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·药事管理·

我国50家医疗机构剩余药品管理现状及我院相应管控模式的建

立与实践 Δ

#
刘 丹 ，黄景彬，钱 青，李卫平，王 庆，张 蓉（陆军军医大学第二附属医院药学部，重庆 400037）
＊
中图分类号 R951；R954 文献标志码 A 文章编号 1001-0408（2020）08-0897-05
DOI 10.6039/j.issn.1001-0408.2020.08.01

摘 要 目的：了解我国医疗机构剩余药品管理现状及存在问题，评价我院相应管控模式的实践效果，探索减少剩余药品产生及
规范管理的对策。方法：采用随机抽样，于2019年5月1－31日分别选取全国不同地区的三级医院30家和二级医院20家，针对药
学人员和医师、护士群体等非药学人员，发放自行设计的医疗机构剩余药品现状调研问卷；采用Excel 2010软件统计有效问卷的
基础数据，分析医疗机构病区剩余药品的产生原因、管理现状、处置规范及可能危害。在我院建立和实施全环节剩余药品管控模
式（包括减少源头生成、落实过程管控、严格执行处置等3个环节），评价其运行效果，并提出对策与建议。结果与结论：共发放400
份问卷，回收有效问卷311份，有效回收率77.75％。造成医疗机构出现剩余药品的原因复杂，主要有同药“拼用”，预先医嘱摆药，
药品不良反应，患者依从性差，医嘱录入错误，患者突然转院、出院或死亡，药房发错或护士核对错误等；其管理现状较为混乱，处
置方式缺乏规范性，可能导致药品变质过期、非法回收、污染环境等危害。我院建立了全环节剩余药品管控模式，主要措施为出台
《临床科室剩余药品安全管理规定》，明确管理层、临床科室、药剂科的职责；采用合理用药管控软件减少处方开具错误；增加药品
盘点次数；出台《退药退费管理规定》，畅通退药流程；自主研发“剩余药品管理系统”，规范并简化回收流程；将剩余药品纳入医疗
救助专项基金项目管理。经过2018年1－10月的管控实践显示，共计回收价值100余万元的剩余药品；不符合回收条件的剩余药
品已按规定流程销毁，病区管理不规范通报例数明显降低。我院所建立的全环节模式管理能有效减少剩余药品产生，规范其管理
及处置。建议国家及省级层面出台医疗机构剩余药品专项管理规定，各医疗机构制定适合本单位的具体管理措施，同时通过积极
探索减少剩余药品的途径、制定相应的财务账目处理规范和配套激励机制等手段进一步系统性地规范医疗机构剩余药品的管理。
关键词 医疗机构；剩余药品；全环节管控模式；药品管理；实践
Status of Residual Drug Management in 50 Medical Institutions in China and Its Control Mode
Construction and Application Practice in Our Hospital
LIU Dan，HUANG Jingbin，QIAN Qing，LI Weiping，WANG Qing，ZHANG Rong（Dept. of Pharmacy，the
Second Affiliated Hospital of Army Medical University，Chongqing 400037，China）

ABSTRACT OBJECTIVE：To understand the current management situation and problems of residual drugs in medical institutions
in China，evaluate the practice effect of corresponding control mode of our hospital and to explore the countermeasures to reduce
the production of residual drugs and standardize its management. METHODS：By random sampling，30 third-level hospitals and 20
second-level hospitals in different regions were selected respectively during May 1st to 31st in 2019. For the pharmaceutical
personnel，doctors，nurses and other non-pharmaceutical personnel，a self-designed questionnaire on the status quo of residual
drugs in medical institutions was issued. Excel 2010 software was used to count basic data of valid questionnaire，and the causes，
management status，disposal status and possible hazards of residual drugs in medical institutions were analyzed. A management
mode of residual drugs was established and implemented （involving reducing the generation of sources，implementing process
management，and strictly implementing disposal）. The effects of the model were evaluated，then the countermeasures and
suggestions were put forward. RESULTS & CONCLUSIONS：A total of 400 questionnaires were sent out，and 311 valid
questionnaires were collected with effective recovery rate of 77.75％. The causes of drug residual were complicated，which included
the“combination”of the same drugs，the pre-order dispensing，adverse drug reactions，poor compliance of patients，wrong order
imput，sudden transfer，discharge or death of patients，wrong dispensing or nurse check error，etc. The management status of
residual drugs was chaotic，the disposal methods lacked of standardization，which may lead to harm such as deterioration，illegal
recycling and pollution. The established whole-link residual
Δ 基金项目：重庆市技术预见与制度创新项目（No.cstc2018jsyj-
drug management model in our hospital， mainly included
zdcxX0093）
＊主管药师，硕士。研究方向：药事管理、抗肿瘤药理。电话： measures of introducing Clinical Departments Residual Drug
023-68774769。E-mail：513293274@qq.com Safety Management Regulations to clarify the responsibilities
# 通信作者：主任药师，博士生导师，博士。研究方向：药事管理、 of management group， clinical department， pharmacy
临床药学。电话：023-68755580。E-mail：zrcq73@163.com department； using rational medication control software to

中国药房 2020年第31卷第8期 China Pharmacy 2020 Vol. 31 No. 8 ·897 ·