Page 117 - 《中国药房》2021年5期

医药护一体化监管模式对我院TDM全过程实施的影响 Δ

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刘剑敏 ，黄鹤归，林奕凯，易艳东，张韶辉（武汉市中西医结合医院药学部，武汉 430022）
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中图分类号 R969.3 文献标志码 A 文章编号 1001-0408（2021）05-0619-05
DOI 10.6039/j.issn.1001-0408.2021.05.19

摘 要 目的：探讨医药护一体化监管模式对治疗药物监测（TDM）全过程实施的影响。方法：将我院2018年1－12月期间实施
TDM的患者作为对照组，采用传统监管模式（即医师、药师、护士三方的工作相对独立）；将2019年1－12月期间TDM监测患者作
为观察组，采用医药护一体化监管模式（即医师、药师、护士三方相互合作，以患者和样本为中心，药师作为关键衔接，制订各环节
的执行标准，明确各自职责）。比较两组患者药物浓度总体达标率、问题样本发生率、危急值通报率、临床满意度、用药建议反馈与
采纳情况以及6种监测药物（丙戊酸钠、地高辛、他克莫司、环孢霉素、甲氨蝶呤、万古霉素）的药物浓度达标率。结果：观察组的药
物浓度总体达标率、危急值通报率、临床满意度合格率分别为64.57％、99.39％、97.22％，均显著高于对照组的57.86％、96.80％、
92.22％（P＜0.05）；而观察组的问题样本发生率为0.72％，显著低于对照组的3.09％（P＜0.001）。观察组的个体化药师发出反馈
率（89.19％）、医师反馈交流率（80.50％）、用药建议采纳率（69.98％），均显著高于对照组的50.34％、71.46％、55.36％（P＜0.001）。
观察组患者除他克莫司的药物浓度达标率略低于对照组外（73.40％ vs. 75.77％，P＞0.05），其余5种监测药物的药物浓度达标率
均高于对照组，其中丙戊酸钠、地高辛、万古霉素的药物浓度达标率差异有统计学意义（P＜0.05）。结论：对TDM全过程实施医药
护一体化监管模式，可有效提高药物浓度达标率，并实现个体化用药的全程动态监督和反馈，有利于保障临床用药安全。
关键词 个体化药学服务；治疗药物监测；一体化监管模式；全程动态监督

Effects of Integrated Supervision Mode by Doctors， Pharmacists and Nurses on the Whole-process
Implementation of TDM in Our Hospital
LIU Jianmin，HUANG Hegui，LIN Yikai，YI Yandong，ZHANG Shaohui（Dept. of Pharmacy，Wuhan Hospital of
Integrated Traditional Chinese and Western Medicine，Wuhan 430022，China）

ABSTRACT OBJECTIVE：To investigate the effects of integrated supervision mode by doctors，pharmacists and nurses on the
whole-process implementation of therapeutic drug monitoring （TDM）. METHODS：The patients monitored with TDM in our
hospital admitted from Jan. to Dec. 2018 were selected as control group，treated with the traditional drug supervision mode（i.e. the
work of doctors，nurses and pharmacists was relatively independent）. Treatment group was composed of inpatients monitored with
TDM from Jan. to Dec. 2019，treated with the integrated supervision mode of doctors，nurses and pharmacists（i.e. doctors，nurses
and pharmacists cooperated with each other，taking the patients and sample as the center，pharmacists as the key link formulated
the implementation standards of each link，and clarified their respective responsibilities）. The concentration compliance rate，the
incidence of incorrect samples，critical value notification rate，clinical satisfaction，drug recommendation feedback and adoption，
compliance rates of 6 kinds of monitored drugs（sodium valproate，digoxin，tacrolimus，cyclosporin，methotrexate，vancomycin）
were compared between two groups. RESULTS：The overall compliance rate，critical value notification rate and clinical satisfaction
rate of the observation group were respectively 64.57％ ，99.39％ and 97.22％ ，which were significantly higher than 57.86％ ，
96.80％ and 92.22％ of control group（P＜0.05）. The incidence of incorrect samples in observation group was 0.72％，which was
significantly lower than 3.09％ of control group（P＜0.001）. The feedback rate of individual pharmacists（89.19％），the feedback
rate of doctors（80.50％）and the adoption rate of medication suggestions（69.98％）in the observation group were significantly
higher than control group （50.34％ ，71.46％ and 55.36％ ，P＜0.001）. The compliance rate of tacrolimus concentration in
observation group was slightly lower than control group（73.40％ vs 75.77％ ，P＞0.05）. The concentration compliance rate of
other 5 varieties was higher than control group，and the differences of valproate sodium，digoxin and vancomycin concentrations
between two groups were statistically significant（P＜0.05）. CONCLUSIONS：The implementation of integrated doctors，nurses
and pharmacists supervision mode in TDM can effectively
Δ 基金项目：“十二五”中医药重点学科临床中药学建设项目（No.
国中医药人教发〔2012〕32 号）；湖北省“十三五”中医重点专科项目 improve the drug concentration compliance rate，realize the
（No.鄂卫办通〔2019〕125号）；中国药学会科技开发中心科普项目[No. dynamic supervision and feedback of individualized drug use，
CMEI2020KPYJ（JZYY）00301] which is conducive to ensure the safety of clinical medication.
＊主管药师，博士。研究方向：治疗药物监测、药物基因检测。电 KEYWORDS Individualized pharmaceutical care；
话：027-85332034。E-mail：81683985@qq.com Therapeutic drug monitoring； Integrated supervision mode；
# 通信作者：副主任药师，博士。研究方向：临床药学、治疗药物 Whole-process dynamic supervision
监测。电话：027-85332276。E-mail：53685340@qq.com

中国药房 2021年第32卷第5期 China Pharmacy 2021 Vol. 32 No. 5 ·619 ·