注射薬を含めた相互作用チェックシステムによる併用禁忌の解析 : 薬歴の中での相互作用チェックの重要性  [in Japanese] Analysis of Contraindicated Combinations Using a Check System for Drug Interactions, Including those of Injections : Pharmacists Should Verify Drug Interactions in Patient Medication Histories  [in Japanese]

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Author(s)

    • 粟屋 敏雄 AWAYA Toshio
    • 旭川医科大学医学部附属病院薬剤部 Department of Hospital Pharmacy and Pharmacology, Asahikawa Medical College
    • 大滝 康一 OHTAKI Ko-ichi
    • 旭川医科大学医学部附属病院薬剤部 Department of Hospital Pharmacy and Pharmacology, Asahikawa Medical College
    • 小野 尚志 ONO Takashi
    • 旭川医科大学医学部附属病院薬剤部 Department of Hospital Pharmacy and Pharmacology, Asahikawa Medical College
    • 千葉 薫 CHIBA Kaoru
    • 旭川医科大学医学部附属病院薬剤部 Department of Hospital Pharmacy and Pharmacology, Asahikawa Medical College
    • 板垣 祐一 ITAGAKI Yu-ichi
    • 旭川医科大学医学部附属病院薬剤部 Department of Hospital Pharmacy and Pharmacology, Asahikawa Medical College
    • 山田 武宏 YAMADA Takehiro
    • 旭川医科大学医学部附属病院薬剤部 Department of Hospital Pharmacy and Pharmacology, Asahikawa Medical College
    • 須野 学 SUNO Manabu
    • 旭川医科大学医学部附属病院薬剤部 Department of Hospital Pharmacy and Pharmacology, Asahikawa Medical College
    • 松原 和夫 MATSUBARA Kazuo
    • 旭川医科大学医学部附属病院薬剤部 Department of Hospital Pharmacy and Pharmacology, Asahikawa Medical College

Abstract

出版社版新規システム導入後のオーダシステム内の記録から,処方が試みられた併用禁忌の組み合わせなどを解析した.相互作用チェックは,その処方の投与期間内に重複しているすべての薬品を自処方内および他処方内の薬歴データファイルから抽出し,チェック対象薬剤が重複した場合,チェックメッセージを表示した.システム運用開始以降,13ヵ月間における処方せんおよび注射指示せんの枚数はそれぞれ290956枚,299017枚の計589973枚であった.調査期間内にチェックのかかった回数は299件であった.警告としたものを除く173件中,96件は処方が中止された.時間外の併用禁忌の処方の危険率は時間内に比べ実に4倍近くにも上った.オーダ別にみると,実に80%近くの併用禁忌の組み合わせは注射薬が関与するものであった.最もチェックのかかった頻度が高かった薬剤の組み合わせはトランサミン注とトロンビン細粒の組み合わせであった

In order to avoid adverse drug-interactions, we improved a computerized check system incorporated in the physician order-entry system. The improved system checks all drugs prescribed for a patient, including injections, and does not allow contraindicated combinations of drugs to be used. Our system also has a function for recommending safer substitutions for contraindicated drugs. In cases where contraindicated combinations are unavoidable, physicians may prescribe them by entering a password that is valid for one day only. The improved system can also evaluate the kinds of contraindicated combinations that physicians intend to prescribe. On checking our system's database, we found that there had been 299 contraindication alerts during 13 months for 589, 973 prescriptions. Also, the incidence of attempts to prescribe contraindicated drugs after clinical hours was almost 4 times as high as that during clinical hours. The contraindicated drug combinations were found in more than one type of prescription. Surprisingly, 80% of contraindicated combination events involved in injections and more than a half of contraindicated combinations were oral medicines with injections. We released alerts when requested by physicians when we judged these requests to be reasonable and 77 alerts were released during the 13-month period.<BR>Thus, our computerized system, which checks drugs as physicians enter orders for them, should be extremely useful in ensuring medication safety. Our findings indicate the possibility that pharmacists are often unaware of the contraindicated combinations after physicians have ordered prescriptions, and also the desirability of pharmacists verifying drug interactions in patient medication histories.

Journal

  • Iryo Yakugaku (Japanese Journal of Pharmaceutical Health Care and Sciences)

    Iryo Yakugaku (Japanese Journal of Pharmaceutical Health Care and Sciences) 31(6), 425-434, 2005-06-10

    Japanese Society of Pharmaceutical Health Care and Sciences

References:  11

Cited by:  1

Codes

  • NII Article ID (NAID)
    110001258511
  • NII NACSIS-CAT ID (NCID)
    AA11527197
  • Text Lang
    JPN
  • Article Type
    Journal Article
  • ISSN
    1346342X
  • Data Source
    CJP  CJPref  NII-ELS  IR  J-STAGE  NDL-Digital 
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