(cha)異有統(tong)計(ji)(ji)(ji)學意義(yi)。

2結果

【摘要】目(mu)的(de)(de)(de)(de)分析并評價(jia)藥(yao)(yao)師(shi)(shi)參(can)(can)與的(de)(de)(de)(de)規(gui)(gui)范(fan)化藥(yao)(yao)品(pin)管(guan)(guan)理(li)(li)(li)(li)(li)措施在日(ri)間(jian)手術(shu)(shu)(shu)病(bing)(bing)房藥(yao)(yao)品(pin)管(guan)(guan)理(li)(li)(li)(li)(li)中的(de)(de)(de)(de)效果。方法日(ri)間(jian)手術(shu)(shu)(shu)病(bing)(bing)房于2019年(nian)1月開始實(shi)施藥(yao)(yao)師(shi)(shi)參(can)(can)與的(de)(de)(de)(de)規(gui)(gui)范(fan)化藥(yao)(yao)品(pin)管(guan)(guan)理(li)(li)(li)(li)(li)，包括(kuo)成立藥(yao)(yao)品(pin)管(guan)(guan)理(li)(li)(li)(li)(li)小(xiao)組、加(jia)強病(bing)(bing)房藥(yao)(yao)品(pin)管(guan)(guan)理(li)(li)(li)(li)(li)規(gui)(gui)范(fan)、加(jia)強標準(zhun)化藥(yao)(yao)品(pin)管(guan)(guan)理(li)(li)(li)(li)(li)的(de)(de)(de)(de)培訓(xun)、藥(yao)(yao)師(shi)(shi)定(ding)期(qi)督查等措施。采用《藥(yao)(yao)品(pin)管(guan)(guan)理(li)(li)(li)(li)(li)質(zhi)(zhi)量評價(jia)表》對實(shi)施前（2018年(nian)10月）和實(shi)施后（2019年(nian)10月）的(de)(de)(de)(de)日(ri)間(jian)手術(shu)(shu)(shu)病(bing)(bing)房藥(yao)(yao)品(pin)管(guan)(guan)理(li)(li)(li)(li)(li)質(zhi)(zhi)量進行評價(jia)。結果通過為(wei)期(qi)10個月的(de)(de)(de)(de)規(gui)(gui)范(fan)化管(guan)(guan)理(li)(li)(li)(li)(li)，日(ri)間(jian)手術(shu)(shu)(shu)病(bing)(bing)房的(de)(de)(de)(de)藥(yao)(yao)品(pin)管(guan)(guan)理(li)(li)(li)(li)(li)品(pin)質(zhi)(zhi)得到有效提升(sheng)，藥(yao)(yao)品(pin)品(pin)質(zhi)(zhi)管(guan)(guan)理(li)(li)(li)(li)(li)總(zong)分從規(gui)(gui)范(fan)化管(guan)(guan)理(li)(li)(li)(li)(li)前的(de)(de)(de)(de)88.0分提升(sheng)到規(gui)(gui)范(fan)化管(guan)(guan)理(li)(li)(li)(li)(li)后的(de)(de)(de)(de)95.0分。結論藥(yao)(yao)師(shi)(shi)參(can)(can)與日(ri)間(jian)手術(shu)(shu)(shu)病(bing)(bing)房的(de)(de)(de)(de)藥(yao)(yao)品(pin)規(gui)(gui)范(fan)化管(guan)(guan)理(li)(li)(li)(li)(li)可以有效提升(sheng)日(ri)間(jian)手術(shu)(shu)(shu)病(bing)(bing)房對藥(yao)(yao)品(pin)的(de)(de)(de)(de)管(guan)(guan)理(li)(li)(li)(li)(li)品(pin)質(zhi)(zhi)，進而保障患者的(de)(de)(de)(de)用藥(yao)(yao)安全。

【關(guan)鍵詞】日間手術；藥品管理；規范(fan)化

臨(lin)床科室作(zuo)為(wei)(wei)藥(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)管(guan)(guan)(guan)(guan)理(li)(li)、使用(yong)(yong)的(de)(de)(de)主(zhu)要場所，護理(li)(li)人員(yuan)作(zuo)為(wei)(wei)藥(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)的(de)(de)(de)主(zhu)要操(cao)作(zuo)者(zhe)，臨(lin)床科室及(ji)護理(li)(li)人員(yuan)對(dui)藥(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)的(de)(de)(de)管(guan)(guan)(guan)(guan)理(li)(li)直接(jie)關(guan)系(xi)到(dao)藥(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)的(de)(de)(de)質(zhi)(zhi)(zhi)量(liang)(liang)和患(huan)者(zhe)用(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)的(de)(de)(de)安(an)全(quan)(quan)(quan)(quan)與(yu)(yu)治療(liao)效果，直接(jie)影響醫(yi)(yi)(yi)療(liao)質(zhi)(zhi)(zhi)量(liang)(liang)與(yu)(yu)安(an)全(quan)(quan)(quan)(quan)。但由于缺乏藥(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)專(zhuan)業知識的(de)(de)(de)培訓，臨(lin)床科室常(chang)存在護理(li)(li)人員(yuan)對(dui)藥(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)管(guan)(guan)(guan)(guan)理(li)(li)知識缺乏、藥(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)質(zhi)(zhi)(zhi)量(liang)(liang)管(guan)(guan)(guan)(guan)理(li)(li)意識薄(bo)弱以及(ji)病(bing)(bing)(bing)房管(guan)(guan)(guan)(guan)理(li)(li)制(zhi)度不規范(fan)等諸多(duo)問題，從(cong)而導(dao)致(zhi)病(bing)(bing)(bing)房儲(chu)備藥(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)質(zhi)(zhi)(zhi)量(liang)(liang)管(guan)(guan)(guan)(guan)理(li)(li)效果不佳(jia)，進而影響藥(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)的(de)(de)(de)質(zhi)(zhi)(zhi)量(liang)(liang)，存在一(yi)定的(de)(de)(de)用(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)安(an)全(quan)(quan)(quan)(quan)隱患(huan)和風險[1]。2019年中國醫(yi)(yi)(yi)院(yuan)管(guan)(guan)(guan)(guan)理(li)(li)協會再(zai)次將(jiang)“確保(bao)用(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)安(an)全(quan)(quan)(quan)(quan)”列(lie)為(wei)(wei)患(huan)者(zhe)十(shi)大(da)(da)安(an)全(quan)(quan)(quan)(quan)目標之一(yi)[2]，用(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)安(an)全(quan)(quan)(quan)(quan)與(yu)(yu)患(huan)者(zhe)安(an)全(quan)(quan)(quan)(quan)息(xi)息(xi)相(xiang)關(guan)，規范(fan)臨(lin)床科室的(de)(de)(de)藥(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)管(guan)(guan)(guan)(guan)理(li)(li)刻不容緩。日間(jian)手(shou)(shou)(shou)(shou)術(shu)涉及(ji)病(bing)(bing)(bing)種較(jiao)多(duo)，病(bing)(bing)(bing)房常(chang)用(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)品(pin)(pin)(pin)(pin)(pin)種、規格相(xiang)對(dui)較(jiao)多(duo)，加之日間(jian)手(shou)(shou)(shou)(shou)術(shu)模式具有“短、頻、快”的(de)(de)(de)特點[3]，存在一(yi)定的(de)(de)(de)用(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)安(an)全(quan)(quan)(quan)(quan)風險，如何提高(gao)日間(jian)手(shou)(shou)(shou)(shou)術(shu)病(bing)(bing)(bing)房用(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)的(de)(de)(de)安(an)全(quan)(quan)(quan)(quan)性和有效性值得管(guan)(guan)(guan)(guan)理(li)(li)者(zhe)深思。然而目前對(dui)日間(jian)手(shou)(shou)(shou)(shou)術(shu)的(de)(de)(de)研究熱點主(zhu)要聚焦于對(dui)其定義的(de)(de)(de)解析(xi)、模式的(de)(de)(de)探(tan)討、護理(li)(li)的(de)(de)(de)探(tan)索(suo)、管(guan)(guan)(guan)(guan)理(li)(li)的(de)(de)(de)研究以及(ji)醫(yi)(yi)(yi)療(liao)安(an)全(quan)(quan)(quan)(quan)與(yu)(yu)質(zhi)(zhi)(zhi)量(liang)(liang)的(de)(de)(de)探(tan)索(suo)等[4]，而如何保(bao)證日間(jian)手(shou)(shou)(shou)(shou)術(shu)病(bing)(bing)(bing)房藥(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)的(de)(de)(de)管(guan)(guan)(guan)(guan)理(li)(li)質(zhi)(zhi)(zhi)量(liang)(liang)尚未(wei)見報道。自(zi)2019年1月開始，四川大(da)(da)學華西醫(yi)(yi)(yi)院(yuan)日間(jian)手(shou)(shou)(shou)(shou)術(shu)中心通過(guo)藥(yao)(yao)(yao)(yao)(yao)師參與(yu)(yu)臨(lin)床科室藥(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)規范(fan)管(guan)(guan)(guan)(guan)理(li)(li)和督導(dao)，在藥(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)質(zhi)(zhi)(zhi)量(liang)(liang)管(guan)(guan)(guan)(guan)理(li)(li)方面取(qu)得了較(jiao)好(hao)的(de)(de)(de)效果。現報告(gao)如下。

