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目的运用PDCA循环(质量环)对肾功能异常的特殊患者不合理用药干预,以期提高用药安全,减少对肾脏药源性伤害。方法应用PDCA循环管理方法,对医院肾功能异常患者用药作持续性干预,通过PASS系统抽选医院2015年3-5月肾功能异常患者病历217例,为对照组;第一干预循环阶段,208份病历,2015年6-8月为干预一组;第二干预循环阶段,211份病历,2015年9月-12月为干预二组;比较3组用药情况。结果本次研究调查共涉及医务人员874人次,设计9个问题,进行调查研究分析,其中主要因素A为特殊人群肾功能不全患者剂量计算、特殊患者相关知识培训、特殊患者的个体化治疗方案;次要因素B为特殊患者药物选择、特殊患者注射用溶媒选择、特殊患者与普通患者用药区别。在工作中加大力度对A因素循环的干预,重视主要因素的同时,并不能忽视次要因素,在一定条件和环境下,它们之间可能发生互相转换。PDCA循环完成第二次干预后,药物选择、溶媒及配伍、剂量选择调整等7项指标发生变化,第一次干预后7项指标的比例升高与干预前比较,差异有统计学意义(P<0.05),第二次循环干预7项指标的比例升高与第一次干预比较差异有统计学意义(P<0.01)。PDCA干预前肾功能异常患者内生肌酐清除率、血清肌酐、血尿素氮三项出入院患者肾功能生化指标进行比较,差异有统计学意义(P<0.05),而PDCA干预后1期、2期,出入院生化指标进行比较,差异均无统计学意义(P>0.05),提示干预后肾功能无进一步恶化。结论借助PDCA循环管理控制模式,有助于肾功能异常患者合理选择治疗药品,得到有效的实施,并达到个体化精准治疗。
OBJECTIVE: To improve the medication safety and reduce the drug-induced injury to the kidney by using the PDCA cycle (mass ring) to unreasonable drug intervention in special patients with abnormal renal function. Methods PDCA cyclical management method was used to make continuous intervention for patients with renal dysfunction in hospital. 217 patients with renal dysfunction in hospital from March to May 2015 were selected by PASS system as the control group. In the first interventional cycle phase, 208 The medical record was from June to August in 2015. The second intervention phase consisted of 211 medical records and September-December 2015 as the intervention group. The drug use in the three groups was compared. Results A total of 874 medical staff were involved in this study. Nine questions were designed for investigation and analysis. The main factors A were dose calculation for special patients, training for special patients and individualized treatment for special patients. Secondary factors B for special patient drug selection, special patients with solvent selection, special patients and ordinary patients medication difference. In the work to step up the intervention of A cycle of factors, focusing on the main factors at the same time, and can not ignore the secondary factors, under certain conditions and circumstances, between them may occur between the conversion. PDCA cycle after the completion of the second intervention, the drug selection, solvent and compatibility, dose adjustment and other indicators of seven changes, the first intervention after the seven indicators of the proportion of increased compared with the pre-intervention, the difference was statistically significant (P <0.05). There was a significant difference between the first intervention and the second intervention (P <0.01). PDCA intervention before renal function abnormalities in patients with endogenous creatinine clearance, serum creatinine, blood urea nitrogen in patients with three entrance and exit of renal biochemical indicators were compared, the difference was statistically significant (P <0.05), while the PDCA intervention 1, 2 There was no significant difference in the biochemical indexes between the admission and admission (P> 0.05), suggesting no further deterioration of renal function after intervention. Conclusions With PDCA cycle management and control mode, it is helpful for patients with abnormal renal function to select drugs for treatment reasonably, get effective implementation and achieve accurate individualized treatment.