中国临床药学杂志2025，Vol.34Issue(3)：161-167,7.DOI:10.19577/j.1007-4406.2025.03.001
多模态管理对消化道大手术病组肠外营养合理用药的管控效果评价
Effectiveness of multimodal management in rational parenteral nutrition use control for patients undergoing major digestive tract surgery
摘要
Abstract
AIM To assess the impact of multimodal management on rational use of parenteral nutrition(PN)under the diagnosis related groups(DRGs)payment system.METHODS A hospital-wide multidisciplinary cooperation,centered around the analysis of medication use in overspent cases of DRG disease groups,was carried out for patients undergoing gastrointestinal major surgery who received PN therapy.On August 1,2023,the cross-departmental quality-enhancing project was initiated.It adopted a comprehensive management model featuring multimodal control systems and real-time monitoring mechanisms for PN administration.The intervention plan consisted of regulating the drug utilization data of overspent cases in the gastrointestinal major surgery group,creating an intelligent computerized physician order entry(CPOE)system for PN to detect and correct irrational prescriptions,and setting up a dynamic medication assessment and feedback mechanism to continuously optimize the system.A total of 217 patients undergoing gastrointestinal major surgery(GB group)and receiving PN therapy from July 1,2022,to June 30,2024,were gathered.Among them,130 patients were in the pre-intervention period(from July 1,2022,to June 30,2023),and 87 patients were in the post-intervention period(from July 1,2023,to June 30,2024).Comparative assessments of PN utilization appropriateness and pharmacoeconomic performance metrics within the GB group were systematically conducted during pre-and post-intervention phases.RESULTS Post-intervention,the utilization rate of PN intravenous infusions across the hospital was reduced from 3.09％to 3.00％,irrational PN rate(22.1％vs 5.5％,P＜0.01)and irrationality monitored compound amino acid injection(18AA-IX)rate(64.0％vs 3.4％,P＜0.01)were decreased.GB group's total medical expenditure(P＜0.05),drug cost ratio(P＜0.01),and drug expenses(P＜0.01)were significantly declined.CONCLUSION Multimodal management significantly enhanced hospital-wide rational use of PN and improved pharmaceutical expenditure patterns in targeted clinical groups.关键词
肠外营养/疾病诊断分组/多模态管理/计算机处方订单输入系统/医嘱点评Key words
parenteral nutrition/diagnosis related group,multimodal management/CPOE system/medication review分类
医药卫生引用本文复制引用
宋周烨,叶见青,周子路,张良,金锦,王丹,夏琴杰,程敏毓..多模态管理对消化道大手术病组肠外营养合理用药的管控效果评价[J].中国临床药学杂志,2025,34(3):161-167,7.基金项目
浙江省药学会医院药学专项科研资助项目(编号2023ZYY27) （编号2023ZYY27）
国家卫生健康委医院管理研究所医院药学高质量发展研究项目(编号NIHAYS2429) （编号NIHAYS2429）