1資料與方法

1.1一般資料(liao)。四川大學(xue)華西醫(yi)院日(ri)(ri)間(jian)(jian)手(shou)術(shu)(shu)中(zhong)心(xin)共計55張病(bing)(bing)(bing)(bing)(bing)床(chuang)(chuang)、20名護(hu)(hu)(hu)(hu)理(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)人員，涉及病(bing)(bing)(bing)(bing)(bing)種包(bao)括(kuo)膽囊結(jie)石、肺(fei)結(jie)節、甲狀(zhuang)腺瘤(liu)、結(jie)腸(chang)癌、耳鼻喉疾病(bing)(bing)(bing)(bing)(bing)等(deng)(deng)60余種。1.2藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)管(guan)(guan)(guan)(guan)(guan)理(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)措施。2019年1月(yue)(yue)(yue)前，該中(zhong)心(xin)采用以(yi)(yi)(yi)臨(lin)(lin)床(chuang)(chuang)護(hu)(hu)(hu)(hu)士為(wei)主(zhu)導的(de)(de)(de)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)管(guan)(guan)(guan)(guan)(guan)理(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)模式，由(you)(you)病(bing)(bing)(bing)(bing)(bing)房(fang)(fang)(fang)(fang)總(zong)務護(hu)(hu)(hu)(hu)士負(fu)責藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)管(guan)(guan)(guan)(guan)(guan)理(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)質量(liang)(liang)(liang)(liang)，未(wei)形(xing)成(cheng)標(biao)(biao)(biao)準(zhun)化(hua)(hua)(hua)(hua)(hua)(hua)的(de)(de)(de)科室藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)管(guan)(guan)(guan)(guan)(guan)理(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)制度，未(wei)成(cheng)立藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)管(guan)(guan)(guan)(guan)(guan)理(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)小(xiao)組(zu)(zu)，缺(que)少藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)相關知(zhi)識的(de)(de)(de)系(xi)統(tong)化(hua)(hua)(hua)(hua)(hua)(hua)培(pei)訓(xun)，存(cun)(cun)(cun)在(zai)(zai)病(bing)(bing)(bing)(bing)(bing)房(fang)(fang)(fang)(fang)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)管(guan)(guan)(guan)(guan)(guan)理(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)缺(que)乏監(jian)(jian)督(du)(du)機制、藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)質量(liang)(liang)(liang)(liang)檢查(cha)流(liu)于(yu)形(xing)式、臨(lin)(lin)床(chuang)(chuang)護(hu)(hu)(hu)(hu)理(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)人員藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)規范化(hua)(hua)(hua)(hua)(hua)(hua)管(guan)(guan)(guan)(guan)(guan)理(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)知(zhi)識欠缺(que)的(de)(de)(de)情況。針(zhen)(zhen)對以(yi)(yi)(yi)上(shang)問(wen)題(ti)，2019年1月(yue)(yue)(yue)起該中(zhong)心(xin)改(gai)用藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)師(shi)(shi)參(can)與(yu)的(de)(de)(de)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)規范化(hua)(hua)(hua)(hua)(hua)(hua)管(guan)(guan)(guan)(guan)(guan)理(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)模式，具(ju)體(ti)措施如下。1.2.1成(cheng)立日(ri)(ri)間(jian)(jian)手(shou)術(shu)(shu)規范化(hua)(hua)(hua)(hua)(hua)(hua)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)管(guan)(guan)(guan)(guan)(guan)理(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)小(xiao)組(zu)(zu)。　日(ri)(ri)間(jian)(jian)手(shou)術(shu)(shu)病(bing)(bing)(bing)(bing)(bing)房(fang)(fang)(fang)(fang)成(cheng)立藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)管(guan)(guan)(guan)(guan)(guan)理(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)小(xiao)組(zu)(zu)，由(you)(you)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)師(shi)(shi)、病(bing)(bing)(bing)(bing)(bing)房(fang)(fang)(fang)(fang)護(hu)(hu)(hu)(hu)士長、質量(liang)(liang)(liang)(liang)控制護(hu)(hu)(hu)(hu)士、總(zong)務護(hu)(hu)(hu)(hu)士組(zu)(zu)成(cheng)；通(tong)(tong)(tong)過QQ、微信(xin)、電話(hua)等(deng)(deng)聯系(xi)方(fang)式暢(chang)通(tong)(tong)(tong)溝通(tong)(tong)(tong)渠道，以(yi)(yi)(yi)便(bian)(bian)臨(lin)(lin)床(chuang)(chuang)科室能及時(shi)與(yu)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)師(shi)(shi)進(jin)(jin)(jin)(jin)行(xing)(xing)(xing)(xing)(xing)溝通(tong)(tong)(tong)交流(liu)，藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)師(shi)(shi)根據臨(lin)(lin)床(chuang)(chuang)科室用藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)存(cun)(cun)(cun)在(zai)(zai)的(de)(de)(de)相關問(wen)題(ti)進(jin)(jin)(jin)(jin)行(xing)(xing)(xing)(xing)(xing)指導、監(jian)(jian)督(du)(du)與(yu)反(fan)饋。管(guan)(guan)(guan)(guan)(guan)理(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)小(xiao)組(zu)(zu)主(zhu)要職責是加強日(ri)(ri)間(jian)(jian)手(shou)術(shu)(shu)病(bing)(bing)(bing)(bing)(bing)房(fang)(fang)(fang)(fang)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)的(de)(de)(de)規范化(hua)(hua)(hua)(hua)(hua)(hua)管(guan)(guan)(guan)(guan)(guan)理(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)，加強對日(ri)(ri)間(jian)(jian)手(shou)術(shu)(shu)病(bing)(bing)(bing)(bing)(bing)房(fang)(fang)(fang)(fang)用藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)的(de)(de)(de)指導與(yu)督(du)(du)查(cha)，以(yi)(yi)(yi)及根據日(ri)(ri)間(jian)(jian)手(shou)術(shu)(shu)的(de)(de)(de)特(te)點制定(ding)標(biao)(biao)(biao)準(zhun)化(hua)(hua)(hua)(hua)(hua)(hua)的(de)(de)(de)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)管(guan)(guan)(guan)(guan)(guan)理(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)規范，并(bing)進(jin)(jin)(jin)(jin)行(xing)(xing)(xing)(xing)(xing)實(shi)施與(yu)效果(guo)評(ping)價(jia)。1.2.2加強病(bing)(bing)(bing)(bing)(bing)房(fang)(fang)(fang)(fang)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)的(de)(de)(de)規范化(hua)(hua)(hua)(hua)(hua)(hua)管(guan)(guan)(guan)(guan)(guan)理(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)　。由(you)(you)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)師(shi)(shi)收集整理(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)日(ri)(ri)間(jian)(jian)手(shou)術(shu)(shu)病(bing)(bing)(bing)(bing)(bing)房(fang)(fang)(fang)(fang)所有的(de)(de)(de)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)說明(ming)書，制作《日(ri)(ri)間(jian)(jian)手(shou)術(shu)(shu)病(bing)(bing)(bing)(bing)(bing)房(fang)(fang)(fang)(fang)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)使用說明(ming)書手(shou)冊》，管(guan)(guan)(guan)(guan)(guan)理(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)小(xiao)組(zu)(zu)成(cheng)員在(zai)(zai)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)師(shi)(shi)的(de)(de)(de)指導下制訂《日(ri)(ri)間(jian)(jian)手(shou)術(shu)(shu)病(bing)(bing)(bing)(bing)(bing)房(fang)(fang)(fang)(fang)常見藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)說明(ming)書》，其內容包(bao)括(kuo)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)物(wu)的(de)(de)(de)商品(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)名、化(hua)(hua)(hua)(hua)(hua)(hua)學(xue)名、適應(ying)證(zheng)、藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)理(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)作用、常規劑量(liang)(liang)(liang)(liang)、用藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)途(tu)徑、不良反(fan)應(ying)等(deng)(deng)，存(cun)(cun)(cun)放(fang)于(yu)病(bing)(bing)(bing)(bing)(bing)房(fang)(fang)(fang)(fang)文件柜，便(bian)(bian)于(yu)護(hu)(hu)(hu)(hu)理(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)人員隨(sui)時(shi)翻閱學(xue)習(xi)及參(can)考。1.2.3加強標(biao)(biao)(biao)準(zhun)化(hua)(hua)(hua)(hua)(hua)(hua)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)管(guan)(guan)(guan)(guan)(guan)理(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)的(de)(de)(de)培(pei)訓(xun)。　藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)師(shi)(shi)定(ding)期(qi)到日(ri)(ri)間(jian)(jian)手(shou)術(shu)(shu)病(bing)(bing)(bing)(bing)(bing)房(fang)(fang)(fang)(fang)進(jin)(jin)(jin)(jin)行(xing)(xing)(xing)(xing)(xing)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)儲存(cun)(cun)(cun)效果(guo)的(de)(de)(de)檢查(cha)及藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)物(wu)知(zhi)識的(de)(de)(de)培(pei)訓(xun)。臨(lin)(lin)床(chuang)(chuang)科室組(zu)(zu)織(zhi)護(hu)(hu)(hu)(hu)理(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)人員針(zhen)(zhen)對病(bing)(bing)(bing)(bing)(bing)房(fang)(fang)(fang)(fang)常用藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)物(wu)的(de)(de)(de)管(guan)(guan)(guan)(guan)(guan)理(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)制度、各類藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)的(de)(de)(de)保(bao)管(guan)(guan)(guan)(guan)(guan)知(zhi)識進(jin)(jin)(jin)(jin)行(xing)(xing)(xing)(xing)(xing)系(xi)統(tong)的(de)(de)(de)學(xue)習(xi)，以(yi)(yi)(yi)使病(bing)(bing)(bing)(bing)(bing)房(fang)(fang)(fang)(fang)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)管(guan)(guan)(guan)(guan)(guan)理(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)科學(xue)化(hua)(hua)(hua)(hua)(hua)(hua)、規范化(hua)(hua)(hua)(hua)(hua)(hua)、制度化(hua)(hua)(hua)(hua)(hua)(hua)，保(bao)障患(huan)者的(de)(de)(de)用藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)安全。1.2.4藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)師(shi)(shi)定(ding)期(qi)到病(bing)(bing)(bing)(bing)(bing)房(fang)(fang)(fang)(fang)進(jin)(jin)(jin)(jin)行(xing)(xing)(xing)(xing)(xing)督(du)(du)導。　總(zong)務護(hu)(hu)(hu)(hu)士做(zuo)好藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)的(de)(de)(de)管(guan)(guan)(guan)(guan)(guan)理(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)與(yu)登記，每天(tian)對病(bing)(bing)(bing)(bing)(bing)房(fang)(fang)(fang)(fang)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)進(jin)(jin)(jin)(jin)行(xing)(xing)(xing)(xing)(xing)檢查(cha)。藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)師(shi)(shi)每月(yue)(yue)(yue)到病(bing)(bing)(bing)(bing)(bing)房(fang)(fang)(fang)(fang)進(jin)(jin)(jin)(jin)行(xing)(xing)(xing)(xing)(xing)檢查(cha)與(yu)督(du)(du)導，主(zhu)要針(zhen)(zhen)對科室藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)的(de)(de)(de)存(cun)(cun)(cun)放(fang)、標(biao)(biao)(biao)識的(de)(de)(de)規范、近(jin)(jin)效期(qi)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)的(de)(de)(de)監(jian)(jian)控、基數藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)的(de)(de)(de)合(he)理(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)性(xing)、藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)的(de)(de)(de)儲存(cun)(cun)(cun)條件等(deng)(deng)進(jin)(jin)(jin)(jin)行(xing)(xing)(xing)(xing)(xing)督(du)(du)導，并(bing)針(zhen)(zhen)對病(bing)(bing)(bing)(bing)(bing)房(fang)(fang)(fang)(fang)存(cun)(cun)(cun)在(zai)(zai)的(de)(de)(de)問(wen)題(ti)進(jin)(jin)(jin)(jin)行(xing)(xing)(xing)(xing)(xing)反(fan)饋。藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)管(guan)(guan)(guan)(guan)(guan)理(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)小(xiao)組(zu)(zu)定(ding)期(qi)召開(kai)規范化(hua)(hua)(hua)(hua)(hua)(hua)管(guan)(guan)(guan)(guan)(guan)理(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)小(xiao)組(zu)(zu)溝通(tong)(tong)(tong)會，將(jiang)存(cun)(cun)(cun)在(zai)(zai)的(de)(de)(de)問(wen)題(ti)、藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)最(zui)近(jin)(jin)的(de)(de)(de)進(jin)(jin)(jin)(jin)展及時(shi)傳達(da)給(gei)病(bing)(bing)(bing)(bing)(bing)房(fang)(fang)(fang)(fang)。1.3評(ping)價(jia)方(fang)法。采用李凌等(deng)(deng)[5]報(bao)道的(de)(de)(de)《藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)管(guan)(guan)(guan)(guan)(guan)理(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)質量(liang)(liang)(liang)(liang)評(ping)價(jia)表(biao)》對日(ri)(ri)間(jian)(jian)手(shou)術(shu)(shu)病(bing)(bing)(bing)(bing)(bing)房(fang)(fang)(fang)(fang)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)管(guan)(guan)(guan)(guan)(guan)理(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)質量(liang)(liang)(liang)(liang)進(jin)(jin)(jin)(jin)行(xing)(xing)(xing)(xing)(xing)評(ping)價(jia)。該量(liang)(liang)(liang)(liang)表(biao)主(zhu)要針(zhen)(zhen)對藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)品(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)規基數管(guan)(guan)(guan)(guan)(guan)理(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)、藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)標(biao)(biao)(biao)識管(guan)(guan)(guan)(guan)(guan)理(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)、藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)存(cun)(cun)(cun)儲管(guan)(guan)(guan)(guan)(guan)理(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)、藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)效期(qi)管(guan)(guan)(guan)(guan)(guan)理(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)和藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)質量(liang)(liang)(liang)(liang)管(guan)(guan)(guan)(guan)(guan)理(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)5個維度，各維度最(zui)高得分分別(bie)為(wei)20、10、30、20、20分，總(zong)分最(zui)高為(wei)100分，得分越高提示(shi)病(bing)(bing)(bing)(bing)(bing)房(fang)(fang)(fang)(fang)針(zhen)(zhen)對藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)管(guan)(guan)(guan)(guan)(guan)理(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)的(de)(de)(de)質量(liang)(liang)(liang)(liang)越高。由(you)(you)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)師(shi)(shi)于(yu)2018年10月(yue)(yue)(yue)（規范化(hua)(hua)(hua)(hua)(hua)(hua)管(guan)(guan)(guan)(guan)(guan)理(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)前）和2019年10月(yue)(yue)(yue)（規范化(hua)(hua)(hua)(hua)(hua)(hua)管(guan)(guan)(guan)(guan)(guan)理(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)后）對日(ri)(ri)間(jian)(jian)手(shou)術(shu)(shu)中(zhong)心(xin)的(de)(de)(de)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)管(guan)(guan)(guan)(guan)(guan)理(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)(li)分別(bie)進(jin)(jin)(jin)(jin)行(xing)(xing)(xing)(xing)(xing)評(ping)價(jia)。通(tong)(tong)(tong)過SPSS22.0統(tong)計學(xue)軟件對數據進(jin)(jin)(jin)(jin)行(xing)(xing)(xing)(xing)(xing)錄入(ru)與(yu)分析(xi)。

2結果

隨著我國醫療(liao)的不(bu)斷改革，在(zai)(zai)一(yi)定程度上推動了醫院(yuan)藥(yao)事(shi)管(guan)理制度的發(fa)展。傳(chuan)統的藥(yao)品保障制度已不(bu)能(neng)滿(man)足當代臨床藥(yao)學(xue)服(fu)務的需求[1-3]。加強醫院(yuan)藥(yao)事(shi)管(guan)理已成為現(xian)階段(duan)醫院(yuan)質(zhi)量管(guan)理的重要內容。結合醫院(yuan)臨床的實際需求，改善(shan)其藥(yao)物服(fu)務質(zhi)量，完成臨床藥(yao)學(xue)管(guan)理體(ti)系，保證醫療(liao)質(zhi)量[4-5]。在(zai)(zai)本次研究(jiu)中(zhong)，對一(yi)年內來我院(yuan)行藥(yao)事(shi)管(guan)理前(qian)后收治(zhi)的200例患者進行調查分(fen)析，其具體(ti)調查結果如下。

1資料與方法

1.1一般資料(liao)。提(ti)(ti)取我院2016年(nian)3月(yue)—2017年(nian)3月(yue)收治(zhi)的(de)(de)(de)(de)(de)(de)200例(li)(li)(li)患(huan)(huan)(huan)者(zhe)作(zuo)為(wei)調(diao)(diao)查(cha)對(dui)(dui)(dui)(dui)象，將行(xing)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)事管(guan)理(li)前收治(zhi)的(de)(de)(de)(de)(de)(de)100例(li)(li)(li)患(huan)(huan)(huan)者(zhe)作(zuo)為(wei)參照(zhao)組(zu)(zu)(zu)，行(xing)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)事管(guan)理(li)后的(de)(de)(de)(de)(de)(de)100例(li)(li)(li)患(huan)(huan)(huan)者(zhe)作(zuo)為(wei)觀(guan)(guan)察組(zu)(zu)(zu)。其(qi)(qi)中觀(guan)(guan)察組(zu)(zu)(zu)100例(li)(li)(li)患(huan)(huan)(huan)者(zhe)中，男57例(li)(li)(li)，女43例(li)(li)(li)，年(nian)齡(ling)(ling)18～80歲(sui)，平均(jun)年(nian)齡(ling)(ling)為(wei)（50.2±8.5）歲(sui)；參照(zhao)組(zu)(zu)(zu)100例(li)(li)(li)患(huan)(huan)(huan)者(zhe)中，男56例(li)(li)(li)，女44例(li)(li)(li)，年(nian)齡(ling)(ling)19～83歲(sui)，平均(jun)年(nian)齡(ling)(ling)為(wei)（51.6±8.4）歲(sui)；本(ben)次(ci)(ci)(ci)研究(jiu)均(jun)獲得(de)(de)兩(liang)(liang)組(zu)(zu)(zu)患(huan)(huan)(huan)者(zhe)的(de)(de)(de)(de)(de)(de)知情(qing)(qing)(qing)同意(yi)(yi)(yi)及(ji)(ji)倫理(li)委員會的(de)(de)(de)(de)(de)(de)批準。兩(liang)(liang)組(zu)(zu)(zu)患(huan)(huan)(huan)者(zhe)的(de)(de)(de)(de)(de)(de)年(nian)齡(ling)(ling)、性(xing)別等(deng)一般資料(liao)進(jin)行(xing)對(dui)(dui)(dui)(dui)比，組(zu)(zu)(zu)間數(shu)(shu)(shu)據對(dui)(dui)(dui)(dui)比差(cha)異無統(tong)計(ji)(ji)學意(yi)(yi)(yi)義（P＞0.05）。1.2方(fang)法。本(ben)次(ci)(ci)(ci)調(diao)(diao)查(cha)研究(jiu)對(dui)(dui)(dui)(dui)兩(liang)(liang)組(zu)(zu)(zu)患(huan)(huan)(huan)者(zhe)的(de)(de)(de)(de)(de)(de)用(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)后不(bu)(bu)良(liang)(liang)反(fan)應(ying)(ying)(ying)情(qing)(qing)(qing)況(kuang)(kuang)(kuang)(kuang)及(ji)(ji)并(bing)發(fa)癥(zheng)發(fa)生(sheng)(sheng)情(qing)(qing)(qing)況(kuang)(kuang)(kuang)(kuang)進(jin)行(xing)調(diao)(diao)查(cha)分(fen)(fen)(fen)析，依據隨(sui)訪時(shi)問卷調(diao)(diao)查(cha)的(de)(de)(de)(de)(de)(de)形式(shi)來記(ji)錄(lu)患(huan)(huan)(huan)者(zhe)對(dui)(dui)(dui)(dui)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)事管(guan)理(li)實(shi)施(shi)的(de)(de)(de)(de)(de)(de)滿意(yi)(yi)(yi)度(du)(du)情(qing)(qing)(qing)況(kuang)(kuang)(kuang)(kuang)；其(qi)(qi)具體調(diao)(diao)查(cha)內容(rong)(rong)包括：（1）患(huan)(huan)(huan)者(zhe)對(dui)(dui)(dui)(dui)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)師(shi)(shi)(shi)(shi)服(fu)務(wu)態度(du)(du)的(de)(de)(de)(de)(de)(de)滿意(yi)(yi)(yi)度(du)(du)。（2）用(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)后的(de)(de)(de)(de)(de)(de)不(bu)(bu)良(liang)(liang)反(fan)應(ying)(ying)(ying)發(fa)生(sheng)(sheng)率。（3）藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)事管(guan)理(li)內容(rong)(rong)的(de)(de)(de)(de)(de)(de)滿意(yi)(yi)(yi)度(du)(du)。（4）藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)物處方(fang)的(de)(de)(de)(de)(de)(de)滿意(yi)(yi)(yi)度(du)(du)。（5）行(xing)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)后發(fa)生(sheng)(sheng)不(bu)(bu)良(liang)(liang)反(fan)應(ying)(ying)(ying)是否得(de)(de)到及(ji)(ji)時(shi)處理(li)。本(ben)次(ci)(ci)(ci)具體調(diao)(diao)查(cha)實(shi)施(shi)有10名護理(li)人員進(jin)行(xing)全(quan)程跟進(jin)。藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)師(shi)(shi)(shi)(shi)管(guan)理(li)具體內容(rong)(rong)如(ru)下：（1）完善藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)事管(guan)理(li)組(zu)(zu)(zu)織(zhi)(zhi)機構(gou)。為(wei)保證藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)學服(fu)務(wu)質(zhi)量良(liang)(liang)好(hao)，應(ying)(ying)(ying)先(xian)完善其(qi)(qi)組(zu)(zu)(zu)織(zhi)(zhi)結構(gou)；加強藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)師(shi)(shi)(shi)(shi)對(dui)(dui)(dui)(dui)醫(yi)院科室(shi)病(bing)房及(ji)(ji)臨床(chuang)科室(shi)現(xian)有情(qing)(qing)(qing)況(kuang)(kuang)(kuang)(kuang)的(de)(de)(de)(de)(de)(de)深入了解，詳細記(ji)錄(lu)臨床(chuang)用(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)方(fang)法及(ji)(ji)其(qi)(qi)注意(yi)(yi)(yi)事項(xiang)并(bing)對(dui)(dui)(dui)(dui)其(qi)(qi)進(jin)行(xing)分(fen)(fen)(fen)析，進(jin)而評定醫(yi)師(shi)(shi)(shi)(shi)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)物處方(fang)對(dui)(dui)(dui)(dui)患(huan)(huan)(huan)者(zhe)的(de)(de)(de)(de)(de)(de)改善作(zuo)用(yong)(yong)(yong)；在患(huan)(huan)(huan)者(zhe)使用(yong)(yong)(yong)處方(fang)過程中出現(xian)不(bu)(bu)良(liang)(liang)事件(jian)應(ying)(ying)(ying)對(dui)(dui)(dui)(dui)醫(yi)師(shi)(shi)(shi)(shi)給(gei)予(yu)相(xiang)應(ying)(ying)(ying)處罰。定期舉辦藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)師(shi)(shi)(shi)(shi)培訓，以(yi)(yi)此提(ti)(ti)高其(qi)(qi)專業技(ji)能，保證用(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)的(de)(de)(de)(de)(de)(de)安全(quan)及(ji)(ji)合理(li)。（2）重視藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)師(shi)(shi)(shi)(shi)作(zuo)用(yong)(yong)(yong)。藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)師(shi)(shi)(shi)(shi)在臨床(chuang)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)學服(fu)務(wu)質(zhi)量中起到至關重要的(de)(de)(de)(de)(de)(de)作(zuo)用(yong)(yong)(yong)，只有充分(fen)(fen)(fen)發(fa)揮藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)師(shi)(shi)(shi)(shi)的(de)(de)(de)(de)(de)(de)作(zuo)用(yong)(yong)(yong)才能保證藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)學服(fu)務(wu)質(zhi)量得(de)(de)到提(ti)(ti)高。達到相(xiang)應(ying)(ying)(ying)的(de)(de)(de)(de)(de)(de)臨床(chuang)治(zhi)療(liao)效果；密(mi)切監督藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)師(shi)(shi)(shi)(shi)對(dui)(dui)(dui)(dui)各(ge)科室(shi)的(de)(de)(de)(de)(de)(de)用(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)情(qing)(qing)(qing)況(kuang)(kuang)(kuang)(kuang)，給(gei)予(yu)特殊用(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)患(huan)(huan)(huan)者(zhe)進(jin)行(xing)重點檢查(cha)。（3）計(ji)(ji)算(suan)機技(ji)術的(de)(de)(de)(de)(de)(de)應(ying)(ying)(ying)用(yong)(yong)(yong)。隨(sui)著計(ji)(ji)算(suan)機技(ji)術的(de)(de)(de)(de)(de)(de)不(bu)(bu)斷提(ti)(ti)高，在醫(yi)學服(fu)務(wu)中心加入計(ji)(ji)算(suan)機技(ji)術，實(shi)現(xian)電子處方(fang)，醫(yi)師(shi)(shi)(shi)(shi)所(suo)開出的(de)(de)(de)(de)(de)(de)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)方(fang)無需給(gei)予(yu)劃階，而是通(tong)過計(ji)(ji)算(suan)機達到臨床(chuang)醫(yi)師(shi)(shi)(shi)(shi)與病(bing)房情(qing)(qing)(qing)況(kuang)(kuang)(kuang)(kuang)進(jin)行(xing)實(shi)時(shi)溝通(tong)交流，以(yi)(yi)進(jin)一步提(ti)(ti)高藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)師(shi)(shi)(shi)(shi)的(de)(de)(de)(de)(de)(de)服(fu)務(wu)質(zhi)量及(ji)(ji)管(guan)理(li)工(gong)作(zuo)的(de)(de)(de)(de)(de)(de)效率。1.3觀(guan)(guan)察指(zhi)標。本(ben)次(ci)(ci)(ci)問卷調(diao)(diao)查(cha)各(ge)項(xiang)分(fen)(fen)(fen)數(shu)(shu)(shu)均(jun)為(wei)0～10分(fen)(fen)(fen)，其(qi)(qi)評分(fen)(fen)(fen)越(yue)高，則代表患(huan)(huan)(huan)者(zhe)的(de)(de)(de)(de)(de)(de)滿意(yi)(yi)(yi)度(du)(du)越(yue)高，總(zong)分(fen)(fen)(fen)為(wei)50分(fen)(fen)(fen)；滿意(yi)(yi)(yi)為(wei)45～50分(fen)(fen)(fen)；25分(fen)(fen)(fen)以(yi)(yi)下則判定為(wei)不(bu)(bu)滿意(yi)(yi)(yi)。對(dui)(dui)(dui)(dui)比分(fen)(fen)(fen)析兩(liang)(liang)組(zu)(zu)(zu)患(huan)(huan)(huan)者(zhe)的(de)(de)(de)(de)(de)(de)不(bu)(bu)良(liang)(liang)反(fan)應(ying)(ying)(ying)情(qing)(qing)(qing)況(kuang)(kuang)(kuang)(kuang)。1.4統(tong)計(ji)(ji)學分(fen)(fen)(fen)析。本(ben)次(ci)(ci)(ci)研究(jiu)數(shu)(shu)(shu)據應(ying)(ying)(ying)用(yong)(yong)(yong)統(tong)計(ji)(ji)學SPSS19.0軟件(jian)進(jin)行(xing)數(shu)(shu)(shu)據分(fen)(fen)(fen)析，計(ji)(ji)量資料(liao)對(dui)(dui)(dui)(dui)比用(yong)(yong)(yong)（x-±s）表示，行(xing)t檢驗；計(ji)(ji)數(shu)(shu)(shu)資料(liao)對(dui)(dui)(dui)(dui)比用(yong)(yong)(yong)（%）表示，采用(yong)(yong)(yong)χ2檢驗，當P＜0.05時(shi)，組(zu)(zu)(zu)間數(shu)(shu)(shu)據對(dui)(dui)(dui)(dui)比差(cha)異具有統(tong)計(ji)(ji)學意(yi)(yi)(yi)義。

