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        關于簡論門診藥房常見發藥差錯及防范措施網站位置: >> 醫藥學論文 >> 微生物藥物學論文 >> 瀏覽文章
        簡論門診藥房常見發藥差錯及防范措施

        論文導讀:房調配差錯理由分析及干預措施討論.中國藥物應用與監測,2013,10(2):115-116  斌蘭.門診藥房發藥差錯的理由分析及防范.中國藥事,2013,27(10):1108-1109  唐巧萍,王彥東.門診藥房差錯理由分析及防范措施.包頭醫學,2013,37(4):251-252  (收稿日期:2014.07.28)

        門診藥房常見發藥差錯及防范措施【摘要】目的:防范門診藥房發藥差錯,杜絕藥療事故發生。策略:從藥品、藥師等方面分析門診藥房常見調劑差錯,并采取相應的防范措施。結果:確保患者用藥安全、合理、有效。結論:提高藥劑人員的服務水平,查找不安全因素,確保為患者提供安全有效的藥學服務。
          【關鍵詞】門診藥房;發藥差錯;防范措施
          1007-8517(2014)19-0132-01
          門診藥房是醫院面向社會服務的一個重要窗口,它的優劣不僅在某種程度上反映了藥劑科人員的素質和專業水平,而且直接影響到醫院的醫療質量和社會聲譽。如何減少差錯及事故的發生是提高醫療質量、防止糾紛的重要因素[1]。
          1資料與策略
          收集我院2013年1月至12月門診藥房發藥差錯登記,共記錄39例。 對記錄在冊的理由進行分析并歸類,報告如下。
          2結果
          2.1名稱相似的藥品差錯此類差錯有6例,占差錯的15.4%。名稱相似的藥品很多,如依那普利與貝那普利,辛伐他汀與洛伐他汀,藥師在沒有仔細核對處方的情況下,急于調配藥品造成發藥差錯。
          2.2同種藥品不同規格的發藥差錯此類差錯有8例,占差錯的20.5%。如紅霉素腸溶膠囊0.125g和紅霉素腸溶膠囊0.25g;阿奇霉素0.5g和阿奇霉素0.25g,若藥師調配藥品時,不仔細核對藥品規格,很容易出現差錯。
          2.3有效成分相同,劑型不同的藥品差錯此類差錯有10例,占差錯的25.6%。如鹽酸左氧氟沙星膠囊和鹽酸左氧氟沙星片,頭孢克肟分散片與頭孢克肟顆粒等。藥師在調配藥品時,不仔細核對藥物劑型,易引發差錯。
          2.4包裝相似藥品差錯此類差錯有5例,占差錯的12.8%。這種情況多出現于同一廠家生產的藥品,如我院有某廠家生產的依巴斯汀和愛普列特,這兩種藥品其作用完全不同,但外包裝大小和顏色都極為相似,極易發生藥品差錯。
          2.5藥品數量差錯此類差錯有10例,占差錯總數的25.6%。由于藥師勞動強度大,易發生疲勞感,容易把處方中同時存在多種藥品的數量看串,發生投藥差錯。
          3討論
          藥師有時因勞動強度過大,遇到患者較多的高峰時段,藥師易產生從速心理,不仔細核對處方,單人發藥,不實行雙復核制度,把藥品直接投出窗口,既容易造成錯發藥品,又容易導致患者之間取錯藥品。同時長時間工作易產生大腦疲勞,在疲勞工作狀態下導致藥品調配差錯。外界干擾,藥師調配藥品時,外界環境吵雜,藥師之間相互聊天,患者之間聊天,患者咨詢理由等,都會分散藥師注意力,導致調配差錯。藥師工作不熟練,責任心不強,馬虎大意,隨意擺放藥品,發藥時沒有仔細逐一核對,易造成錯發。
          4防范措施
          4.1嚴格制度健全各項規章制度,嚴格執行“四查十對”制度,制定藥品調配操作規程。好的工作程序對用藥安全至關重要,如果藥房調劑程序做得足夠規范,調配、核對、發藥各司其職,那么處方調劑出現差錯就會比之前呈幾何倍數下降[2]。
          4.2實現藥物一品雙規在藥品多元化的今天,應落實藥物一品雙規制度,不得隨意增加藥物的品規數量,從而減少藥品調劑差錯的發生。
          4.3加強藥師培訓,提高風險意識在調研中發現,新聘藥師和實習學生,發生差錯占半數以上,因此,藥師崗位培訓是提高業務水平的重要手段[3]。全體藥劑人員要認識到錯發藥品的后果和危害性,在發藥之前要認真審核處方,不要同時調配多張處方,加強責任心,培訓認真細致的工作作風,嚴格執行雙人復核制度,不僅保證患者用藥安全,同時也是減少藥患糾紛的必要措施。
          4.4減輕工作壓力,合理安排窗口人員配備超負荷的工作使藥劑人員神經處于高度緊張的疲勞狀態,尤其在患者較多的高峰時段,應合理配備窗口人員的數量,開設藥物咨詢窗口,專門解答患者用藥理由,保證藥品調劑人員的精力,避開因疲勞、忙亂工作而導致的藥品調配差錯。
          4.5合理擺放藥品,建立警示標志按藥理作用將藥品進行分類,擺放藥品時要確保品名與貨架上的標簽嚴格對應(藥名、規格、生產廠家)[4],把外觀相似容易錯發的藥品分開擺放,高危藥品單獨存放。將高危藥品、易混淆的藥品、近效期藥品等建立醒目標志。
          4.6建立發藥錯誤登記、報告制度對發藥時出現的各種差錯,當事人應及時如實報告,發生嚴重差錯應立即上報上級職能部門及分管領導,并應設立差錯事故登記本以及時登記差錯。在定期學習中進行分析、總結,以避開相同的差錯事故的再次發生。
          5小結
          隨著衛生體制改革的不斷深入,醫療技術的不斷發展,新的技術和新的藥物也不斷的出現,患者對醫院要求越來越高,包括對門診藥房的服務也提出了更高的要求。我們必須提高對藥劑人員的服務水平,加強對專業知識的培訓,加強對工作技能的提升,加強藥品質量的各項管理,查找到任何不安全的因素,確保為患者提供安全有效的優質藥學服務[5]。確保用藥的安全性、有效性與經濟性,同時提高藥師的社會地位,體現藥師的社會價值。
          參考文獻
          [1]薛玉華,楊乃華.談某院門診處方差錯及防范措施[J].中國醫藥指南,2011,9(21):379-380
          [2]許虹娟.西藥房中確保發藥準確的分析[J]. 臨床合理用藥,2013,6(11):95-96
          [3]欒瀟瀟,陳琿,李星,等.門診藥房調配差錯理由分析及干預措施討論[J].中國藥物應用與監測,2013,10(2):115-116
          [4]斌蘭.門診藥房發藥差錯的理由分析及防范[J].中國藥事,2013,27(10):1108-1109
          [5]唐巧萍,王彥東.門診藥房差錯理由分析及防范措施[J].包頭醫學,2013,37(4):251-252
          (收稿日期:2014.07.28) 全文地址:http://www.qdhlgm.com/wswywxlw/lw50507.html
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