首页|PDCA监管机制对人血白蛋白合理使用监管的效果评价

PDCA监管机制对人血白蛋白合理使用监管的效果评价

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目的 探索人血白蛋白在PDCA循环监管机制下是否促进其合理安全使用.方法 采取PDCA循环的管理方法,建立人血白蛋白合理使用管理体系.分阶段分析调查白蛋白的临床使用状况,参考美国大学医院联合会推荐的《人血白蛋白,非蛋白液体及晶体溶液使用指南》、药品说明书以及相关文献,结合临床实际情况,探索和建立适应实际工作需要的"人血白蛋白临床合理应用规范""人血白蛋白临床合理用药动态监测与分析系统",并分析实施PDCA循环管理前后各项用药指标和效果.结果 2019 年至 2022 年,合理性比例分别为 34.65%、41.07%、47.35%和48.74%(P<0.001).人血白蛋白的平均使用量从(88.59±54.6)g逐渐下降到(49.35±41.6)g(P=0.038).在监管干预后大部分科室,特别是ICU、心胸手术和肝胆外科,白蛋白的临床使用量显著下降.除11~20 d组以外,各组均显著减少,长疗程(>20d)从2019 年至2022 年的比例显著降低.此外,血清白蛋白水平<25g的患者比例从15.43%增加到39.31%(P<0.001).高血压或肾功能不全患者有监测血压或肌酐清除率的比例轻微增加(P=0.039).结论 通过PDCA监管机制,对人血白蛋白的监管取得一定效果,推进了人血白蛋白的合理安全使用,在一定程度上促进了医疗资源合理分配.
Effect of PDCA Model on Investigation and Analysis of Clinical Application of Human Albumin
OBJECTIVE There are so many misunderstandings in the clinical application of human serum albu-min(HSA).This study investigated whether the PDCA(Plan,Do,Check,and Action)model helps promote the ra-tional clinical use of HSA.METHODS The PDCA model was applied to establish a management strategy for the ra-tional use of HSA.We established two systems namely"the clinical rational application of HSA"and"the dynamic monitoring system of rational use of HSA".Subsequently,the clinical rationality use of HSA was analyzed and evalua-ted stage by stage.RESULTS From 2019 to 2022,the proportion of rationality was 34.65%,41.07%,47.35%and 48.74%,respectively(P<0.001).The average use of HSA was decreased gradually from(88.59±54.6)g to(49.35±41.6)g(P=0.038).The amount of clinical use of HSA was significantly declined in most of the depart-ments after regulatory intervention,especially for ICU,cardiothoracic surgery,and hepatobiliary surgery.All courses were significantly reduced except 11-20 d group,and the proportion of extraordinary course(>20 d)from 2019 to 2022 showed a significant decrease.Additionally,the proportion of patients with serum albumin level<25 g was in-creased from 15.43%to 39.31%(P<0.001).The proportion of hypertension or renal function inadequacy patients should be monitored for blood pressure or creatinine clearance rate,and showed a slight increase(P=0.039).CONCLUSION The PDCA model promoted the rational and safe use of HSA,optimizing the rational allocation of medical resources to a certain extent.

Human albuminRational use of drugPDCA modelPharmaceutical intervention

沈盼、林莹、庄燕琴

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南京中医药大学附属南京医院(南京市第二医院),江苏南京 210000

常州市第二人民医院,江苏常州 213000

人血白蛋白 合理用药 PDCA循环 药学干预

2024

海峡药学
中国药学会福建分会

海峡药学

影响因子:0.643
ISSN:1006-3765
年,卷(期):2024.36(4)
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