摘要
目的 运用PDCA联合帕累托法,对某医院工业化三腔袋医嘱的合理性进行提升.方法 参照专家共识及相关文献,建立评价标准15条,对2021年某医院全部工业化三腔袋医嘱的合理性进行分析,通过帕累托图分析其中的主要问题,并针对主要问题进行改进.结果 2021年某医院工业化三腔袋医嘱合理率为60.50%,最主要的问题是N(2)-L-丙氨酰-L-谷氨酰胺注射液超量,出现该问题的医嘱在所有工业化三腔袋医嘱中占比38.41%,在不合理医嘱中占比96.38%,其中最需要干预的病区为胃肠外科一病区.制定干预计划后,2022年上半年工业化三腔袋医嘱合理率上升至67.79%,最主要的问题依然是N(2)-L-丙氨酰-L-谷氨酰胺注射液超量,在全部医嘱中占比下降至30.74%,不合理医嘱中占比93.38%,其中最需要干预的病区依然为胃肠外科一病区.调整干预计划后,2022年下半年工业化三腔袋医嘱合理率大幅上升至96.74%,N(2)-L-丙氨酰-L-谷氨酰胺注射液超量在所有医嘱中占比下降至1.25%,不合理医嘱中占比下降至38.46%.结论 采用PDCA联合帕累托法进行干预,该院工业化三腔袋医嘱合理性得到大幅度提升.
Abstract
Objective To improve the rationality of medical orders for industrialized three-chamber bags in one hospital using the PDCA method combined with a Pareto diagram.Methods According to the expert consensus and related literature,15 evaluation criteria were established to analyze the rationality of all medical orders for industrialized three-chamber bags in 2021.The main problems were identified via a Plato diagram before countermeasures were recommended.Results In 2021,the percentage of standard medical orders for industrialized three-chamber bags in the hospital was 60.50%.The main problem was the overdose of N(2)-L-alanyl-L-glutamine injection,accounting for 38.41%of all medical orders and 96.38%of improper medical orders.The ward where interventions were needed most was the first ward of gastrointestinal surgery.After interventions,the percentage of proper medical orders for industrialized three-chamber bags increased to 67.79%in the first half of 2022.However,the biggest problem still lay in the excessive usage of N(2)-L-alanyl-L-glutamine injection.The proportion of related medical orders decreased to 30.74%of the total,and the proportion of improper medical orders was 93.38%.The first ward of gastrointestinal surgery remained the most problematic.After adjustment of interventions,the percentage of proper medical orders for industrialized three-chamber bags increased significantly to 96.74%in the second half of 2022,the proportion of overdose of N(2)-L-alanyl-L-glutamine injection in all medi-cal orders decreased to 1.25%,and the proportion of improper medical orders decreased to 38.46%.Conclusion The combination of PDCA with a Pareto diagram can go a long way towards improving the rationality of medical orders for industrialized three-chamber bags in a hospital.
基金项目
中国药学会青年医院药学创新研究项目(CPA-B04-ZC-2021-001)
安徽中医药大学研究生教育教学改革研究项目(2022YJG011)
NETL
NSTL
万方数据