2結果

2.1對(dui)(dui)(dui)比(bi)兩(liang)組(zu)(zu)(zu)患(huan)(huan)者用藥(yao)不(bu)良反應率(lv)情(qing)況。觀察組(zu)(zu)(zu)患(huan)(huan)者不(bu)良反應率(lv)優于參(can)照(zhao)組(zu)(zu)(zu)患(huan)(huan)者，組(zu)(zu)(zu)間數據對(dui)(dui)(dui)比(bi)差(cha)異具(ju)有(you)統計(ji)學意(yi)(yi)義(yi)（χ2=21.6450，P＜0.05）。具(ju)體詳見表1。2.2對(dui)(dui)(dui)比(bi)兩(liang)組(zu)(zu)(zu)患(huan)(huan)者的滿意(yi)(yi)度(du)情(qing)況。觀察組(zu)(zu)(zu)滿意(yi)(yi)度(du)評分(fen)在(zai)45～50分(fen)的患(huan)(huan)者有(you)85例(li)，參(can)照(zhao)組(zu)(zu)(zu)患(huan)(huan)者滿意(yi)(yi)度(du)評分(fen)在(zai)45～50分(fen)的患(huan)(huan)者有(you)50例(li)。組(zu)(zu)(zu)間數據對(dui)(dui)(dui)比(bi)差(cha)異具(ju)有(you)統計(ji)學意(yi)(yi)義(yi)（χ2=27.9202，P＜0.05）。具(ju)體詳見表2。

3討論

摘要：目的(de)：探討心(xin)內科(ke)用(yong)(yong)藥(yao)(yao)安(an)(an)全(quan)(quan)隱(yin)患(huan)，并(bing)(bing)制定(ding)規范(fan)化管理措施(shi)(shi)(shi)。方法：對(dui)2019年7～12月(yue)心(xin)內科(ke)375例患(huan)者用(yong)(yong)藥(yao)(yao)過(guo)程進行分(fen)析，統(tong)計用(yong)(yong)藥(yao)(yao)不良(liang)事(shi)(shi)件(jian)，設為(wei)實(shi)(shi)(shi)(shi)施(shi)(shi)(shi)前(qian)(qian)。分(fen)析實(shi)(shi)(shi)(shi)施(shi)(shi)(shi)前(qian)(qian)用(yong)(yong)藥(yao)(yao)安(an)(an)全(quan)(quan)隱(yin)患(huan)并(bing)(bing)制定(ding)規范(fan)化安(an)(an)全(quan)(quan)管理措施(shi)(shi)(shi)，于2020年1～6月(yue)對(dui)心(xin)內科(ke)用(yong)(yong)藥(yao)(yao)過(guo)程實(shi)(shi)(shi)(shi)施(shi)(shi)(shi)規范(fan)化安(an)(an)全(quan)(quan)管理，設為(wei)實(shi)(shi)(shi)(shi)施(shi)(shi)(shi)后。比較實(shi)(shi)(shi)(shi)施(shi)(shi)(shi)前(qian)(qian)后護理人員藥(yao)(yao)品知識掌握情況、用(yong)(yong)藥(yao)(yao)不良(liang)事(shi)(shi)件(jian)發生(sheng)率(lv)。結果：實(shi)(shi)(shi)(shi)施(shi)(shi)(shi)后護理人員在藥(yao)(yao)品儲存、藥(yao)(yao)品使(shi)用(yong)(yong)、藥(yao)(yao)品禁(jin)忌、不良(liang)反應及處(chu)理等藥(yao)(yao)品知識得分(fen)，顯著高于實(shi)(shi)(shi)(shi)施(shi)(shi)(shi)前(qian)(qian)（P＜0．05）。實(shi)(shi)(shi)(shi)施(shi)(shi)(shi)后用(yong)(yong)藥(yao)(yao)不良(liang)事(shi)(shi)件(jian)發生(sheng)率(lv)，顯著低于實(shi)(shi)(shi)(shi)施(shi)(shi)(shi)前(qian)(qian)（P＜0．05）。結論：對(dui)心(xin)內科(ke)用(yong)(yong)藥(yao)(yao)過(guo)程進行安(an)(an)全(quan)(quan)管理，能夠提高護理人員藥(yao)(yao)品知識掌握水平，減少用(yong)(yong)藥(yao)(yao)不良(liang)事(shi)(shi)件(jian)的(de)發生(sheng)，有利于降低用(yong)(yong)藥(yao)(yao)風險，保(bao)障(zhang)患(huan)者用(yong)(yong)藥(yao)(yao)安(an)(an)全(quan)(quan)。

關鍵詞：心(xin)內科；用藥安全；安全管(guan)理；不良事件

心(xin)(xin)(xin)內科是(shi)主(zhu)要收治(zhi)(zhi)心(xin)(xin)(xin)絞痛、心(xin)(xin)(xin)力(li)衰竭、心(xin)(xin)(xin)律(lv)失常、高血壓(ya)、心(xin)(xin)(xin)肌梗死(si)等心(xin)(xin)(xin)血管疾病(bing)的(de)臨床(chuang)科室，藥(yao)物治(zhi)(zhi)療非常重要。心(xin)(xin)(xin)內科涉及藥(yao)物種類多、數量大，對藥(yao)物的(de)安(an)全(quan)(quan)管控(kong)難度大，容易(yi)發生(sheng)藥(yao)物安(an)全(quan)(quan)事(shi)件(jian)［1］。用(yong)藥(yao)安(an)全(quan)(quan)是(shi)決定治(zhi)(zhi)療效果的(de)關(guan)鍵因素，藥(yao)物不(bu)良事(shi)件(jian)的(de)發生(sheng)不(bu)僅影響治(zhi)(zhi)療效果，還(huan)會降(jiang)低(di)患(huan)(huan)者(zhe)滿意(yi)度，不(bu)利于(yu)良好護患(huan)(huan)關(guan)系的(de)構建(jian)［2］。因此(ci)，如何降(jiang)低(di)用(yong)藥(yao)風險、保障(zhang)患(huan)(huan)者(zhe)用(yong)藥(yao)安(an)全(quan)(quan)成為心(xin)(xin)(xin)內科的(de)管理(li)(li)重點。故醫院(yuan)對心(xin)(xin)(xin)內科用(yong)藥(yao)安(an)全(quan)(quan)隱(yin)患(huan)(huan)進行了分析，并制定了安(an)全(quan)(quan)管理(li)(li)對策，以保障(zhang)患(huan)(huan)者(zhe)用(yong)藥(yao)安(an)全(quan)(quan)。

