【摘要】 目的通过基于危害分析和关键控制点的多学科合作对儿科肠外营养治疗进行综合管理,观察多学科人员的临床参与率、处方质量、治疗安全、患儿医疗成本等变化情况。方法选取干预前后的肠外营养处方及相关治疗费用、治疗时间,及总并发症发生率等分别为对照组和干预组的研究指标;借助危害分析和关键控制点体系确定关键干预点,选取医生、营养师、药剂师组成多学科团队,进行营养会诊、审方改进、建立配液中心等综合干预。结果干预组医师标准操作流程执行率、营养师会诊率、药师干预率、处方指标合格率均高于对照组(P<0.05);全院总体并发症发生率呈下降趋势;患儿治疗总天数及相关总花费较干预前下降(P<0.05)。结论该模式能显著提高营养师、药剂师的临床参与率,进而提高临床医生处方的质量,降低并发症风险,并减少相关总费用,有利于保障儿科肠外营养治疗质量和减轻患儿家属经济负担,值得借鉴。更多还原

【Abstract】 Objective To observe the clinical participation rate of multiple disciplines members,parenteral nutrition(PN)prescription quality,treatment safety and treatment cost change through HACCP-based MDT which carried on management of pediatric PN treatment. Methods PN prescriptions,corresponding treatment expenses,treatment time and total complication rate were separately chosen to be the research objectives of control group and intervention group before and after intervention;the key intervention points by using HACCP system was determined,then the comprehensive intervention(nutritional consultation,improvement of prescription checking and construction of PIVAS) was executed by MDT(clinicians,dietitians and pharmacists involved). Results SOP execution rate of clinicians,rate of nutritional consultation,rate of pharmacist intervention and qualified rate of PN prescription indicators of intervention group were higher than those of control group(P<0.05);the total complication rate showed a downward trend;the total treatment expenses and time were lower and less after intervention(P<0.05). Conclusion The model can enhance clinical participation rate of dietitians and pharmacists,and then improve the PN prescription quality,and reduce the risk of complications and rela ted expenses. It is worthy of reference by guaranteeing the quality of pediatric PN and reducing the economic burden of family members.更多还原