' Nghien ctru - Ky thuat
vPhan tich boat dong cap phat thuoc ngoai trii tai Benh vien Noi tiet Trung wong
nam 2014
Nguyen Thi Song Ha', Le Thi Uyln^*, Nguyen Manh TU^n'
'Tnrong Dgi hoc Dirg^c Hd Ngi
^Benh vien Not tiet Trung uang 'E-mail: [email protected]
Summary
A study was performed at National Hospital of Endocrinology during the period of October- December, 2014' to assess the quality of drug dispensing activities in reference to the process of preparing and giving medicine to a named individual on the basis of the prescription. In general, the drug dispenslon to out-patients was in due time, sufficient amount, and correct manners. The average dispensing time was 1.95 ± 0.74 minutes. This was just enough for preparing and giving the drugs to the patients, but quite short for giving any intructlons or additional advice. 99.9 % of prescribed drugs were actually dispensed, and thereof, 99.7 % were adequately labelled. Some interventions would be proposed to improve the quality of drug dispensing procedure, as follows: Writing SOPs for good dispensing practice, further training all the professinal staffs, improving the man power and practical facilities to facilitate the acitities of counseling the patients.
K e y w o r d s : Dispensing, out-patient. National Hospital of Endocrinology.
D^t van de
Hipn nay, vipe s u dyng thuoc h y p ly dang Id muc tidu hudng tdi eua n h i l u quoc gia tren t h i gidi, trong dd cd Vi^t Nam. Tuy nhidn, cdc bidn phdp thue day va edi thipn viec s u dyng t h u l c h y p \^ t h u d n g chi tdp trung vao vipc dam bao ke dan hyp ly md bd qua hoat ddng cap phat t h u l c vd s u dyng thuoc eho ngudi bdnh. N l u d p phat khdng dCing thuoc, khflng dung lieu, khdng dung l u y n g , e l p phdt n h i m ngudi bpnh, dflng gdi khdng dam bao, t u van khdng dung thi todn bp e l gang cua vl^c cham sde trudc do deu trd len vd nghTa. V d i 92,05% ngudi b^nh kham vd d i l u trj ngogi tru '^', cflng tac e l p phat thuoc eho ngudi bpnh d i l u trj ngogi tru tgi Benh vien NOi t i l t Trung u a n g (TW) r i t d n phai d u y e quan tam, giam sat, gop p h i n ddm bao s u dyng t h u i e h y p \)f. X u i t phdt t u nhu c l u thyc t l dfl, ehung tfli tien hdnh nghidn c u u : "Phin tich thuc trang hoat d^ng dp phit thuoc ngo^i trO t^i Binh vien Noi tiit TW nim 2014".
P h i r o - n g p h a p n g h i e n c i > u Phirang phdp m d ta cat n g a n g
Oanh gid hogt dpng cap phat thuoc eho ngudi bdnh d i l u trj ngoai trii tgi q u i y phat thuoc BHYT s u dyng bdng k i l m d u y c xdy dyng dya tren quy trinh cap phdt thuoc theo hudng d i n ci^a WHO va C a quan Khoa hpe vi sue khde Hoa Ky (MSH) '5).
P h u v n g phap quan sat
T i l n hanh quan sat ngau nhien vdo t i t ca cdc thdi d i l m trong ngay t d thu 2 d i n thu 6 trong khoang thdi gian t u thdng 10/2014 d i n thdng 12/2014, mfli ngay quan sat 15-20 mau cho den khi du 400 luyt; quan sat hogt dflng eua d u y c sy q u I y d p phdt xac djnh mpt s l ch? s l theo hudng d i n cua To chuc Y t l t h i gidi'^: thdi gian e l p phdt, ty le t h u l c d p phdt thyc t l , t j le t h u l c ddn nhan day du.
K e t q u a n g h i e n CLPU
Phan t i c h hogt d o n g cap phat t h u l c d ^ tren bdng k i l m xdy d y n g san
Quan sdt hoat dflng e l p phat t h u l c cho 400 l u y t ngudi bpnh dieu trj ngogi tru tgi q u I y phat t h u l c s u dyng bang k i l m da xdy d y n g sdn. k i t qua thu d u y c nhu trong bang 1.