1資料與方法

1．1一(yi)(yi)(yi)般資料(liao)(liao)。對(dui)(dui)(dui)2019年(nian)7～12月(yue)心(xin)(xin)(xin)(xin)內(nei)科(ke)(ke)375例(li)患(huan)(huan)(huan)(huan)者(zhe)(zhe)(zhe)(zhe)用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)過(guo)程(cheng)進(jin)行(xing)(xing)(xing)分(fen)(fen)(fen)(fen)(fen)析，統(tong)(tong)(tong)計(ji)(ji)用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)不(bu)(bu)(bu)(bu)(bu)(bu)良(liang)(liang)事(shi)件(jian)，設為實(shi)(shi)施(shi)(shi)(shi)(shi)(shi)(shi)前(qian)。分(fen)(fen)(fen)(fen)(fen)析實(shi)(shi)施(shi)(shi)(shi)(shi)(shi)(shi)前(qian)用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)安(an)(an)(an)(an)(an)(an)(an)(an)全(quan)(quan)(quan)(quan)(quan)(quan)(quan)(quan)(quan)(quan)隱(yin)患(huan)(huan)(huan)(huan)并(bing)制(zhi)(zhi)(zhi)定(ding)(ding)規范化(hua)(hua)(hua)安(an)(an)(an)(an)(an)(an)(an)(an)全(quan)(quan)(quan)(quan)(quan)(quan)(quan)(quan)(quan)(quan)管(guan)(guan)(guan)(guan)理(li)(li)(li)(li)(li)(li)措(cuo)施(shi)(shi)(shi)(shi)(shi)(shi)，于2020年(nian)1～6月(yue)對(dui)(dui)(dui)心(xin)(xin)(xin)(xin)內(nei)科(ke)(ke)用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)過(guo)程(cheng)實(shi)(shi)施(shi)(shi)(shi)(shi)(shi)(shi)規范化(hua)(hua)(hua)安(an)(an)(an)(an)(an)(an)(an)(an)全(quan)(quan)(quan)(quan)(quan)(quan)(quan)(quan)(quan)(quan)管(guan)(guan)(guan)(guan)理(li)(li)(li)(li)(li)(li)，設為實(shi)(shi)施(shi)(shi)(shi)(shi)(shi)(shi)后(hou)(hou)，實(shi)(shi)施(shi)(shi)(shi)(shi)(shi)(shi)后(hou)(hou)有(you)(you)(you)390例(li)患(huan)(huan)(huan)(huan)者(zhe)(zhe)(zhe)(zhe)。所有(you)(you)(you)患(huan)(huan)(huan)(huan)者(zhe)(zhe)(zhe)(zhe)具備一(yi)(yi)(yi)定(ding)(ding)認(ren)知(zhi)(zhi)(zhi)、溝通(tong)能力，排除患(huan)(huan)(huan)(huan)有(you)(you)(you)精神疾病、認(ren)知(zhi)(zhi)(zhi)功能障礙者(zhe)(zhe)(zhe)(zhe)。實(shi)(shi)施(shi)(shi)(shi)(shi)(shi)(shi)前(qian)患(huan)(huan)(huan)(huan)者(zhe)(zhe)(zhe)(zhe)中(zhong)，男210例(li)，女165例(li)；年(nian)齡(ling)為43～75歲(sui)；高血壓(ya)104例(li)，心(xin)(xin)(xin)(xin)絞(jiao)痛(tong)99例(li)，心(xin)(xin)(xin)(xin)肌梗死73例(li)，心(xin)(xin)(xin)(xin)率(lv)失常(chang)(chang)54例(li)，心(xin)(xin)(xin)(xin)力衰(shuai)(shuai)竭45例(li)。實(shi)(shi)施(shi)(shi)(shi)(shi)(shi)(shi)后(hou)(hou)患(huan)(huan)(huan)(huan)者(zhe)(zhe)(zhe)(zhe)中(zhong)，男214例(li)，女176例(li)；年(nian)齡(ling)為45～78歲(sui)；高血壓(ya)112例(li)，心(xin)(xin)(xin)(xin)絞(jiao)痛(tong)93例(li)，心(xin)(xin)(xin)(xin)肌梗死78例(li)，心(xin)(xin)(xin)(xin)律失常(chang)(chang)57例(li)，心(xin)(xin)(xin)(xin)力衰(shuai)(shuai)竭50例(li)。實(shi)(shi)施(shi)(shi)(shi)(shi)(shi)(shi)前(qian)后(hou)(hou)患(huan)(huan)(huan)(huan)者(zhe)(zhe)(zhe)(zhe)的(de)(de)(de)(de)(de)(de)(de)一(yi)(yi)(yi)般資料(liao)(liao)比(bi)較(jiao)(jiao)差異不(bu)(bu)(bu)(bu)(bu)(bu)顯著（P＞0．05），具有(you)(you)(you)可比(bi)性。1．2方(fang)法(fa)。（1）成立用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)安(an)(an)(an)(an)(an)(an)(an)(an)全(quan)(quan)(quan)(quan)(quan)(quan)(quan)(quan)(quan)(quan)管(guan)(guan)(guan)(guan)理(li)(li)(li)(li)(li)(li)小組(zu)。成立包括(kuo)心(xin)(xin)(xin)(xin)內(nei)科(ke)(ke)護(hu)士(shi)(shi)長、科(ke)(ke)室(shi)(shi)(shi)主(zhu)任(ren)(ren)(ren)、臨(lin)床藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)師(shi)、主(zhu)管(guan)(guan)(guan)(guan)醫(yi)生(sheng)、責任(ren)(ren)(ren)護(hu)士(shi)(shi)在(zai)(zai)內(nei)的(de)(de)(de)(de)(de)(de)(de)用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)安(an)(an)(an)(an)(an)(an)(an)(an)全(quan)(quan)(quan)(quan)(quan)(quan)(quan)(quan)(quan)(quan)管(guan)(guan)(guan)(guan)理(li)(li)(li)(li)(li)(li)小組(zu)，明(ming)(ming)確(que)各成員(yuan)(yuan)職責。護(hu)士(shi)(shi)長擔任(ren)(ren)(ren)小組(zu)組(zu)長，負(fu)(fu)責用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)安(an)(an)(an)(an)(an)(an)(an)(an)全(quan)(quan)(quan)(quan)(quan)(quan)(quan)(quan)(quan)(quan)因(yin)(yin)(yin)(yin)素(su)的(de)(de)(de)(de)(de)(de)(de)分(fen)(fen)(fen)(fen)(fen)析、協調安(an)(an)(an)(an)(an)(an)(an)(an)全(quan)(quan)(quan)(quan)(quan)(quan)(quan)(quan)(quan)(quan)管(guan)(guan)(guan)(guan)理(li)(li)(li)(li)(li)(li)措(cuo)施(shi)(shi)(shi)(shi)(shi)(shi)的(de)(de)(de)(de)(de)(de)(de)開(kai)展(zhan)、安(an)(an)(an)(an)(an)(an)(an)(an)全(quan)(quan)(quan)(quan)(quan)(quan)(quan)(quan)(quan)(quan)管(guan)(guan)(guan)(guan)理(li)(li)(li)(li)(li)(li)制(zhi)(zhi)(zhi)度(du)(du)(du)(du)(du)的(de)(de)(de)(de)(de)(de)(de)制(zhi)(zhi)(zhi)定(ding)(ding)、監督并(bing)考核(he)安(an)(an)(an)(an)(an)(an)(an)(an)全(quan)(quan)(quan)(quan)(quan)(quan)(quan)(quan)(quan)(quan)管(guan)(guan)(guan)(guan)理(li)(li)(li)(li)(li)(li)措(cuo)施(shi)(shi)(shi)(shi)(shi)(shi)的(de)(de)(de)(de)(de)(de)(de)執(zhi)行(xing)(xing)(xing)情(qing)況(kuang)(kuang)，科(ke)(ke)室(shi)(shi)(shi)主(zhu)任(ren)(ren)(ren)、臨(lin)床藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)師(shi)負(fu)(fu)責護(hu)理(li)(li)(li)(li)(li)(li)人(ren)員(yuan)(yuan)安(an)(an)(an)(an)(an)(an)(an)(an)全(quan)(quan)(quan)(quan)(quan)(quan)(quan)(quan)(quan)(quan)用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)的(de)(de)(de)(de)(de)(de)(de)知(zhi)(zhi)(zhi)識培訓(xun)(xun)，主(zhu)管(guan)(guan)(guan)(guan)醫(yi)生(sheng)負(fu)(fu)責患(huan)(huan)(huan)(huan)者(zhe)(zhe)(zhe)(zhe)開(kai)具用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)醫(yi)囑(zhu)和(he)制(zhi)(zhi)(zhi)定(ding)(ding)治療方(fang)案，責任(ren)(ren)(ren)護(hu)士(shi)(shi)負(fu)(fu)責用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)安(an)(an)(an)(an)(an)(an)(an)(an)全(quan)(quan)(quan)(quan)(quan)(quan)(quan)(quan)(quan)(quan)管(guan)(guan)(guan)(guan)理(li)(li)(li)(li)(li)(li)措(cuo)施(shi)(shi)(shi)(shi)(shi)(shi)的(de)(de)(de)(de)(de)(de)(de)具體(ti)落實(shi)(shi)。（2）分(fen)(fen)(fen)(fen)(fen)析用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)安(an)(an)(an)(an)(an)(an)(an)(an)全(quan)(quan)(quan)(quan)(quan)(quan)(quan)(quan)(quan)(quan)隱(yin)患(huan)(huan)(huan)(huan)。對(dui)(dui)(dui)實(shi)(shi)施(shi)(shi)(shi)(shi)(shi)(shi)前(qian)的(de)(de)(de)(de)(de)(de)(de)2019年(nian)7～12月(yue)心(xin)(xin)(xin)(xin)內(nei)科(ke)(ke)用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)數(shu)(shu)(shu)據進(jin)行(xing)(xing)(xing)分(fen)(fen)(fen)(fen)(fen)析，查(cha)找各項(xiang)用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)安(an)(an)(an)(an)(an)(an)(an)(an)全(quan)(quan)(quan)(quan)(quan)(quan)(quan)(quan)(quan)(quan)隱(yin)患(huan)(huan)(huan)(huan)。①護(hu)理(li)(li)(li)(li)(li)(li)人(ren)員(yuan)(yuan)因(yin)(yin)(yin)(yin)素(su)。護(hu)士(shi)(shi)責任(ren)(ren)(ren)心(xin)(xin)(xin)(xin)不(bu)(bu)(bu)(bu)(bu)(bu)足(zu)、缺(que)(que)乏(fa)安(an)(an)(an)(an)(an)(an)(an)(an)全(quan)(quan)(quan)(quan)(quan)(quan)(quan)(quan)(quan)(quan)意(yi)識和(he)風險(xian)意(yi)識，未(wei)(wei)(wei)養成良(liang)(liang)好的(de)(de)(de)(de)(de)(de)(de)工作(zuo)習(xi)慣(guan)，用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)過(guo)程(cheng)中(zhong)未(wei)(wei)(wei)嚴格(ge)(ge)(ge)執(zhi)行(xing)(xing)(xing)三查(cha)七(qi)對(dui)(dui)(dui)，導(dao)(dao)致(zhi)臨(lin)床用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)存(cun)(cun)在(zai)(zai)安(an)(an)(an)(an)(an)(an)(an)(an)全(quan)(quan)(quan)(quan)(quan)(quan)(quan)(quan)(quan)(quan)隱(yin)患(huan)(huan)(huan)(huan)。護(hu)士(shi)(shi)欠缺(que)(que)臨(lin)床用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)知(zhi)(zhi)(zhi)識，未(wei)(wei)(wei)掌握(wo)腸溶(rong)片(pian)、緩(huan)／控釋片(pian)、膠(jiao)囊等(deng)(deng)(deng)制(zhi)(zhi)(zhi)劑不(bu)(bu)(bu)(bu)(bu)(bu)可掰開(kai)服(fu)(fu)用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)，缺(que)(que)乏(fa)正確(que)的(de)(de)(de)(de)(de)(de)(de)用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)宣(xuan)教(jiao)(jiao)和(he)指導(dao)(dao)，導(dao)(dao)致(zhi)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)效(xiao)(xiao)(xiao)降(jiang)低(di)。配藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)期(qi)(qi)間未(wei)(wei)(wei)完全(quan)(quan)(quan)(quan)(quan)(quan)(quan)(quan)(quan)(quan)掌握(wo)配伍(wu)禁忌(ji)，對(dui)(dui)(dui)需要避光(guang)放(fang)(fang)(fang)(fang)置(zhi)(zhi)、現(xian)(xian)配現(xian)(xian)用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)的(de)(de)(de)(de)(de)(de)(de)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)物(wu)(wu)(wu)(wu)處(chu)理(li)(li)(li)(li)(li)(li)不(bu)(bu)(bu)(bu)(bu)(bu)當，同(tong)樣降(jiang)低(di)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)效(xiao)(xiao)(xiao)，甚(shen)至引發(fa)(fa)(fa)輸(shu)(shu)液(ye)不(bu)(bu)(bu)(bu)(bu)(bu)良(liang)(liang)事(shi)件(jian)。護(hu)士(shi)(shi)對(dui)(dui)(dui)需要控制(zhi)(zhi)(zhi)滴(di)速(su)的(de)(de)(de)(de)(de)(de)(de)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)物(wu)(wu)(wu)(wu)如(ru)硝酸甘油、西地蘭、米(mi)力農(nong)、新(xin)活素(su)、艾司洛(luo)爾等(deng)(deng)(deng)掌握(wo)不(bu)(bu)(bu)(bu)(bu)(bu)足(zu)，未(wei)(wei)(wei)嚴格(ge)(ge)(ge)控制(zhi)(zhi)(zhi)滴(di)速(su)，存(cun)(cun)在(zai)(zai)較(jiao)(jiao)高的(de)(de)(de)(de)(de)(de)(de)輸(shu)(shu)液(ye)隱(yin)患(huan)(huan)(huan)(huan)風險(xian)。護(hu)士(shi)(shi)對(dui)(dui)(dui)患(huan)(huan)(huan)(huan)者(zhe)(zhe)(zhe)(zhe)的(de)(de)(de)(de)(de)(de)(de)用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)宣(xuan)教(jiao)(jiao)力度(du)(du)(du)(du)(du)不(bu)(bu)(bu)(bu)(bu)(bu)足(zu)，如(ru)針對(dui)(dui)(dui)同(tong)時(shi)(shi)伴有(you)(you)(you)高血壓(ya)、糖尿病、心(xin)(xin)(xin)(xin)絞(jiao)痛(tong)等(deng)(deng)(deng)多(duo)種基礎疾病的(de)(de)(de)(de)(de)(de)(de)患(huan)(huan)(huan)(huan)者(zhe)(zhe)(zhe)(zhe)，應(ying)(ying)(ying)(ying)教(jiao)(jiao)育患(huan)(huan)(huan)(huan)者(zhe)(zhe)(zhe)(zhe)積(ji)極服(fu)(fu)用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)抗高血壓(ya)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)物(wu)(wu)(wu)(wu)、降(jiang)糖藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)物(wu)(wu)(wu)(wu)、綜合服(fu)(fu)用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)硝酸酯類和(he)鈣離子拮(jie)抗劑類藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)物(wu)(wu)(wu)(wu)。②患(huan)(huan)(huan)(huan)者(zhe)(zhe)(zhe)(zhe)因(yin)(yin)(yin)(yin)素(su)。心(xin)(xin)(xin)(xin)內(nei)科(ke)(ke)患(huan)(huan)(huan)(huan)者(zhe)(zhe)(zhe)(zhe)大(da)(da)多(duo)為中(zhong)老年(nian)群(qun)體(ti)，知(zhi)(zhi)(zhi)識水(shui)平、理(li)(li)(li)(li)(li)(li)解(jie)能力有(you)(you)(you)限，記憶力下(xia)降(jiang)，同(tong)時(shi)(shi)服(fu)(fu)用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)物(wu)(wu)(wu)(wu)較(jiao)(jiao)多(duo)、頻率(lv)不(bu)(bu)(bu)(bu)(bu)(bu)一(yi)(yi)(yi)致(zhi)，容(rong)易出現(xian)(xian)漏(lou)服(fu)(fu)、錯服(fu)(fu)、多(duo)服(fu)(fu)的(de)(de)(de)(de)(de)(de)(de)情(qing)況(kuang)(kuang)，造成用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)安(an)(an)(an)(an)(an)(an)(an)(an)全(quan)(quan)(quan)(quan)(quan)(quan)(quan)(quan)(quan)(quan)隱(yin)患(huan)(huan)(huan)(huan)。部(bu)(bu)分(fen)(fen)(fen)(fen)(fen)患(huan)(huan)(huan)(huan)者(zhe)(zhe)(zhe)(zhe)用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)依從(cong)性差，不(bu)(bu)(bu)(bu)(bu)(bu)遵(zun)醫(yi)囑(zhu)服(fu)(fu)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)，常(chang)(chang)常(chang)(chang)自(zi)行(xing)(xing)(xing)停藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)、自(zi)行(xing)(xing)(xing)加(jia)減劑量，影響治療效(xiao)(xiao)(xiao)果。③科(ke)(ke)室(shi)(shi)(shi)管(guan)(guan)(guan)(guan)理(li)(li)(li)(li)(li)(li)因(yin)(yin)(yin)(yin)素(su)。科(ke)(ke)室(shi)(shi)(shi)缺(que)(que)乏(fa)完善的(de)(de)(de)(de)(de)(de)(de)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)存(cun)(cun)儲制(zhi)(zhi)(zhi)度(du)(du)(du)(du)(du)，藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)大(da)(da)多(duo)隨意(yi)放(fang)(fang)(fang)(fang)置(zhi)(zhi)，未(wei)(wei)(wei)嚴格(ge)(ge)(ge)按照(zhao)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)物(wu)(wu)(wu)(wu)儲存(cun)(cun)條件(jian)放(fang)(fang)(fang)(fang)置(zhi)(zhi)，需要放(fang)(fang)(fang)(fang)在(zai)(zai)特定(ding)(ding)溫度(du)(du)(du)(du)(du)下(xia)的(de)(de)(de)(de)(de)(de)(de)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)物(wu)(wu)(wu)(wu)未(wei)(wei)(wei)按適當溫度(du)(du)(du)(du)(du)環(huan)境保存(cun)(cun)，導(dao)(dao)致(zhi)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)物(wu)(wu)(wu)(wu)變(bian)質。需要避光(guang)的(de)(de)(de)(de)(de)(de)(de)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)物(wu)(wu)(wu)(wu)未(wei)(wei)(wei)放(fang)(fang)(fang)(fang)置(zhi)(zhi)在(zai)(zai)黑(hei)暗處(chu)或進(jin)行(xing)(xing)(xing)避光(guang)處(chu)理(li)(li)(li)(li)(li)(li)，降(jiang)低(di)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)物(wu)(wu)(wu)(wu)效(xiao)(xiao)(xiao)能。需要嚴封的(de)(de)(de)(de)(de)(de)(de)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)物(wu)(wu)(wu)(wu)未(wei)(wei)(wei)密封，導(dao)(dao)致(zhi)空氣或水(shui)分(fen)(fen)(fen)(fen)(fen)滲(shen)入造成藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)污染(ran)。科(ke)(ke)室(shi)(shi)(shi)缺(que)(que)乏(fa)完善的(de)(de)(de)(de)(de)(de)(de)清點(dian)審核(he)制(zhi)(zhi)(zhi)度(du)(du)(du)(du)(du)，導(dao)(dao)致(zhi)部(bu)(bu)分(fen)(fen)(fen)(fen)(fen)搶救藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)長時(shi)(shi)間積(ji)壓(ya)而(er)失效(xiao)(xiao)(xiao)。（3）制(zhi)(zhi)(zhi)定(ding)(ding)用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)安(an)(an)(an)(an)(an)(an)(an)(an)全(quan)(quan)(quan)(quan)(quan)(quan)(quan)(quan)(quan)(quan)管(guan)(guan)(guan)(guan)理(li)(li)(li)(li)(li)(li)措(cuo)施(shi)(shi)(shi)(shi)(shi)(shi)。加(jia)強護(hu)士(shi)(shi)安(an)(an)(an)(an)(an)(an)(an)(an)全(quan)(quan)(quan)(quan)(quan)(quan)(quan)(quan)(quan)(quan)用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)培訓(xun)(xun)，邀請臨(lin)床藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)師(shi)定(ding)(ding)期(qi)(qi)舉辦心(xin)(xin)(xin)(xin)內(nei)科(ke)(ke)常(chang)(chang)用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)物(wu)(wu)(wu)(wu)的(de)(de)(de)(de)(de)(de)(de)知(zhi)(zhi)(zhi)識講座，提高全(quan)(quan)(quan)(quan)(quan)(quan)(quan)(quan)(quan)(quan)體(ti)醫(yi)護(hu)人(ren)員(yuan)(yuan)用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)知(zhi)(zhi)(zhi)識水(shui)平，避免因(yin)(yin)(yin)(yin)自(zi)身(shen)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)物(wu)(wu)(wu)(wu)知(zhi)(zhi)(zhi)識不(bu)(bu)(bu)(bu)(bu)(bu)足(zu)引發(fa)(fa)(fa)的(de)(de)(de)(de)(de)(de)(de)用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)安(an)(an)(an)(an)(an)(an)(an)(an)全(quan)(quan)(quan)(quan)(quan)(quan)(quan)(quan)(quan)(quan)隱(yin)患(huan)(huan)(huan)(huan)。同(tong)時(shi)(shi)加(jia)強安(an)(an)(an)(an)(an)(an)(an)(an)全(quan)(quan)(quan)(quan)(quan)(quan)(quan)(quan)(quan)(quan)教(jiao)(jiao)育培訓(xun)(xun)，組(zu)織護(hu)理(li)(li)(li)(li)(li)(li)人(ren)員(yuan)(yuan)學(xue)(xue)習(xi)法(fa)律知(zhi)(zhi)(zhi)識，提升風險(xian)意(yi)識和(he)安(an)(an)(an)(an)(an)(an)(an)(an)全(quan)(quan)(quan)(quan)(quan)(quan)(quan)(quan)(quan)(quan)意(yi)識，促進(jin)護(hu)理(li)(li)(li)(li)(li)(li)人(ren)員(yuan)(yuan)提高對(dui)(dui)(dui)安(an)(an)(an)(an)(an)(an)(an)(an)全(quan)(quan)(quan)(quan)(quan)(quan)(quan)(quan)(quan)(quan)用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)的(de)(de)(de)(de)(de)(de)(de)重(zhong)視程(cheng)度(du)(du)(du)(du)(du)，嚴格(ge)(ge)(ge)執(zhi)行(xing)(xing)(xing)各項(xiang)規章制(zhi)(zhi)(zhi)度(du)(du)(du)(du)(du)。建立安(an)(an)(an)(an)(an)(an)(an)(an)全(quan)(quan)(quan)(quan)(quan)(quan)(quan)(quan)(quan)(quan)用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)流(liu)程(cheng)。分(fen)(fen)(fen)(fen)(fen)析藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)物(wu)(wu)(wu)(wu)發(fa)(fa)(fa)放(fang)(fang)(fang)(fang)、使(shi)用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)的(de)(de)(de)(de)(de)(de)(de)各個(ge)環(huan)節，制(zhi)(zhi)(zhi)定(ding)(ding)規范化(hua)(hua)(hua)安(an)(an)(an)(an)(an)(an)(an)(an)全(quan)(quan)(quan)(quan)(quan)(quan)(quan)(quan)(quan)(quan)用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)流(liu)程(cheng)。醫(yi)生(sheng)開(kai)具用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)醫(yi)囑(zhu)后(hou)(hou)，護(hu)士(shi)(shi)應(ying)(ying)(ying)(ying)核(he)對(dui)(dui)(dui)用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)單(dan)(dan)，確(que)認(ren)無誤(wu)后(hou)(hou)進(jin)行(xing)(xing)(xing)配藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)或發(fa)(fa)(fa)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)，若(ruo)存(cun)(cun)在(zai)(zai)疑問則(ze)(ze)應(ying)(ying)(ying)(ying)立即詢(xun)問主(zhu)管(guan)(guan)(guan)(guan)醫(yi)生(sheng)，避免發(fa)(fa)(fa)生(sheng)治療方(fang)案模糊(hu)不(bu)(bu)(bu)(bu)(bu)(bu)清的(de)(de)(de)(de)(de)(de)(de)情(qing)況(kuang)(kuang)。嚴格(ge)(ge)(ge)執(zhi)行(xing)(xing)(xing)分(fen)(fen)(fen)(fen)(fen)餐發(fa)(fa)(fa)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)制(zhi)(zhi)(zhi)度(du)(du)(du)(du)(du)，責任(ren)(ren)(ren)護(hu)士(shi)(shi)分(fen)(fen)(fen)(fen)(fen)別(bie)于7：00～7：30、11：00～11：30、17：00～17：30發(fa)(fa)(fa)放(fang)(fang)(fang)(fang)三餐藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)物(wu)(wu)(wu)(wu)，嚴格(ge)(ge)(ge)執(zhi)行(xing)(xing)(xing)三查(cha)七(qi)對(dui)(dui)(dui)制(zhi)(zhi)(zhi)度(du)(du)(du)(du)(du)，實(shi)(shi)行(xing)(xing)(xing)雙人(ren)核(he)對(dui)(dui)(dui)和(he)條碼管(guan)(guan)(guan)(guan)理(li)(li)(li)(li)(li)(li)。交接班時(shi)(shi)核(he)對(dui)(dui)(dui)電(dian)腦上(shang)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)物(wu)(wu)(wu)(wu)執(zhi)行(xing)(xing)(xing)情(qing)況(kuang)(kuang)，未(wei)(wei)(wei)執(zhi)行(xing)(xing)(xing)的(de)(de)(de)(de)(de)(de)(de)查(cha)找原(yuan)因(yin)(yin)(yin)(yin)。配制(zhi)(zhi)(zhi)靜(jing)脈用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)時(shi)(shi)嚴格(ge)(ge)(ge)遵(zun)守無菌操作(zuo)原(yuan)則(ze)(ze)，充分(fen)(fen)(fen)(fen)(fen)考慮(lv)配伍(wu)禁忌(ji)、用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)濃度(du)(du)(du)(du)(du)、輸(shu)(shu)注順序，保障藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)液(ye)的(de)(de)(de)(de)(de)(de)(de)安(an)(an)(an)(an)(an)(an)(an)(an)全(quan)(quan)(quan)(quan)(quan)(quan)(quan)(quan)(quan)(quan)性和(he)有(you)(you)(you)效(xiao)(xiao)(xiao)性。輸(shu)(shu)注藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)物(wu)(wu)(wu)(wu)前(qian)調整輸(shu)(shu)液(ye)速(su)度(du)(du)(du)(du)(du)，講解(jie)可能出現(xian)(xian)的(de)(de)(de)(de)(de)(de)(de)不(bu)(bu)(bu)(bu)(bu)(bu)良(liang)(liang)反應(ying)(ying)(ying)(ying)和(he)注意(yi)事(shi)項(xiang)，輸(shu)(shu)液(ye)期(qi)(qi)間做好監督巡(xun)視，觀(guan)察(cha)患(huan)(huan)(huan)(huan)者(zhe)(zhe)(zhe)(zhe)是否出現(xian)(xian)不(bu)(bu)(bu)(bu)(bu)(bu)良(liang)(liang)反應(ying)(ying)(ying)(ying)。實(shi)(shi)行(xing)(xing)(xing)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)分(fen)(fen)(fen)(fen)(fen)類管(guan)(guan)(guan)(guan)理(li)(li)(li)(li)(li)(li)。不(bu)(bu)(bu)(bu)(bu)(bu)同(tong)種類、不(bu)(bu)(bu)(bu)(bu)(bu)同(tong)規格(ge)(ge)(ge)的(de)(de)(de)(de)(de)(de)(de)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)物(wu)(wu)(wu)(wu)放(fang)(fang)(fang)(fang)置(zhi)(zhi)于單(dan)(dan)架的(de)(de)(de)(de)(de)(de)(de)不(bu)(bu)(bu)(bu)(bu)(bu)同(tong)層次(ci)和(he)不(bu)(bu)(bu)(bu)(bu)(bu)同(tong)排列(lie)處(chu)，常(chang)(chang)規搶救藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)物(wu)(wu)(wu)(wu)放(fang)(fang)(fang)(fang)置(zhi)(zhi)在(zai)(zai)配藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)室(shi)(shi)(shi)醒目位置(zhi)(zhi)。對(dui)(dui)(dui)于存(cun)(cun)放(fang)(fang)(fang)(fang)條件(jian)要求嚴格(ge)(ge)(ge)的(de)(de)(de)(de)(de)(de)(de)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)物(wu)(wu)(wu)(wu)，應(ying)(ying)(ying)(ying)為其設置(zhi)(zhi)相應(ying)(ying)(ying)(ying)存(cun)(cun)放(fang)(fang)(fang)(fang)空間，對(dui)(dui)(dui)溫度(du)(du)(du)(du)(du)有(you)(you)(you)要求的(de)(de)(de)(de)(de)(de)(de)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)物(wu)(wu)(wu)(wu)放(fang)(fang)(fang)(fang)置(zhi)(zhi)在(zai)(zai)恒溫冰箱內(nei)，要求避光(guang)保存(cun)(cun)的(de)(de)(de)(de)(de)(de)(de)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)物(wu)(wu)(wu)(wu)應(ying)(ying)(ying)(ying)放(fang)(fang)(fang)(fang)置(zhi)(zhi)于干(gan)燥通(tong)風的(de)(de)(de)(de)(de)(de)(de)陰涼處(chu)，配制(zhi)(zhi)(zhi)輸(shu)(shu)液(ye)時(shi)(shi)也應(ying)(ying)(ying)(ying)注意(yi)避光(guang)，配制(zhi)(zhi)(zhi)完成后(hou)(hou)使(shi)用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)黑(hei)色(se)紙袋遮蔽。高危藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)應(ying)(ying)(ying)(ying)做好標(biao)簽(qian)識別(bie)，相似(si)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)名(ming)、類似(si)包裝(zhuang)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)單(dan)(dan)獨放(fang)(fang)(fang)(fang)置(zhi)(zhi)，并(bing)貼上(shang)標(biao)簽(qian)。定(ding)(ding)期(qi)(qi)核(he)查(cha)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)有(you)(you)(you)效(xiao)(xiao)(xiao)期(qi)(qi)，并(bing)對(dui)(dui)(dui)臨(lin)近(jin)過(guo)期(qi)(qi)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)實(shi)(shi)行(xing)(xing)(xing)顏(yan)色(se)化(hua)(hua)(hua)管(guan)(guan)(guan)(guan)理(li)(li)(li)(li)(li)(li)，有(you)(you)(you)效(xiao)(xiao)(xiao)期(qi)(qi)6個(ge)月(yue)內(nei)貼綠色(se)標(biao)簽(qian)，3個(ge)月(yue)內(nei)有(you)(you)(you)效(xiao)(xiao)(xiao)期(qi)(qi)貼紅(hong)色(se)標(biao)簽(qian)，原(yuan)則(ze)(ze)上(shang)優先(xian)使(shi)用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)近(jin)效(xiao)(xiao)(xiao)期(qi)(qi)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)物(wu)(wu)(wu)(wu)。加(jia)強患(huan)(huan)(huan)(huan)者(zhe)(zhe)(zhe)(zhe)用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)安(an)(an)(an)(an)(an)(an)(an)(an)全(quan)(quan)(quan)(quan)(quan)(quan)(quan)(quan)(quan)(quan)教(jiao)(jiao)育。心(xin)(xin)(xin)(xin)內(nei)科(ke)(ke)患(huan)(huan)(huan)(huan)者(zhe)(zhe)(zhe)(zhe)大(da)(da)多(duo)為中(zhong)老年(nian)群(qun)體(ti)，用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)知(zhi)(zhi)(zhi)識水(shui)平優先(xian)，對(dui)(dui)(dui)用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)安(an)(an)(an)(an)(an)(an)(an)(an)全(quan)(quan)(quan)(quan)(quan)(quan)(quan)(quan)(quan)(quan)的(de)(de)(de)(de)(de)(de)(de)關(guan)注度(du)(du)(du)(du)(du)不(bu)(bu)(bu)(bu)(bu)(bu)足(zu)，護(hu)理(li)(li)(li)(li)(li)(li)人(ren)員(yuan)(yuan)應(ying)(ying)(ying)(ying)加(jia)強與患(huan)(huan)(huan)(huan)者(zhe)(zhe)(zhe)(zhe)的(de)(de)(de)(de)(de)(de)(de)溝通(tong)交流(liu)，利于專業知(zhi)(zhi)(zhi)識解(jie)答患(huan)(huan)(huan)(huan)者(zhe)(zhe)(zhe)(zhe)疑問，提升治療依從(cong)性。發(fa)(fa)(fa)放(fang)(fang)(fang)(fang)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)、輸(shu)(shu)注藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)時(shi)(shi)詳細講解(jie)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)副作(zuo)用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)、注意(yi)事(shi)項(xiang)，促進(jin)患(huan)(huan)(huan)(huan)者(zhe)(zhe)(zhe)(zhe)做好用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)安(an)(an)(an)(an)(an)(an)(an)(an)全(quan)(quan)(quan)(quan)(quan)(quan)(quan)(quan)(quan)(quan)觀(guan)察(cha)。1．3觀(guan)察(cha)指標(biao)。實(shi)(shi)施(shi)(shi)(shi)(shi)(shi)(shi)前(qian)后(hou)(hou)采(cai)用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)自(zi)制(zhi)(zhi)(zhi)量表(biao)分(fen)(fen)(fen)(fen)(fen)別(bie)對(dui)(dui)(dui)護(hu)理(li)(li)(li)(li)(li)(li)人(ren)員(yuan)(yuan)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)知(zhi)(zhi)(zhi)識掌握(wo)情(qing)況(kuang)(kuang)進(jin)行(xing)(xing)(xing)評估，包括(kuo)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)儲存(cun)(cun)、藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)使(shi)用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)、藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)禁忌(ji)、不(bu)(bu)(bu)(bu)(bu)(bu)良(liang)(liang)反應(ying)(ying)(ying)(ying)及(ji)處(chu)理(li)(li)(li)(li)(li)(li)4個(ge)維度(du)(du)(du)(du)(du)，每個(ge)維度(du)(du)(du)(du)(du)得分(fen)(fen)(fen)(fen)(fen)10分(fen)(fen)(fen)(fen)(fen)，得分(fen)(fen)(fen)(fen)(fen)越高表(biao)明(ming)(ming)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)掌握(wo)情(qing)況(kuang)(kuang)越好。統(tong)(tong)(tong)計(ji)(ji)實(shi)(shi)施(shi)(shi)(shi)(shi)(shi)(shi)前(qian)后(hou)(hou)患(huan)(huan)(huan)(huan)者(zhe)(zhe)(zhe)(zhe)用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)不(bu)(bu)(bu)(bu)(bu)(bu)良(liang)(liang)事(shi)件(jian)，包括(kuo)用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)方(fang)法(fa)錯誤(wu)、用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)劑量不(bu)(bu)(bu)(bu)(bu)(bu)當、重(zhong)復(fu)用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)、藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)過(guo)期(qi)(qi)等(deng)(deng)(deng)事(shi)件(jian)。1．4統(tong)(tong)(tong)計(ji)(ji)學(xue)(xue)方(fang)法(fa)。選擇SPSS19．0統(tong)(tong)(tong)計(ji)(ji)學(xue)(xue)軟件(jian)進(jin)行(xing)(xing)(xing)數(shu)(shu)(shu)據分(fen)(fen)(fen)(fen)(fen)析，計(ji)(ji)量資料(liao)(liao)用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)（χ±s）表(biao)示，采(cai)用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)t檢驗，計(ji)(ji)數(shu)(shu)(shu)資料(liao)(liao)采(cai)用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)百分(fen)(fen)(fen)(fen)(fen)比(bi)表(biao)示，比(bi)較(jiao)(jiao)采(cai)用(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)(yong)χ2檢驗，P＜0．05表(biao)示差異有(you)(you)(you)統(tong)(tong)(tong)計(ji)(ji)學(xue)(xue)意(yi)義。

