镇痛药物“三级四维”管理在围术期中的构建及应用成效评价

Construction and Application Effectiveness Evaluation of the "Three Levels, Four Dimensions" Management of Analgesic Drugs in the Perioperative Period

关键词:  镇痛药物  “三级四维”管理  阿片类药物管控  合理用药

Key words:  Analgesic drugs  

摘要:

目的：探讨借助PDCA 循环法，镇痛药物分线分级管理体系的构建路径，并评价其在围术期疼痛管理中的应用效果。方法：依据WHO三阶梯镇痛原则，结合药物风险分级和处方权限控制，构建“三级四维”管理模式。结果：经过上述建立“三级四维”支撑架构，不合格处方比率、剩余药液登记不完整比率有改进，药品批号登记与处方不相符比率、镇痛泵剩余药液回收记录不完整比率等显著提升（P＜0.05）；并在围术期患者年龄、性别相仿、不增加患者住院天数情况下，阿片类药品的使用疗程、单次使用剂量、平均用药总剂量、阿片类药物药占比都有明显改善（P＜0.05）。结论：“三级四维”管理能够有效平衡镇痛疗效与用药安全，需通过制度设计、技术监管和多学科协作实现精准落地。

Abstract:

Objective:?To explore the construction pathway of a tiered and classified management system for analgesic drugs using the PDCA cycle method and evaluate its application effectiveness in perioperative pain management. Methods:?Based on the WHO three-step analgesic ladder principle, a "three-level, four-dimensional" management model was established by integrating drug risk classification and prescription authority control. Results:?Through the establishment of the "three-level, four-dimensional" support framework, the rates of non-compliant prescriptions and incomplete registration of residual medication showed improvement, while the rates of mismatched drug batch numbers with prescriptions and incomplete recovery records of analgesic pump residual medication were significantly enhanced (P < 0.05). Furthermore, under comparable patient age and gender and without increasing hospital stay duration, significant improvements were observed in the duration of opioid use, single-dose usage, average total dosage, and the proportion of opioid drug costs (P < 0.05). Conclusion:?The "three-level, four-dimensional" management model effectively balances analgesic efficacy and medication safety. Its precise implementation requires institutional design, technical supervision, and multidisciplinary collaboration.