TAPCHI niror wor- lI/7ftl^r«o4'7«^IAMcc^
• Nghien CIFU - Ky thuat
B a n g 1 ; Kil qua (3anh gia hoat dong cap phat tliudc ngoai tru dwa tren bang kiim
NOI dung Sotfon
thuc hien Tong so
don Tyle
%
T7ep nhan 6tm thuoc
Sb li/ot dam bao don ttiu6c xep theo t h i , tif So li/ot cd kiem tra dan ve linh hop le
So dpn ctiira hpp le, huong dan ngt/pi benh khac phuc, hoan thien
400 400 89
400 400 m
too too
22,3 Hieu va kiem ua Hon tltudc
So lan cd tien hanh kiem tra lai don thubc v§ thpi diem dung, duung diing, lieu diing, tupng tac Sd luot cd lien he vdi bac sy trong truong hpp don cd van de
0 0
«w 4IW
0 9 Chuan bi thuoc, bao goi va ghi nhan
So lupt lay thupc theo dung ten ndng dp dang bap che, se lupng ghi trong don So lupt l^y thudc dam bao khdng md nhi&u hop thuoc cung luc Sd lu'ot lay thudc dam bao khdng l i y thudc cho nhieu dpn cung mot luc
So luoi lay thudc dam bao qua trinh ra le duoc tien hanh bang cac dung cu thlch hpp, dam bad ve smh Sd lupt ra le thudc dam bao cd bao bi neng chp ttfng Ipai thudc
400 400 395 6 6
400 400 400 6 6
100 too
98,8
too too
Kiem Ira tai tan cuoi
Sd lucrt cd kiem tra lan cudi thdng tin giOa dpn thudc va thuoc phat cho ngucyi bpnh 400 400 too
Ghi chep tai cac hoat dong
Sd lupt thuc hien luu lai dpn thudc sau khi d p phat
Sp lupt tien hanh ghi chep lai hoat ddng vap sp theo doi heap luu vap may tinh
400 400
400 400
too 100 Phat thuoc cho ngimi benh
Sn lupt goi ten ngupi benh vao cac khu vire linh thuoc theo thu t u So lupt kiem tra the BHYT hoac CMTND dung sp vpi cac thdng tin tren dpn thupc Sd lupt CD thuc hiijn ky ten va giao thudc cho ngupi benh
Sd lupt cd thuc hien phat kem tui da khd vPi dpn thuoc co thuoc cdn bap quan lanh So luot cd yeu cau ngupi benh ky ten va xac nhan da nhan du thudc truoc khi benh nhan ra ve
400 400 400 0 0
400 400 400 (94 400
too 100 100 0 0 Ttr van, hirong din sir dung thuoc
Sd lupt cd tu' van tmc tiep cho ngudt benh ve lieu, thoi diem udng thudc, each sij' dung, bao quan thuoc.
Sd lupt thuc hien t u v i n ky hpn chp ngudi benh nhung thudc cd dang ban che dac biet, each s u dung thuiic dac biet
Sd luot cd t u van ve thdi gian thudc phat huy tac dung, n h i n manh de ngud'i b^nh hieu v l lot ich cua vipc dUng dUng, du cac thudc dupc ke
Sd luut cd trao doi vd thdi gian udng thudc cho phu hpp vol lich sinh hoat va t u van yd chd dd an udng, tap Iuyen
So luot cp trap dpi ve cac phan img b§t lpi co ttie xay ra, each ngan ngira va k h i c phuc khi gap cac phan ung b i t lpi nay
Sp l i n pp t u van chp ngupi benh viec c i n lam khi trdt quen mdt lieu, khi da het dpn thudc Sd lupt trap ddi vpi ngudi benh v i cap van de lien quan d i n tuong tap thudc-thudc, thuiki-thirc an.
thudc-dd udng
Sd lan tien hanh kiem tra lai viec nam thdng tin cua ngupi benh Sd l i n thuc hien tdm tat lai thdng tin. n h i n manh nhung diem chinh Sd lan cd tttai dd lich sir, hoa nha va diing mi/c tipng khi t u van
4 2 0 0 0 0 0 0 0 6
400 400 400 400 400 400 400 400 400 6
1.0 0,5 0 0 0 0 0 0 0 too T\pr'Mi ni mr u n r . ii/->ni'; (Qh 47*^ \ \\1 551
• Nghien CIFU - Ky thuat
K i t qud t u bang 1 eho thay 100% cdc dan thuoc sau khi d u y c tiep nhgn d i u d u y c k i l m tra tinh hyp 10. Cd 89 trudng hyp (chilm 22,3%) cac dan khdng hap le da d u y c nhdn vien Khoa D u y c t d c h i i e l p phat va hudng d i n ngudi bpnh hoan thidn cdc thu tyc can thilt. Khdng ed luyt d p phdt nao k i l m tra v l lieu dung, dudng dung, thdi cHlm dung hay tuang tdc cua cac thuoc trong dan.
Vigc c h u i n bj t h u l c d u y c thyc hipn kha tot, tuy nhien, v i n edn tinh trgng lay thuoc cho n h i l u dan cung mpt lue (5 luyt quan sat c h i l m 1,2 %).
Chi cd 6 luyt quan sat (1,5%) la cfl ra I I thuoc va todn bp so luyt nay dam bao thyc hien t i t (cd bao bl ridng cho tdng logi thuoc va d u y c ddm bao an toan, hgn ehe toi da nhiem khuin). T)/1$ d u y c sy k i l m tra Igi t h u l c trude khi phat thuoc cho ngudi bpnh la 100%. Tuy nhidn, tuang t y nhu khdu kiem tra trude dfl, vipc k i l m tra ehi dung Igi d dam bao dung cac thCi tyc hdnh chinh cOa dan thulc. dung so luyng, ehung logi thuoc ehu chua ehu trpng d i n l i l u dung, dudng dOng, thdi d i l m dung hay tuang tdc giua cdc thuoc ed trong dan.