2結果

摘要：目的(de)(de)(de)：分析普外(wai)科(ke)(ke)高(gao)(gao)危(wei)藥(yao)品(pin)的(de)(de)(de)用(yong)(yong)藥(yao)安(an)全(quan)管(guan)理策略。方法(fa)：研究(jiu)時間(jian)為2017年(nian)(nian)(nian)(nian)1月(yue)(yue)～2019年(nian)(nian)(nian)(nian)2月(yue)(yue)，于(yu)2018年(nian)(nian)(nian)(nian)2月(yue)(yue)起實施(shi)(shi)(shi)用(yong)(yong)藥(yao)安(an)全(quan)管(guan)理，2017年(nian)(nian)(nian)(nian)1月(yue)(yue)～2018年(nian)(nian)(nian)(nian)1月(yue)(yue)為實施(shi)(shi)(shi)前(qian)，2018年(nian)(nian)(nian)(nian)2月(yue)(yue)～2019年(nian)(nian)(nian)(nian)2月(yue)(yue)為實施(shi)(shi)(shi)后(hou)。比較(jiao)實施(shi)(shi)(shi)前(qian)后(hou)普外(wai)科(ke)(ke)醫護人員的(de)(de)(de)高(gao)(gao)危(wei)藥(yao)品(pin)相關知(zhi)識掌(zhang)(zhang)握情(qing)況(kuang)，分析實施(shi)(shi)(shi)前(qian)后(hou)患者的(de)(de)(de)高(gao)(gao)危(wei)藥(yao)品(pin)用(yong)(yong)藥(yao)不良事(shi)件發生(sheng)情(qing)況(kuang)。結果：實施(shi)(shi)(shi)后(hou)醫護人員的(de)(de)(de)高(gao)(gao)危(wei)藥(yao)品(pin)相關知(zhi)識掌(zhang)(zhang)握評分，顯著(zhu)高(gao)(gao)于(yu)實施(shi)(shi)(shi)前(qian)（P＜0．05）。實施(shi)(shi)(shi)后(hou)患者的(de)(de)(de)用(yong)(yong)藥(yao)不良事(shi)件發生(sheng)率，顯著(zhu)低(di)于(yu)實施(shi)(shi)(shi)前(qian)（P＜0．05）。結論：于(yu)普外(wai)科(ke)(ke)中開展高(gao)(gao)危(wei)藥(yao)品(pin)的(de)(de)(de)用(yong)(yong)藥(yao)安(an)全(quan)管(guan)理策略，可(ke)以促進藥(yao)品(pin)管(guan)理質量的(de)(de)(de)提升，對患者用(yong)(yong)藥(yao)安(an)全(quan)有保(bao)障(zhang)。

