目的 分析药师对天津医院住院患者静脉用药不合理医嘱的干预结果，为临床的合理用药提供参考。方法 对天津医院2018—2020年拦截的住院患者静脉药物不合理医嘱进行统计分析。结果 2018—2020年不合理医嘱854份，占总配置数量的0.27%；按错误类型排名前3位分别是溶媒选择不当、给药频次错误、用药剂量错误；按药品类别统计依次为普通药品、抗菌药物、细胞毒药物与全静脉营养药物；创伤病区不合理医嘱数量最多。在药师的干预下，静脉药物不合理医嘱发生率从2018年的0.305 5%下降至2020年的0.219 5%。结论 药师进行用药干预可有效减少不合理医嘱，显著提高天津医院静脉药物的合理用药水平。

Objective To analyze the intervention results of pharmacists on unreasonable intravenous drug use in inpatients of Tianjin Hospital, and to provide references for rational drug use in clinic. Methods A statistical analysis was made on unreasonable medical orders for intravenous drugs in hospital patients intercepted from 2018 to 2020. Results There were 854 unreasonable medical orders from 2018 to 2020, accounting for 0.27% of total allocation. According to the type of errors, the top three were the improper selection of solvent, the wrong frequency of administration, and the wrong dosage. According to drug categories, they were general drugs, antibacterial drugs, cytotoxic drugs and total parenteral nutrition drugs. The number of unreasonable medical orders in the trauma ward was the largest. Under the pharmacist, sintervention, the incidence of unreasonable medical orders for intravenous drugs decreased from 0.305 5% in 2018 to 0.219 5% in 2020. Conclusion Drug intervention by pharmacists can effectively reduce unreasonable doctor, sorders and significantly improve the level of rational drug use intravenous drugs.

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