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          門診西藥房不合理用藥問題探究
          發布時間:2019-08-07

          本篇為 電大藥學畢業論文(推薦范文6篇)之第六篇,文末可查看其他5篇論文

            摘要:目的 研究門診西藥房不合理用藥處方分析及改進措施。方法 選擇2017年1月~2018年12月我院門診西藥房不合理處方150例進行分析, 對處方管理前不合理情況分析并找出原因, 針對原因實施有效的改進措施。結果 我院門診西藥房不合理處方150例, 分析不合理用藥處方在各科室分布情況, 其中內科34張, 外科22張, 兒科16張, 婦科22張, 急診科6張;門診西藥房不合理用藥處方, 分析不合理因素包括醫師因素、藥師因素、環境因素;門診西藥房不合理用藥處方管理前, 分析不合理處方產生的原因, 以此制定有針對性的管理措施, 對比管理前后變化有顯著差異 (P<0.05) .結論 門診西藥房不合理用藥實施有效的改進措施, 能減少不合理處方, 保證患者臨床用藥安全。

            關鍵詞:門診; 西藥房; 不合理用藥; 處方; 改進措施;

            醫藥處方是患者臨床治療的憑證, 處方中包括了用藥名稱、用法、用量、用藥方式等信息, 用藥處方是醫師了解患者的病情、用藥史、過敏史等基本情況后開具, 對患者臨床治療具有重要的作用, 也是患者治療安全的基本保證[1].醫藥處方可以反映出醫師的水平, 而門診西藥房的處方管理工作也可以直接反映出醫院的服務水平。本次研究中, 選擇2017年1月~2018年12月我院門診西藥房不合理處方150例進行分析, 分析不合理用藥原因后實程度也改進措施, 分析如下。

            1、資料與方法

            1.1 一般資料

            選擇2017年1月~2018年12月我院門診西藥房不合理處方150例進行分析, 分析不合理用藥處方在各科室分布情況, 其中內科34張, 外科22張, 兒科16張, 婦科22張, 急診科6張。150例處方中, 患者男性79例, 女性71例;年齡26~88歲, 平均 (64.5±5.8) 歲。

            1.2 方法

            1.2.1 不合理處方成因

            分析不合理處方原因, 主要是醫師因素、藥師因素、環境因素, 具體如: (1) 醫師因素。臨床醫師經過培訓和學習, 掌握疾病的基礎病理學理論知識, 對藥物作用機制和適應證上認知程度較差, 藥典知識不斷在更新, 特殊藥物使用時會發生改變。而且醫院并沒有建立起完善藥品管理制度, 醫師有處方開具權同時還具備管理權, 醫師缺乏監督管理, 有個別醫師法律意識過于薄弱, 不能意識到不規范和不適宜處方的后果。 (2) 藥師因素。醫院藥房的藥是在藥方的審核、監督等方面缺乏系統的管理, 對藥品適應證和給藥方法、作用機制上也缺乏足夠的認知, 尤其是綜合能力水平不高[2]. (3) 環境因素。藥學信息管理系統不斷發展, 處方開具、給藥等環節具有較高的出錯率, 對處方管理各環節缺乏監管, 例如:處方漏寫, 沒有重視規范用藥的作用, 缺乏對臨床醫師與藥房藥師的約束。

            1.2.2 西藥房不合理處方改進措施

            (1) 醫院要加強相關規章制度的管理, 為臨床醫師發放最新處方集, 使臨床醫師可以高效掌握藥品作用機制、適應證和禁忌證, 開具處方時要確保書寫工整和清晰, 防止發生漏字或錯字, 避免配藥出錯。 (2) 改進處方點評制度。醫院要指定專人檢查西藥科處方, 分析不合理處方成因, 將處方開具情況在院內信息內網進行公開, 定期檢查并監督處方開具的情況。處方點評和干預方案要在網上公開, 用于醫師與藥師共同分享和學習。 (3) 修正處方管理制度。對臨床醫師和藥師處方檢查, 要及時退回不合理處方, 指導臨床醫師根據規定修正, 對發現不合理處方藥師獎勵, 控制處方質量在合理范圍內要予以獎勵。 (4) 提升醫師和藥師能力。定期培訓醫師和藥師, 加強對藥學知識的培訓, 加強對藥物禁忌與配伍的學習, 提升醫師和藥師的專業能力, 提升藥師對處方審核和干預能力[3].

            1.3 觀察指標

            分析門診西藥房不合理用藥處方在各科室的分布情況, 產生不合理情況的因素, 實施改進措施后與管理前的處方變化情況。不合理用藥包括處方不規范、處方不規范及其他, 而其他指重復用藥、無理由用藥、超說明書劑量用藥等情況[4].

            1.4 統計學方法

            數據用SPSS 17.0統計學處理, 計數資料用n (%) 表示, 用x2檢驗, 以P<0.05表差異有統計學意義。

            2、結果

            2.1 分析門診西藥房不合理用藥處方各科室分布情況

            我院門診西藥房不合理處方150例, 分析不合理用藥處方在各科室分布情況, 其中內科34張, 外科22張, 兒科16張, 婦科22張, 急診科6張。

            2.2 分析門診西藥房不合理用藥處方原因

            門診西藥房不合理用藥處方, 分析不合理因素包括醫師因素、藥師因素、環境因素。

            2.3 分析門診西藥房不合理用藥處方管理前后變化情況

            門診西藥房不合理用藥處方管理前, 分析不合理處方產生的原因, 以此制定有針對性的管理措施, 對比管理前后變化有顯著差異 (P<0.05) , 見表1.

            3、討論

            隨著我國老齡化的加劇, 老年患者自身合并基礎疾病較多, 導致西藥臨床用藥也越來越復雜, 這就對西藥處方管理有了更高的要求, 才能保證臨床治療安全性與有效性。臨床治療用藥安全和有效是醫師重點考慮的內容, 用藥合理性與患者生命安全有著密切的關系。隨著現代醫學的發展, 藥物不斷更新, 臨床用藥方案也不斷改變, 開具處方不能僅憑現有知識和用藥經驗, 處方不規范或不適宜的開具都會使臨床治療受到影響, 甚至危及患者的生命安全。分析門診西藥房不合理處理成因, 以此實施有針對性的干預措施, 可以有效降低處方不合理發生率[5].醫師加強藥學知識的學習, 對處方點評制度不斷完善, 提高處方修正與督察管理制度, 可以使處方實現系統性、科學性的管理。

          表1 分析門診西藥房不合理用藥處方管理前后變化情況[n (%) ]

          分析門診西藥房不合理用藥處方管理前后變化情況

            參考文獻

            [1]何皖蘇。醫院西藥房不合理用藥處方分析及處理[J].臨床合理用藥, 2017, 10 (10) :81-82.
            [2]陳巧月, 陳煜輝。西藥房不合理用藥處方的分析及報告[J].中國衛生標準管理, 2016, 7 (16) :127-128.
            [3]孫黎明。西藥房不合理用藥處方的研究與分析[J].北方藥學, 2018, 15 (1) :180-181.
            [4]金英錦。門診西藥房不合理用藥處方調查分析[J].中國衛生產業, 2015, 13 (19) :47-49.
            [5]曾立青。門診西藥房不合理用藥處方分析及改進措施[J].中國實用醫藥, 2016, 11 (18) :273-274.

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