關鍵詞(ci)：普(pu)外科；高危藥品(pin)；安全管(guan)理

普(pu)外(wai)科為外(wai)科系統當(dang)中最(zui)大的(de)(de)(de)(de)專科，該(gai)科室(shi)中所收(shou)治患(huan)(huan)者(zhe)的(de)(de)(de)(de)疾病種(zhong)類(lei)(lei)繁(fan)雜，因(yin)此(ci)科室(shi)內使(shi)用(yong)(yong)藥(yao)(yao)(yao)(yao)物的(de)(de)(de)(de)種(zhong)類(lei)(lei)亦有(you)多樣化(hua)的(de)(de)(de)(de)特征，且(qie)科室(shi)中多數藥(yao)(yao)(yao)(yao)物屬(shu)于(yu)(yu)高(gao)(gao)(gao)危(wei)(wei)藥(yao)(yao)(yao)(yao)品(pin)(pin)。高(gao)(gao)(gao)危(wei)(wei)藥(yao)(yao)(yao)(yao)品(pin)(pin)即為藥(yao)(yao)(yao)(yao)物使(shi)用(yong)(yong)不(bu)(bu)得當(dang)即可威(wei)脅(xie)患(huan)(huan)者(zhe)生(sheng)命安(an)(an)全(quan)(quan)或(huo)者(zhe)對(dui)患(huan)(huan)者(zhe)機體(ti)產生(sheng)嚴(yan)重傷害的(de)(de)(de)(de)藥(yao)(yao)(yao)(yao)物，且(qie)美國醫療(liao)安(an)(an)全(quan)(quan)協會已經將高(gao)(gao)(gao)危(wei)(wei)藥(yao)(yao)(yao)(yao)品(pin)(pin)目(mu)錄(lu)公(gong)布，以(yi)利于(yu)(yu)臨(lin)床高(gao)(gao)(gao)危(wei)(wei)藥(yao)(yao)(yao)(yao)品(pin)(pin)的(de)(de)(de)(de)使(shi)用(yong)(yong)和(he)管理。近幾年來，高(gao)(gao)(gao)危(wei)(wei)藥(yao)(yao)(yao)(yao)品(pin)(pin)的(de)(de)(de)(de)種(zhong)類(lei)(lei)伴隨著(zhu)醫療(liao)水(shui)平的(de)(de)(de)(de)提升及醫學的(de)(de)(de)(de)發(fa)展而進(jin)一步(bu)增加，且(qie)藥(yao)(yao)(yao)(yao)物的(de)(de)(de)(de)使(shi)用(yong)(yong)范(fan)圍逐漸加大，一定程度(du)上提升用(yong)(yong)藥(yao)(yao)(yao)(yao)差(cha)錯(cuo)和(he)不(bu)(bu)良(liang)反應的(de)(de)(de)(de)發(fa)生(sheng)率(lv)［1］。因(yin)高(gao)(gao)(gao)危(wei)(wei)藥(yao)(yao)(yao)(yao)品(pin)(pin)使(shi)用(yong)(yong)的(de)(de)(de)(de)管理方面常較(jiao)普(pu)通藥(yao)(yao)(yao)(yao)品(pin)(pin)嚴(yan)格，因(yin)此(ci)該(gai)類(lei)(lei)藥(yao)(yao)(yao)(yao)物的(de)(de)(de)(de)用(yong)(yong)藥(yao)(yao)(yao)(yao)差(cha)錯(cuo)事件(jian)的(de)(de)(de)(de)發(fa)生(sheng)率(lv)相較(jiao)于(yu)(yu)普(pu)通藥(yao)(yao)(yao)(yao)物較(jiao)低，但是高(gao)(gao)(gao)危(wei)(wei)藥(yao)(yao)(yao)(yao)品(pin)(pin)一旦有(you)用(yong)(yong)藥(yao)(yao)(yao)(yao)差(cha)錯(cuo)事件(jian)發(fa)生(sheng)，則可導致嚴(yan)重的(de)(de)(de)(de)不(bu)(bu)良(liang)后果(guo)，甚至可對(dui)患(huan)(huan)者(zhe)的(de)(de)(de)(de)生(sheng)命安(an)(an)全(quan)(quan)構成威(wei)脅(xie)，對(dui)此(ci)研究(jiu)普(pu)外(wai)科高(gao)(gao)(gao)危(wei)(wei)藥(yao)(yao)(yao)(yao)品(pin)(pin)的(de)(de)(de)(de)用(yong)(yong)藥(yao)(yao)(yao)(yao)安(an)(an)全(quan)(quan)管理策略。

1資料與方法

1．1一(yi)(yi)(yi)般資(zi)(zi)料。研究(jiu)時(shi)(shi)間為(wei)(wei)2017年(nian)(nian)1月(yue)(yue)～2019年(nian)(nian)2月(yue)(yue)，于2018年(nian)(nian)2月(yue)(yue)起(qi)實施(shi)用(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)安全(quan)(quan)管理(li)(li)(li)(li)，2017年(nian)(nian)1月(yue)(yue)～2018年(nian)(nian)1月(yue)(yue)為(wei)(wei)實施(shi)前(qian)(qian)，2018年(nian)(nian)2月(yue)(yue)～2019年(nian)(nian)2月(yue)(yue)為(wei)(wei)實施(shi)后(hou)(hou)(hou)。實施(shi)前(qian)(qian)的(de)(de)醫(yi)(yi)(yi)(yi)(yi)護(hu)(hu)人(ren)(ren)員(yuan)(yuan)(yuan)(yuan)中(zhong)(zhong)(zhong)(zhong)，護(hu)(hu)理(li)(li)(li)(li)人(ren)(ren)員(yuan)(yuan)(yuan)(yuan)21名，醫(yi)(yi)(yi)(yi)(yi)生(sheng)9名；男5名，女25名。實施(shi)后(hou)(hou)(hou)的(de)(de)醫(yi)(yi)(yi)(yi)(yi)護(hu)(hu)人(ren)(ren)員(yuan)(yuan)(yuan)(yuan)中(zhong)(zhong)(zhong)(zhong)，護(hu)(hu)理(li)(li)(li)(li)人(ren)(ren)員(yuan)(yuan)(yuan)(yuan)20名，醫(yi)(yi)(yi)(yi)(yi)生(sheng)10名；男6名，女24名。實施(shi)前(qian)(qian)后(hou)(hou)(hou)醫(yi)(yi)(yi)(yi)(yi)護(hu)(hu)人(ren)(ren)員(yuan)(yuan)(yuan)(yuan)的(de)(de)一(yi)(yi)(yi)般資(zi)(zi)料比較差異不(bu)顯著（P＞0．05）。實施(shi)前(qian)(qian)后(hou)(hou)(hou)各隨機(ji)選(xuan)擇患(huan)者(zhe)(zhe)100例(li)。1．2方(fang)法(fa)。（1）組(zu)(zu)(zu)建普外科(ke)(ke)(ke)(ke)(ke)(ke)高(gao)(gao)(gao)(gao)(gao)危(wei)(wei)(wei)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)用(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)安全(quan)(quan)管理(li)(li)(li)(li)小(xiao)組(zu)(zu)(zu)，由(you)科(ke)(ke)(ke)(ke)(ke)(ke)室中(zhong)(zhong)(zhong)(zhong)工作時(shi)(shi)間在(zai)3年(nian)(nian)及(ji)以(yi)(yi)上(shang)的(de)(de)護(hu)(hu)理(li)(li)(li)(li)人(ren)(ren)員(yuan)(yuan)(yuan)(yuan)3名和醫(yi)(yi)(yi)(yi)(yi)生(sheng)1名構成(cheng)，要(yao)求(qiu)組(zu)(zu)(zu)員(yuan)(yuan)(yuan)(yuan)具備一(yi)(yi)(yi)定(ding)管理(li)(li)(li)(li)能力與(yu)責(ze)任心、耐心。小(xiao)組(zu)(zu)(zu)成(cheng)員(yuan)(yuan)(yuan)(yuan)主(zhu)要(yao)負責(ze)對(dui)實施(shi)前(qian)(qian)的(de)(de)2017年(nian)(nian)1月(yue)(yue)～2018年(nian)(nian)1月(yue)(yue)醫(yi)(yi)(yi)(yi)(yi)院普外科(ke)(ke)(ke)(ke)(ke)(ke)高(gao)(gao)(gao)(gao)(gao)危(wei)(wei)(wei)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)的(de)(de)使用(yong)(yong)情(qing)(qing)(qing)(qing)(qing)況(kuang)(kuang)進行回顧性(xing)分(fen)(fen)析(xi)與(yu)匯總(zong)，主(zhu)要(yao)分(fen)(fen)析(xi)普外科(ke)(ke)(ke)(ke)(ke)(ke)醫(yi)(yi)(yi)(yi)(yi)護(hu)(hu)人(ren)(ren)員(yuan)(yuan)(yuan)(yuan)的(de)(de)高(gao)(gao)(gao)(gao)(gao)危(wei)(wei)(wei)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)知曉情(qing)(qing)(qing)(qing)(qing)況(kuang)(kuang)、藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)物(wu)(wu)(wu)使用(yong)(yong)后(hou)(hou)(hou)不(bu)良事(shi)件(jian)發(fa)(fa)生(sheng)情(qing)(qing)(qing)(qing)(qing)況(kuang)(kuang)。同(tong)醫(yi)(yi)(yi)(yi)(yi)院藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)劑科(ke)(ke)(ke)(ke)(ke)(ke)展(zhan)開(kai)密切的(de)(de)溝通(tong)與(yu)交(jiao)流(liu)，搜集高(gao)(gao)(gao)(gao)(gao)危(wei)(wei)(wei)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)相關(guan)消(xiao)息。對(dui)普外科(ke)(ke)(ke)(ke)(ke)(ke)中(zhong)(zhong)(zhong)(zhong)高(gao)(gao)(gao)(gao)(gao)危(wei)(wei)(wei)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)的(de)(de)有(you)(you)效期限、存放(fang)(fang)與(yu)保(bao)(bao)(bao)管情(qing)(qing)(qing)(qing)(qing)況(kuang)(kuang)及(ji)數(shu)(shu)量(liang)(liang)等(deng)定(ding)期展(zhan)開(kai)檢(jian)查。（2）小(xiao)組(zu)(zu)(zu)成(cheng)員(yuan)(yuan)(yuan)(yuan)根據(ju)美國(guo)醫(yi)(yi)(yi)(yi)(yi)療安全(quan)(quan)協會公(gong)布的(de)(de)高(gao)(gao)(gao)(gao)(gao)危(wei)(wei)(wei)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)表，同(tong)醫(yi)(yi)(yi)(yi)(yi)院具體情(qing)(qing)(qing)(qing)(qing)況(kuang)(kuang)相結(jie)合，將普外科(ke)(ke)(ke)(ke)(ke)(ke)高(gao)(gao)(gao)(gao)(gao)危(wei)(wei)(wei)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)應(ying)(ying)(ying)用(yong)(yong)管理(li)(li)(li)(li)手(shou)(shou)冊(ce)(ce)制定(ding)好。主(zhu)要(yao)包含注射(she)用(yong)(yong)化療藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)物(wu)(wu)(wu)、腎上(shang)腺(xian)素受(shou)體激動藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)物(wu)(wu)(wu)、阿(a)片類(lei)(lei)麻醉劑及(ji)抗(kang)血栓藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)物(wu)(wu)(wu)等(deng)。根據(ju)科(ke)(ke)(ke)(ke)(ke)(ke)室中(zhong)(zhong)(zhong)(zhong)上(shang)述各類(lei)(lei)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)物(wu)(wu)(wu)的(de)(de)使用(yong)(yong)頻次，在(zai)管理(li)(li)(li)(li)手(shou)(shou)冊(ce)(ce)的(de)(de)目(mu)錄(lu)當(dang)(dang)中(zhong)(zhong)(zhong)(zhong)將頁碼標(biao)(biao)明(ming)。管理(li)(li)(li)(li)小(xiao)組(zu)(zu)(zu)成(cheng)員(yuan)(yuan)(yuan)(yuan)實施(shi)日常管理(li)(li)(li)(li)工作過程中(zhong)(zhong)(zhong)(zhong)，應(ying)(ying)(ying)當(dang)(dang)收集高(gao)(gao)(gao)(gao)(gao)危(wei)(wei)(wei)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)的(de)(de)使用(yong)(yong)說(shuo)明(ming)書，并且(qie)(qie)對(dui)高(gao)(gao)(gao)(gao)(gao)危(wei)(wei)(wei)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)的(de)(de)安全(quan)(quan)應(ying)(ying)(ying)用(yong)(yong)事(shi)項展(zhan)開(kai)分(fen)(fen)類(lei)(lei)整(zheng)理(li)(li)(li)(li)，將其加(jia)入至普外科(ke)(ke)(ke)(ke)(ke)(ke)高(gao)(gao)(gao)(gao)(gao)危(wei)(wei)(wei)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)應(ying)(ying)(ying)用(yong)(yong)手(shou)(shou)冊(ce)(ce)當(dang)(dang)中(zhong)(zhong)(zhong)(zhong)。（3）普外科(ke)(ke)(ke)(ke)(ke)(ke)高(gao)(gao)(gao)(gao)(gao)危(wei)(wei)(wei)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)的(de)(de)存放(fang)(fang)位(wei)置(zhi)，應(ying)(ying)(ying)當(dang)(dang)結(jie)合醫(yi)(yi)(yi)(yi)(yi)院和科(ke)(ke)(ke)(ke)(ke)(ke)室的(de)(de)實際情(qing)(qing)(qing)(qing)(qing)況(kuang)(kuang)決定(ding)，同(tong)時(shi)(shi)需(xu)要(yao)在(zai)護(hu)(hu)理(li)(li)(li)(li)部的(de)(de)指導之下，對(dui)高(gao)(gao)(gao)(gao)(gao)危(wei)(wei)(wei)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)的(de)(de)存放(fang)(fang)位(wei)置(zhi)加(jia)以(yi)(yi)規(gui)范。在(zai)科(ke)(ke)(ke)(ke)(ke)(ke)室中(zhong)(zhong)(zhong)(zhong)單獨設置(zhi)高(gao)(gao)(gao)(gao)(gao)危(wei)(wei)(wei)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)的(de)(de)存放(fang)(fang)區，同(tong)時(shi)(shi)在(zai)該區域當(dang)(dang)中(zhong)(zhong)(zhong)(zhong)張貼(tie)醒目(mu)的(de)(de)警示(shi)標(biao)(biao)識(shi)(shi)。藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)存放(fang)(fang)時(shi)(shi)應(ying)(ying)(ying)當(dang)(dang)注意(yi)(yi)對(dui)相似性(xing)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)與(yu)相鄰性(xing)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)進行準(zhun)(zhun)確區分(fen)(fen)。針對(dui)部分(fen)(fen)對(dui)存放(fang)(fang)條件(jian)有(you)(you)特殊要(yao)求(qiu)的(de)(de)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)，應(ying)(ying)(ying)當(dang)(dang)結(jie)合藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)物(wu)(wu)(wu)的(de)(de)具體特征給(gei)予妥善(shan)的(de)(de)保(bao)(bao)(bao)存。高(gao)(gao)(gao)(gao)(gao)危(wei)(wei)(wei)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)應(ying)(ying)(ying)當(dang)(dang)嚴格(ge)(ge)遵照相關(guan)規(gui)定(ding)，根據(ju)科(ke)(ke)(ke)(ke)(ke)(ke)室當(dang)(dang)中(zhong)(zhong)(zhong)(zhong)以(yi)(yi)及(ji)醫(yi)(yi)(yi)(yi)(yi)院當(dang)(dang)中(zhong)(zhong)(zhong)(zhong)的(de)(de)相關(guan)規(gui)定(ding)設置(zhi)基數(shu)(shu)，并且(qie)(qie)完善(shan)記(ji)錄(lu)工作，醫(yi)(yi)(yi)(yi)(yi)護(hu)(hu)人(ren)(ren)員(yuan)(yuan)(yuan)(yuan)在(zai)交(jiao)接班(ban)時(shi)(shi)應(ying)(ying)(ying)當(dang)(dang)詳實填寫與(yu)記(ji)錄(lu)高(gao)(gao)(gao)(gao)(gao)危(wei)(wei)(wei)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)的(de)(de)數(shu)(shu)量(liang)(liang)，管理(li)(li)(li)(li)小(xiao)組(zu)(zu)(zu)仔細核對(dui)該數(shu)(shu)量(liang)(liang)。除此之外，管理(li)(li)(li)(li)小(xiao)組(zu)(zu)(zu)應(ying)(ying)(ying)當(dang)(dang)定(ding)期或者(zhe)(zhe)不(bu)定(ding)期抽查，以(yi)(yi)確保(bao)(bao)(bao)掌(zhang)握(wo)普外科(ke)(ke)(ke)(ke)(ke)(ke)高(gao)(gao)(gao)(gao)(gao)危(wei)(wei)(wei)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)存放(fang)(fang)情(qing)(qing)(qing)(qing)(qing)況(kuang)(kuang)、警示(shi)標(biao)(biao)識(shi)(shi)張貼(tie)情(qing)(qing)(qing)(qing)(qing)況(kuang)(kuang)及(ji)基數(shu)(shu)情(qing)(qing)(qing)(qing)(qing)況(kuang)(kuang)等(deng)，及(ji)時(shi)(shi)處罰不(bu)遵守規(gui)范使用(yong)(yong)高(gao)(gao)(gao)(gao)(gao)危(wei)(wei)(wei)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)的(de)(de)醫(yi)(yi)(yi)(yi)(yi)護(hu)(hu)人(ren)(ren)員(yuan)(yuan)(yuan)(yuan)。（4）定(ding)期組(zu)(zu)(zu)織(zhi)普外科(ke)(ke)(ke)(ke)(ke)(ke)醫(yi)(yi)(yi)(yi)(yi)護(hu)(hu)人(ren)(ren)員(yuan)(yuan)(yuan)(yuan)針對(dui)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)理(li)(li)(li)(li)學(xue)(xue)知識(shi)(shi)展(zhan)開(kai)培(pei)訓，通(tong)過組(zu)(zu)(zu)織(zhi)醫(yi)(yi)(yi)(yi)(yi)護(hu)(hu)人(ren)(ren)員(yuan)(yuan)(yuan)(yuan)學(xue)(xue)習(xi)高(gao)(gao)(gao)(gao)(gao)危(wei)(wei)(wei)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)使用(yong)(yong)手(shou)(shou)冊(ce)(ce)，學(xue)(xue)習(xi)高(gao)(gao)(gao)(gao)(gao)危(wei)(wei)(wei)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)安全(quan)(quan)用(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)知識(shi)(shi)等(deng)，以(yi)(yi)進一(yi)(yi)(yi)步提升護(hu)(hu)理(li)(li)(li)(li)人(ren)(ren)員(yuan)(yuan)(yuan)(yuan)高(gao)(gao)(gao)(gao)(gao)危(wei)(wei)(wei)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)安全(quan)(quan)使用(yong)(yong)的(de)(de)意(yi)(yi)識(shi)(shi)。護(hu)(hu)理(li)(li)(li)(li)人(ren)(ren)員(yuan)(yuan)(yuan)(yuan)應(ying)(ying)(ying)嚴格(ge)(ge)遵照說(shuo)明(ming)書與(yu)醫(yi)(yi)(yi)(yi)(yi)囑選(xuan)擇溶(rong)媒、輸液器和加(jia)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)器等(deng)，以(yi)(yi)保(bao)(bao)(bao)證藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)物(wu)(wu)(wu)使用(yong)(yong)劑量(liang)(liang)的(de)(de)準(zhun)(zhun)確性(xing)。為(wei)(wei)患(huan)者(zhe)(zhe)使用(yong)(yong)高(gao)(gao)(gao)(gao)(gao)危(wei)(wei)(wei)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)以(yi)(yi)后(hou)(hou)(hou)，醫(yi)(yi)(yi)(yi)(yi)護(hu)(hu)人(ren)(ren)員(yuan)(yuan)(yuan)(yuan)應(ying)(ying)(ying)當(dang)(dang)對(dui)其是否有(you)(you)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)物(wu)(wu)(wu)反(fan)(fan)應(ying)(ying)(ying)出(chu)(chu)現(xian)(xian)進行密切觀(guan)察，加(jia)強巡(xun)視的(de)(de)力度，及(ji)時(shi)(shi)評(ping)估(gu)患(huan)者(zhe)(zhe)的(de)(de)身體狀況(kuang)(kuang)，針對(dui)有(you)(you)嚴重不(bu)良反(fan)(fan)應(ying)(ying)(ying)出(chu)(chu)現(xian)(xian)的(de)(de)患(huan)者(zhe)(zhe)，應(ying)(ying)(ying)當(dang)(dang)及(ji)時(shi)(shi)停(ting)止用(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)，并且(qie)(qie)遵照醫(yi)(yi)(yi)(yi)(yi)囑給(gei)予相應(ying)(ying)(ying)的(de)(de)處理(li)(li)(li)(li)。1．3觀(guan)察指標(biao)(biao)。觀(guan)察并統(tong)計(ji)(ji)實施(shi)前(qian)(qian)后(hou)(hou)(hou)醫(yi)(yi)(yi)(yi)(yi)護(hu)(hu)人(ren)(ren)員(yuan)(yuan)(yuan)(yuan)的(de)(de)高(gao)(gao)(gao)(gao)(gao)危(wei)(wei)(wei)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)相關(guan)知識(shi)(shi)掌(zhang)握(wo)情(qing)(qing)(qing)(qing)(qing)況(kuang)(kuang)，分(fen)(fen)析(xi)實施(shi)前(qian)(qian)后(hou)(hou)(hou)普外科(ke)(ke)(ke)(ke)(ke)(ke)患(huan)者(zhe)(zhe)的(de)(de)高(gao)(gao)(gao)(gao)(gao)危(wei)(wei)(wei)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)用(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)不(bu)良事(shi)件(jian)發(fa)(fa)生(sheng)情(qing)(qing)(qing)(qing)(qing)況(kuang)(kuang)。高(gao)(gao)(gao)(gao)(gao)危(wei)(wei)(wei)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)(pin)相關(guan)知識(shi)(shi)掌(zhang)握(wo)情(qing)(qing)(qing)(qing)(qing)況(kuang)(kuang)主(zhu)要(yao)通(tong)過問卷調查的(de)(de)形式評(ping)估(gu)，由(you)醫(yi)(yi)(yi)(yi)(yi)護(hu)(hu)人(ren)(ren)員(yuan)(yuan)(yuan)(yuan)填寫，滿(man)分(fen)(fen)為(wei)(wei)100分(fen)(fen)，得分(fen)(fen)越高(gao)(gao)(gao)(gao)(gao)表示(shi)其效果越佳。1．4統(tong)計(ji)(ji)學(xue)(xue)方(fang)法(fa)選(xuan)擇SPSS22．0統(tong)計(ji)(ji)學(xue)(xue)軟件(jian)進行數(shu)(shu)據(ju)分(fen)(fen)析(xi)，計(ji)(ji)量(liang)(liang)資(zi)(zi)料用(yong)(yong)t檢(jian)驗，計(ji)(ji)數(shu)(shu)資(zi)(zi)料用(yong)(yong)卡方(fang)檢(jian)驗，P＜0．05表示(shi)差異具有(you)(you)統(tong)計(ji)(ji)學(xue)(xue)意(yi)(yi)義。

