基于FMEA法的住院药房智能麻精药品管理系统的构建和应用

Development and Implementation of Intelligent Management System for Narcotic and Psychotropic Drugs in Inpatient Pharmacy Based on FMEA

关键词:  麻精药品  失效模式与效应分析法  智能麻精药品管理系统  药房管理

Key words:  narcotic and psychotropic drugs  FMEA  intelligent management system for narcotic and psychotropic drugs  pharmacy management

摘要:

目的 通过失效模式与效应分析法(failure mode and effect analysis,FMEA)的实证性研究构建麻精药品全闭环追溯体系,优化药师及护士操作规范,提升麻精药品管理水平及患者用药安全。方法 采用FMEA法识别麻精药品管理全流程的风险点,通过计算风险优先值(risk priority number,RPN)确定优先改善的风险点,制订相应的改进措施,并对实施效果进行评价。结果 在苏州大学附属第二医院麻精药品管理过程中共找出处方不规范、无法完全实现批号追踪、空安瓿回收率低、废弃药品处置不规范等9个中高风险等级的失效模式。经优化改善后,RPN值均 ≤ 20,共下降312个RPN,下降幅度达72.6%。智能麻精药品管理系统顺利运行,处方修改率由11.56%下降至0.95%,差异具有统计学意义(P<0.05);异常事件的发生由每月(6.67±0.58)件下降至0件;人力成本显著下降;其他诸如空安瓿回收率、麻精药品批号管理准确率、废弃药品处置规范率、麻精药品专用账册规范率均显著提高,差异均具有统计学意义(P<0.05)。结论 运用FMEA方法显著降低了住院药房麻精药品管理的风险。智能麻精药品管理系统的应用,不仅保证了麻精药品全程可追溯,也极大便利了医务人员的操作。

Abstract:

OBJECTIVE To establish a full closed-loop traceable system for narcotics and psychotropic drugs through empirical research using failure mode and effect analysis(FMEA), to improve the operation standards of pharmacists and nurses, to improve the risk management level of narcotics and psychotropic drugs and the patients medication safety. METHODS FMEA was used to identify the risk points in the whole process of narcotics and psychotropic drugs management. By calculating the risk priority number(RPN), the risk points for priority improvement were determined. The corresponding improvements measures were formulated and the intervention effect was evaluated. RESULTS For the management of narcotics and psychotropic drugs in the Second Affiliated Hospital of Soochow University, a total of 9 failure modes with medium and high risk level were found, including non-standardized prescriptions, inability to track batch number in the whole process, low recollection rate of empty ampoules, and nonstandard disposal of discarded drugs, et al. After optimization and improvement, the new RPNs were all ≤ 20, and a total of 312 RPNs were reduced, with a descender of 72.6%. The application of intelligent management system for narcotic and psychotropic drugs ran smoothly. The revision rate of prescriptions decreased from 11.56% to 0.95%, the difference was statistically significant(P<0.05). The occurrence of abnormal events decreased from (6.67±0.58)items to 0 per month. The labor cost dropped significantly. Other changes including the recovery rate of empty ampoules, the accuracy rate of batch number management for narcotics and psychotropic drugs, the standard rate of waste drug disposal, and the standard rate of special account books for narcotics and psychotropic drugs were significantly improved, with statistically significant different(P<0.05). CONCLUSION The use of FMEA significantly reduces the risk and harm of narcotic drugs management in inpatient pharmacy. The application of intelligent management system for narcotic and psychotropic drugs has realized the information management. Not only the effective guarantee of narcotic and psychotropic drugs can be traced, but also greatly facilitate the operation of medical staff.