Evaluation And Analysis Of Drug Use By Pharmacy Intravenous Admixture Services

In China,the situation of patients with adverse reactions caused by irrational drug use is increasingly serious,among which injection is the most prominent.This topic aims to explore the role of Pharmacy Intravenous Admixture Services(PIVAS)in promoting rational drug use through the practical study of pharmacists’ intervention in intravenous drug use of inpatients.By comparing the rationality of intravenous medical orders before and after intervention,the effectiveness of pharmacists’ intervention on intravenous medication orders was evaluated,so as to provide a basis for formulating relevant treatment measures and explore methods to promote rational drug use.Through the intervention of doctors,pharmacists,nurses,administration and information,a total of 2,522,778 intravenous medical orders were received by PIVAS from2015 to 2018.The rationality of medication was evaluated and the error rate was compared.After a 4-year intervention,the total amount of intravenous medication in the sample hospital decreased to some extent.The analysis of irrational drug use shows that the number of unreasonable medical orders for solvent selection decreased by 53.0%,the number of unreasonable medical orders for usage and dosage decreased by 29.6%,the number of m medical orders with incompatibility decreased by 43.6%,and the number of medical orders with unreasonable drug concentration decreased by 38.0%.In 2017,based on the update of the list of new medical insurance policies,the standards for reviewing medical orders are raised in PIVAS of the sample hospital.In 2017 and 2018,there were 188 unreasonable medical orders beyond the limits of medical insurance coverage.During the study period,the overall error rate of PIVAS showed a downward trend year by year.The error rates of checking prescription,labeling,dispensing and dispensing were decreased by 73.7%,54.2%,30.7% and 26.7%,respectively.The damage rate of intravenous fluids decreased by78.9%.There is no significant improvement in the error rate of batch arrangement and packaging.This article used the LIKERT mathod,through the questionnaire survey form the clinical nurses and physicians in PIVAS recognition research.The recognition score of clinical nurses for PIVAS was 4.39 ± 0.78.The high recognition program were "decrease of nurses’ occupational exposures","timeliness of the third batch of drug delivery" and "decrease of transfusion reaction in patients".The low recognition program were "timeliness of the first batch of drug delivery " and "solution the problem of clinical nurses".46.9% of the doctors believed that PIVAS prescription-checking pharmacists reviewed the doctor’s orders in full accordance with the standard without any objection.Some doctors believed that PIVAS pharmacists failed to review prescriptions according to the latest treatment guidelines or the actual situation of patients.In the face of consultation from clinicians,pharmacists could give feedback within 2 hours for 84.0% of doubts,and the doubt basic resolution rate was 96%.The results of this study show that the establishment of PIVAS and pharmacists’ pharmaceutical intervention play a positive role in promoting rational drug use.It is also found that there are still some deficiencies in the review of the rationality of doctors’ orders.The pharmacist only reviews the drug itself,and fails to conduct individualized medical order review according to the patients’ physiological and pathological conditions.The impact of previous medication on current treatment regimen is not included in the review criteria.PIVAS needs to be further improved,and meanwhile,the ability cultivation of pharmacists’ team should be strengthened.In order to ensure the rational use of drugs in clinic,we should take into account all the factors of patients,improve the standard of the examination of doctor’s advice,and strengthen the cultivation of the ability of the pharmacist team.