2結果

1相關醫院的級(ji)別及臨(lin)床藥師(shi)配備情況

各醫院級別及(ji)專(zhuan)職臨(lin)床藥師配備情(qing)況見表1。可(ke)見，二級綜(zong)合醫院專(zhuan)職臨(lin)床藥師配備人(ren)(ren)數均不足3人(ren)(ren)，有1家三級中醫醫院配備人(ren)(ren)數不足5人(ren)(ren)，另1家三級綜(zong)合醫院配備人(ren)(ren)數達到5人(ren)(ren)。

2臨床(chuang)藥學工作開展現狀

各(ge)醫(yi)(yi)(yi)院(yuan)均(jun)設有(you)臨(lin)(lin)床(chuang)(chuang)(chuang)(chuang)(chuang)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)學室(shi)(shi)，有(you)專職臨(lin)(lin)床(chuang)(chuang)(chuang)(chuang)(chuang)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)師(shi)(shi)負(fu)責臨(lin)(lin)床(chuang)(chuang)(chuang)(chuang)(chuang)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)學相(xiang)關(guan)(guan)工作。開(kai)展的具體(ti)(ti)工作如下(xia)。參與臨(lin)(lin)床(chuang)(chuang)(chuang)(chuang)(chuang)查(cha)(cha)房:醫(yi)(yi)(yi)院(yuan)臨(lin)(lin)床(chuang)(chuang)(chuang)(chuang)(chuang)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)學室(shi)(shi)會同醫(yi)(yi)(yi)務科(ke)(ke)(處(chu))、護理(li)(li)(li)(li)部、感染辦(ban)等(deng)業務職能管(guan)理(li)(li)(li)(li)部門，定(ding)期查(cha)(cha)閱患(huan)者(zhe)運(yun)行病歷(li)資料，了(le)解患(huan)者(zhe)病情(qing)(qing)及(ji)臨(lin)(lin)床(chuang)(chuang)(chuang)(chuang)(chuang)治(zhi)療(liao)中是否存在問(wen)(wen)題。并(bing)對(dui)(dui)發(fa)現(xian)(xian)的問(wen)(wen)題及(ji)時提(ti)(ti)(ti)出用(yong)(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)方面的建議(yi)，為(wei)(wei)醫(yi)(yi)(yi)護人(ren)(ren)員(yuan)(yuan)提(ti)(ti)(ti)供(gong)用(yong)(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)知識(shi)(shi)，解答用(yong)(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)咨(zi)詢(xun)，糾正(zheng)用(yong)(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)錯誤，并(bing)在此過程中豐富自己的知識(shi)(shi)。查(cha)(cha)房情(qing)(qing)況見表(biao)2。由表(biao)2可(ke)知，有(you)4家醫(yi)(yi)(yi)院(yuan)查(cha)(cha)房次數少(shao)(shao)，查(cha)(cha)房模式簡單，未開(kai)展血藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)濃度監測(ce)，未對(dui)(dui)患(huan)者(zhe)進(jin)行用(yong)(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)指導。收(shou)集、上(shang)(shang)報(bao)(bao)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)不(bu)(bu)良(liang)反(fan)(fan)應(ying)(ying)(ying)(ying)(ying)報(bao)(bao)告:醫(yi)(yi)(yi)院(yuan)臨(lin)(lin)床(chuang)(chuang)(chuang)(chuang)(chuang)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)師(shi)(shi)向(xiang)(xiang)各(ge)科(ke)(ke)室(shi)(shi)發(fa)放藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)不(bu)(bu)良(liang)反(fan)(fan)應(ying)(ying)(ying)(ying)(ying)報(bao)(bao)告表(biao)，相(xiang)關(guan)(guan)科(ke)(ke)室(shi)(shi)發(fa)現(xian)(xian)不(bu)(bu)良(liang)反(fan)(fan)應(ying)(ying)(ying)(ying)(ying)及(ji)時填寫(xie)并(bing)上(shang)(shang)報(bao)(bao)臨(lin)(lin)床(chuang)(chuang)(chuang)(chuang)(chuang)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)學室(shi)(shi)，臨(lin)(lin)床(chuang)(chuang)(chuang)(chuang)(chuang)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)師(shi)(shi)24h內到科(ke)(ke)室(shi)(shi)調查(cha)(cha)了(le)解情(qing)(qing)況，并(bing)詳細填寫(xie)不(bu)(bu)良(liang)反(fan)(fan)應(ying)(ying)(ying)(ying)(ying)報(bao)(bao)表(biao)。對(dui)(dui)收(shou)集到的藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)不(bu)(bu)良(liang)反(fan)(fan)應(ying)(ying)(ying)(ying)(ying)進(jin)行分析(xi)，提(ti)(ti)(ti)出預(yu)防和(he)處(chu)理(li)(li)(li)(li)對(dui)(dui)策，并(bing)及(ji)時反(fan)(fan)饋給相(xiang)關(guan)(guan)科(ke)(ke)室(shi)(shi)。定(ding)期對(dui)(dui)發(fa)生(sheng)的藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)不(bu)(bu)良(liang)反(fan)(fan)應(ying)(ying)(ying)(ying)(ying)進(jin)行歸(gui)納和(he)分析(xi)，及(ji)時向(xiang)(xiang)臨(lin)(lin)床(chuang)(chuang)(chuang)(chuang)(chuang)科(ke)(ke)室(shi)(shi)通報(bao)(bao)信息(xi)，減少(shao)(shao)或(huo)避免(mian)類似(si)情(qing)(qing)況發(fa)生(sheng)。同時，按要求及(ji)時上(shang)(shang)報(bao)(bao)市(shi)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)不(bu)(bu)良(liang)反(fan)(fan)應(ying)(ying)(ying)(ying)(ying)監測(ce)中心。從調查(cha)(cha)情(qing)(qing)況看，5家醫(yi)(yi)(yi)院(yuan)的藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)不(bu)(bu)良(liang)反(fan)(fan)應(ying)(ying)(ying)(ying)(ying)收(shou)集、院(yuan)內通報(bao)(bao)、上(shang)(shang)報(bao)(bao)均(jun)及(ji)時，工作開(kai)展較好。抗(kang)(kang)菌(jun)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)物(wu)(wu)使(shi)(shi)(shi)用(yong)(yong)(yong)(yong)情(qing)(qing)況調查(cha)(cha)分析(xi):據統計(ji)，我國三級醫(yi)(yi)(yi)院(yuan)住(zhu)院(yuan)患(huan)者(zhe)抗(kang)(kang)生(sheng)素使(shi)(shi)(shi)用(yong)(yong)(yong)(yong)率(lv)(lv)約為(wei)(wei)70%，二級醫(yi)(yi)(yi)院(yuan)為(wei)(wei)80%，一級醫(yi)(yi)(yi)院(yuan)為(wei)(wei)90%[1]。正(zheng)確、合(he)理(li)(li)(li)(li)應(ying)(ying)(ying)(ying)(ying)用(yong)(yong)(yong)(yong)抗(kang)(kang)生(sheng)素是提(ti)(ti)(ti)高療(liao)效(xiao)、降低不(bu)(bu)良(liang)反(fan)(fan)應(ying)(ying)(ying)(ying)(ying)發(fa)生(sheng)率(lv)(lv)及(ji)減少(shao)(shao)或(huo)延緩(huan)細菌(jun)耐藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)性發(fa)生(sheng)的關(guan)(guan)鍵。我市(shi)相(xiang)關(guan)(guan)醫(yi)(yi)(yi)院(yuan)抗(kang)(kang)菌(jun)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)物(wu)(wu)分級管(guan)理(li)(li)(li)(li)使(shi)(shi)(shi)用(yong)(yong)(yong)(yong)調查(cha)(cha)情(qing)(qing)況見表(biao)3。由表(biao)3可(ke)知，5家醫(yi)(yi)(yi)院(yuan)對(dui)(dui)抗(kang)(kang)菌(jun)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)物(wu)(wu)均(jun)實行了(le)分級管(guan)理(li)(li)(li)(li)，抗(kang)(kang)菌(jun)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)物(wu)(wu)使(shi)(shi)(shi)用(yong)(yong)(yong)(yong)率(lv)(lv)均(jun)低于60%，但(dan)使(shi)(shi)(shi)用(yong)(yong)(yong)(yong)合(he)格率(lv)(lv)偏(pian)低。書寫(xie)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)歷(li)并(bing)編寫(xie)院(yuan)內藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)訊:各(ge)家醫(yi)(yi)(yi)院(yuan)臨(lin)(lin)床(chuang)(chuang)(chuang)(chuang)(chuang)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)師(shi)(shi)均(jun)通過書寫(xie)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)歷(li)為(wei)(wei)醫(yi)(yi)(yi)護人(ren)(ren)員(yuan)(yuan)提(ti)(ti)(ti)供(gong)必要的藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)物(wu)(wu)參考，為(wei)(wei)個體(ti)(ti)化用(yong)(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)，提(ti)(ti)(ti)高藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)物(wu)(wu)療(liao)效(xiao)，減少(shao)(shao)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)不(bu)(bu)良(liang)反(fan)(fan)應(ying)(ying)(ying)(ying)(ying)，降低藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)物(wu)(wu)治(zhi)療(liao)費用(yong)(yong)(yong)(yong)，促(cu)進(jin)合(he)理(li)(li)(li)(li)用(yong)(yong)(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)提(ti)(ti)(ti)供(gong)重要資料和(he)依(yi)據。每季度編寫(xie)院(yuan)內藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)訊，向(xiang)(xiang)臨(lin)(lin)床(chuang)(chuang)(chuang)(chuang)(chuang)科(ke)(ke)室(shi)(shi)宣傳藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)不(bu)(bu)良(liang)反(fan)(fan)應(ying)(ying)(ying)(ying)(ying)、藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)品(pin)(pin)特性及(ji)新藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)信息(xi)、抗(kang)(kang)菌(jun)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)物(wu)(wu)使(shi)(shi)(shi)用(yong)(yong)(yong)(yong)情(qing)(qing)況等(deng)相(xiang)關(guan)(guan)內容。調查(cha)(cha)顯示，院(yuan)內藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)訊已成為(wei)(wei)臨(lin)(lin)床(chuang)(chuang)(chuang)(chuang)(chuang)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)師(shi)(shi)和(he)臨(lin)(lin)床(chuang)(chuang)(chuang)(chuang)(chuang)科(ke)(ke)室(shi)(shi)溝通的重要途徑。

