The Establishment And Application Of Standard And Operation Of Tube Feeding For Medicine Of ICU In Our Hospital

Objective:To improve the therapeutic level of tube feeding associated with tube feeding by establishing standards and standardized operation procedures for tube feeding administration in the intensive care unit（ICU）ward of our hospital.Methods:Prescriptions for tube feeding administration in the ICU ward in 2017 and registered According to the"Handbook of Drug Administration via Enteral Feeding Tubes","The Law of the People’s Republic of China Pharmacopoeia（2015 edition）",drug instructions and labels,appropriate literature and medication errors in Doctor’s orders and logbooks,the proper use of tube feeding administration in the ward was analyzed.Standards and standardized operation procedures for tube feeding administration were developed and trained the medical staff.The established standards and operating procedures of tube feeding were evaluated preliminarily,that is,the reasonable rate of doctor’s advice and the change of average serum concentration of valproate sodium before and after the intervention in ICU ward in 2018 were analyzed.Results:1.The proportion of tablets and injections in the ICU ward of our hospital was 48.9%and 19.7%respectively in 2017,and 32.3%and 33.5%respectively in 2018.In 2018,compared with 2017,it is more reasonable for clinicians to prescribe tube-fed drugs.Dosage forms suitable for patients with severe diseases will be considered,for example,the proportion of injection dosage form increased from 19.7%in 2017 to 33.5%in 2018,and the proportion of oral liquid dosage form increased from 0.3%in 2017 to 4.8%in2018.In 2018,no further tube-fed administration of delayed and controlled release preparation was issued by clinicians.2.There were obvious medication errors in tube feeding,and the selection of dosage form was unreasonable,such as tube feeding slow controlled release preparation.The selection of drugs by tube feeding was unreasonable,including nifedipine tablets,nifedipine sugar-coated tablets,rifampicin capsules,bifidobacterium trifecta tablets,vitamin E capsules,etc.;The use of tools in the administration of administration administration was not standard.2 to 4 kinds of drugs were grinded,mixed and administered at the same time.Unreasonable timing of drug administration;No tube flushing before and after feeding;The choice of nasogastric tube and nasojejunal tube was wrong.3.In 2017,the number of cases with unreasonable medical orders was 41,with the unreasonable rate of 12.1%.After the established standards and operating procedures of tube feeding were applied in the ward,the number of unreasonable medical orders in2018 dropped to 15,with the unreasonable rate of 3.5%,,and there was a significant difference（P<0.001）.The mean plasma concentration after intervention with sodium valproate was 59.13±22.66μg·ml^-1,which was significantly higher than the average blood concentration before intervention of 23.41±18.31μg·ml^-1.The difference was statistically significant（P<0.001）.Conclusions:1.Formulation of drug administration standards for common tube feeding drugs can significantly improve the rationality rate and reduce medical errors associated with tube feeding in ICU ward.2.Standardizing the operation process of feeding tube can avoid the loss of drugs during feeding tube.