3存在的問題及分(fen)析(xi)

3．1問題

醫(yi)(yi)(yi)院(yuan)(yuan)(yuan)(yuan)(yuan)評(ping)(ping)(ping)(ping)審(shen)(shen)工(gong)(gong)作(zuo)(zuo)(zuo)即按(an)照《醫(yi)(yi)(yi)院(yuan)(yuan)(yuan)(yuan)(yuan)評(ping)(ping)(ping)(ping)審(shen)(shen)暫行辦法》的(de)(de)(de)(de)要求，根據醫(yi)(yi)(yi)院(yuan)(yuan)(yuan)(yuan)(yuan)評(ping)(ping)(ping)(ping)審(shen)(shen)標準及(ji)醫(yi)(yi)(yi)療(liao)機構基本標準，開展(zhan)自(zi)(zi)我(wo)(wo)評(ping)(ping)(ping)(ping)價，持(chi)續改進(jin)(jin)醫(yi)(yi)(yi)院(yuan)(yuan)(yuan)(yuan)(yuan)工(gong)(gong)作(zuo)(zuo)(zuo)，并(bing)就(jiu)其規(gui)劃級(ji)(ji)別(bie)的(de)(de)(de)(de)功能任務完(wan)成情(qing)況接受衛(wei)生(sheng)行政部門(men)的(de)(de)(de)(de)評(ping)(ping)(ping)(ping)價，以(yi)確(que)定醫(yi)(yi)(yi)院(yuan)(yuan)(yuan)(yuan)(yuan)等(deng)(deng)級(ji)(ji)的(de)(de)(de)(de)過程。我(wo)(wo)國自(zi)(zi)1989年(nian)(nian)啟動醫(yi)(yi)(yi)院(yuan)(yuan)(yuan)(yuan)(yuan)等(deng)(deng)級(ji)(ji)評(ping)(ping)(ping)(ping)審(shen)(shen)工(gong)(gong)作(zuo)(zuo)(zuo)至今已有27年(nian)(nian)之(zhi)久(jiu)。參(can)加過醫(yi)(yi)(yi)院(yuan)(yuan)(yuan)(yuan)(yuan)等(deng)(deng)級(ji)(ji)評(ping)(ping)(ping)(ping)審(shen)(shen)工(gong)(gong)作(zuo)(zuo)(zuo)的(de)(de)(de)(de)醫(yi)(yi)(yi)療(liao)工(gong)(gong)作(zuo)(zuo)(zuo)者，上至醫(yi)(yi)(yi)院(yuan)(yuan)(yuan)(yuan)(yuan)管理(li)層下至臨床一線的(de)(de)(de)(de)醫(yi)(yi)(yi)護人員都(dou)切實(shi)感到等(deng)(deng)級(ji)(ji)評(ping)(ping)(ping)(ping)審(shen)(shen)工(gong)(gong)作(zuo)(zuo)(zuo)對于提高醫(yi)(yi)(yi)院(yuan)(yuan)(yuan)(yuan)(yuan)醫(yi)(yi)(yi)療(liao)質量水平的(de)(de)(de)(de)持(chi)續改進(jin)(jin)起到了積極促進(jin)(jin)作(zuo)(zuo)(zuo)用(yong)(yong)。我(wo)(wo)院(yuan)(yuan)(yuan)(yuan)(yuan)于2012年(nian)(nian)10月(yue)(yue)參(can)加了新一周期的(de)(de)(de)(de)醫(yi)(yi)(yi)院(yuan)(yuan)(yuan)(yuan)(yuan)等(deng)(deng)級(ji)(ji)評(ping)(ping)(ping)(ping)審(shen)(shen)活(huo)動。此次評(ping)(ping)(ping)(ping)審(shen)(shen)的(de)(de)(de)(de)標準即衛(wei)生(sheng)部于2011年(nian)(nian)4月(yue)(yue)出臺的(de)(de)(de)(de)《三級(ji)(ji)綜合(he)醫(yi)(yi)(yi)院(yuan)(yuan)(yuan)(yuan)(yuan)評(ping)(ping)(ping)(ping)審(shen)(shen)標準（2011年(nian)(nian)版）》，評(ping)(ping)(ping)(ping)審(shen)(shen)重(zhong)(zhong)點是(shi)醫(yi)(yi)(yi)療(liao)質量和(he)(he)患(huan)者安全。藥(yao)(yao)(yao)(yao)(yao)物(wu)(wu)是(shi)醫(yi)(yi)(yi)院(yuan)(yuan)(yuan)(yuan)(yuan)診療(liao)的(de)(de)(de)(de)重(zhong)(zhong)要手段，自(zi)(zi)然，藥(yao)(yao)(yao)(yao)(yao)品(pin)的(de)(de)(de)(de)質量和(he)(he)合(he)理(li)用(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)管理(li)是(shi)藥(yao)(yao)(yao)(yao)(yao)事(shi)管理(li)工(gong)(gong)作(zuo)(zuo)(zuo)的(de)(de)(de)(de)核心(xin)內容。在2012年(nian)(nian)的(de)(de)(de)(de)評(ping)(ping)(ping)(ping)審(shen)(shen)標準中包含的(de)(de)(de)(de)藥(yao)(yao)(yao)(yao)(yao)事(shi)和(he)(he)藥(yao)(yao)(yao)(yao)(yao)物(wu)(wu)使(shi)用(yong)(yong)管理(li)條(tiao)款多達40余項，約140個(ge)評(ping)(ping)(ping)(ping)價要素。醫(yi)(yi)(yi)院(yuan)(yuan)(yuan)(yuan)(yuan)評(ping)(ping)(ping)(ping)審(shen)(shen)標準中，抗(kang)菌藥(yao)(yao)(yao)(yao)(yao)物(wu)(wu)分級(ji)(ji)管理(li)、用(yong)(yong)藥(yao)(yao)(yao)(yao)(yao)錯誤報(bao)告制度(du)、突(tu)發事(shi)件藥(yao)(yao)(yao)(yao)(yao)事(shi)管理(li)應急預案、藥(yao)(yao)(yao)(yao)(yao)品(pin)召(zhao)回管理(li)、臨床藥(yao)(yao)(yao)(yao)(yao)師(shi)配備(bei)等(deng)(deng)列(lie)為藥(yao)(yao)(yao)(yao)(yao)事(shi)管理(li)的(de)(de)(de)(de)核心(xin)指標或衡量條(tiao)款；高濃(nong)度(du)電解質、抗(kang)凝藥(yao)(yao)(yao)(yao)(yao)等(deng)(deng)高危藥(yao)(yao)(yao)(yao)(yao)品(pin)，音似(si)、形(xing)似(si)等(deng)(deng)易混淆藥(yao)(yao)(yao)(yao)(yao)品(pin)的(de)(de)(de)(de)警(jing)示標識等(deng)(deng)，列(lie)入患(huan)者安全目標。這些涉(she)及(ji)藥(yao)(yao)(yao)(yao)(yao)品(pin)質量和(he)(he)患(huan)者安全的(de)(de)(de)(de)內容，是(shi)持(chi)續改進(jin)(jin)藥(yao)(yao)(yao)(yao)(yao)事(shi)管理(li)與藥(yao)(yao)(yao)(yao)(yao)學服務水平的(de)(de)(de)(de)重(zhong)(zhong)點[1]。

1藥品質量管理

1.1規范藥品采購管理

嚴格按照藥(yao)(yao)品(pin)采(cai)(cai)購(gou)制度(du)、流程及自治(zhi)區衛(wei)(wei)計(ji)委(wei)藥(yao)(yao)品(pin)招(zhao)標采(cai)(cai)購(gou)相(xiang)關規(gui)定，依據本院(yuan)《基本用(yong)藥(yao)(yao)供應目(mu)(mu)錄》制定采(cai)(cai)購(gou)計(ji)劃，并(bing)上報(bao)衛(wei)(wei)計(ji)委(wei)藥(yao)(yao)品(pin)集(ji)中招(zhao)標采(cai)(cai)購(gou)服務中心，嚴格執行衛(wei)(wei)計(ji)委(wei)直屬醫(yi)院(yuan)藥(yao)(yao)品(pin)招(zhao)標采(cai)(cai)購(gou)中標合同，對臨(lin)床急需使用(yong)的計(ji)劃外藥(yao)(yao)品(pin)，執行本院(yuan)“新藥(yao)(yao)引進(jin)暫行管理(li)辦法”。定期對臨(lin)床所用(yong)藥(yao)(yao)物(wu)進(jin)行安全性及療效的評價，綜合分析藥(yao)(yao)物(wu)使用(yong)情況，提(ti)出采(cai)(cai)購(gou)目(mu)(mu)錄的優化意(yi)見(jian)并(bing)上報(bao)藥(yao)(yao)事會。

1.2規范藥品(pin)入庫驗收及儲(chu)存(cun)管(guan)理

嚴(yan)把藥(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)(pin)(pin)入(ru)院(yuan)的(de)第一關，逐批進(jin)行(xing)入(ru)庫(ku)(ku)前的(de)驗收，凡藥(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)(pin)(pin)品(pin)(pin)(pin)(pin)(pin)(pin)(pin)規(gui)、生產廠家、批號、數量(liang)等信息與送(song)貨單(dan)不(bu)符或藥(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)(pin)(pin)包(bao)裝有(you)破損及(ji)發現(xian)有(you)其他質量(liang)問題等異常(chang)情況(kuang)時，及(ji)時報科室質量(liang)管(guan)(guan)(guan)理(li)(li)負責人，并做(zuo)(zuo)退貨處(chu)理(li)(li)；對(dui)庫(ku)(ku)存(cun)藥(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)(pin)(pin)實(shi)行(xing)合格(ge)藥(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)(pin)(pin)區、待驗區、不(bu)合格(ge)藥(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)(pin)(pin)區的(de)色(se)標管(guan)(guan)(guan)理(li)(li)。在(zai)庫(ku)(ku)房(fang)、藥(yao)(yao)(yao)(yao)房(fang)配備(bei)與藥(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)(pin)(pin)陳列、儲(chu)存(cun)相(xiang)適應(ying)的(de)設施(shi)(shi)與設備(bei)，按(an)照(zhao)藥(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)(pin)(pin)貯存(cun)制度(du)，定(ding)(ding)期(qi)對(dui)庫(ku)(ku)存(cun)藥(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)(pin)(pin)進(jin)行(xing)養護和質量(liang)檢查。在(zai)一、二級藥(yao)(yao)(yao)(yao)庫(ku)(ku)設置冷藏、避光、通風及(ji)防(fang)(fang)蟲、防(fang)(fang)鼠等設施(shi)(shi)，每(mei)天按(an)時觀測記錄(lu)溫濕度(du)，當溫濕度(du)不(bu)符合儲(chu)存(cun)條件時及(ji)時采取相(xiang)應(ying)措施(shi)(shi)予(yu)以調整(zheng)，以確保(bao)(bao)藥(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)(pin)(pin)質量(liang)。對(dui)形似音似等易混淆的(de)藥(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)(pin)(pin)做(zuo)(zuo)到分(fen)開放(fang)置，標識清晰(xi)。參考(kao)內地醫院(yuan)高(gao)危藥(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)(pin)(pin)目(mu)(mu)錄(lu)并結合我院(yuan)實(shi)際情況(kuang)制定(ding)(ding)高(gao)危藥(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)(pin)(pin)目(mu)(mu)錄(lu)，專架存(cun)放(fang)高(gao)濃度(du)電(dian)解質、抗凝藥(yao)(yao)(yao)(yao)、胰島素等高(gao)危藥(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)(pin)(pin)，并設置黑色(se)警示牌。“麻、精(jing)”藥(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)(pin)(pin)嚴(yan)格(ge)執(zhi)行(xing)三(san)級管(guan)(guan)(guan)理(li)(li)和“五專”管(guan)(guan)(guan)理(li)(li)制度(du)。嚴(yan)格(ge)按(an)照(zhao)藥(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)(pin)(pin)效(xiao)期(qi)管(guan)(guan)(guan)理(li)(li)制度(du)，做(zuo)(zuo)到藥(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)(pin)(pin)先(xian)進(jin)先(xian)出、近期(qi)先(xian)出，定(ding)(ding)期(qi)檢查藥(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)(pin)(pin)效(xiao)期(qi)，對(dui)近效(xiao)期(qi)藥(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)(pin)(pin)嚴(yan)格(ge)按(an)規(gui)定(ding)(ding)進(jin)行(xing)處(chu)理(li)(li)。定(ding)(ding)期(qi)對(dui)藥(yao)(yao)(yao)(yao)品(pin)(pin)(pin)(pin)(pin)(pin)(pin)進(jin)行(xing)盤點，保(bao)(bao)證(zheng)賬務相(xiang)符率。