Cdc dan t h u l c khi d u y c duyet tren phan mem se d u y c t y ddng luu Igi. Cae dan thuoc ban g i l y in se d u y c luu tru Igi tgi bd p h | n luu tru dan d p phat. Vdi eae dan c l ke thuoc hudng than, 100%
d u y e ghi chep vdo s l theo ddi x u i t - nhap - t i n t h u l c h u d n g tam than.
T i t ca cae l u y t cap phdt d i u t i l n hdnh kiem tra thd BHYT vd chdng minh nhdn dan d l
Bang 2: Kit qua chisS dinh gii ho^t dgng cip phit
dam bao d p phat dung t h u l c cua ngudi benh.
Ngudi bpnh ky ten trudc khi nop dan ndn khi nhgn d u y c t h u l c chi d u y c yeu cau k i l m tra lai cdc t h u l c vua nhdn d u y c trude khi ra khoi quIy.
Vi vgy, khdng cfl trudng h y p nao trong so 400 ngudi benh k]^ xac nhan da nhgn dij t h u l c .
Hoat dpng t u v i n , hudng d i n s u dyng thuoc tai bpnh vien ehua d u y c thyc hidn day du. Chi cd 4 luyt (1%) t u v i n v l l i l u dCing, thdi d i l m dung, each s u dyng va bao quan thulc. Vi^c t u v i n cung chf d u y c thyc hien khi ngudi benh hdi Igi can bp d p phat t h u l c . Vipe t u van eae thdng tin khde cho ngudi bpnh nhu thdi gian thuoc phat huy tac dyng; tac dyng khdng mong muon cua thuoc va each x u tri; hudng gidi q u y l t trong trudng h y p quen t h u l c ; tuang tae thuoc- thuoc, thuoc- thuc an hay viee k i l m tra lai s y n i m thong tin cua ngudi bpnh khdng d u y e t u van qua dd cho t h i y chat luyng cCia hoat ddng hudng ddn.
t u v i n s u dyng t h u i e tren ngudl benh dieu trj ngoai tru d Bdnh vi^n Ndi t i l t TW deu chua d u y c thye hien.
Ddnh gia hoat d d n g cap phdt t h u l c BHYT c h o ngufl^i bpnh dieu trj ngoai t r u qua mpt c h i so cham sdc ngu'di bdnh
Oe danh gia hogt dpng d p phat thuoc BHYT eho ngudi benh d i l u trj ngoai tru, nghidn c d u s u dyng eac chi so trong bp ehi so cham sde ngudi benh cua WHO. K i t qud thu d u y c nhu trinh bdy trong bang 2.
thuoc BHYT t?i Binh vi$n Ngi tiit TW nim 2014
Thdi gian ph^t thu6c tmng binh (phut)
Ty l§ Ihunc cap ph^t th^,p te (%)
T } 1$ lhu6c d^n nhan ddy du (%)
N^dung
Teng thdi gian ph^t ihu6c (phOt) Sp ngudl b^nh So thupc difpc pap phat thifc te T6ng s6 thuoc
S6 thu6c dippc dan nhan day du Tong so thuoc pap phcit
Ket qua 780,2
400 1968 1969 1963 1969
' " '
99,9 99,7 Thdi gian d p phdt t h u l c cOa m i l ngudi bpnh
d u y c tfnh k l t d ILIC ngudi b§nh den quay d p phdt cho d i n lue ngudi bpnh rdi khdi quIy, khflng tinh thdi gian c h d d y i . K i t qud t d bang 2 eho t h i y thdi gian d p phdt t h u l c BHYT trung binh cho ngudi bdnh ngogi tni tgi benh vidn Nfli t i l t TW Id 1,95 ± 0,74 phut, ehu y l u rai vao khoang 1 d i n 3 phut.
Cd 99,9 % ty lp thuoc trong dan BHYT d u y e
d p phat, tuang d u a n g vdi 399 l u y t d p phdt t h u l c ddy du (tren tong s l 400 luyt). Mpt trudng hyp d p phdt t h u i e khong day du Id do loi k i t n i l p h i n mem gida kho thuoc va phdng kham eua bdc sy vd sau dd, da d u y e k h I e phyc kjp thdi dam bao ngudi benh nhdn du thuoc.
Xem xdt cdc t h u l c d p phat n l u cdn nguyen bao gdi cua nha san x u i t thi d u y e coi Id ghi nhan d i y du, k i t qua nghien c d u cho t h i y ty Id thuoc
T A P C H I DU'OC H O C - l l / m i ^ / « : n 47-; MAM M \
• Nghien CIFU - Ky thuat
d u y c ddn nhan day du la 99,7%. Cd 0,3 % t h u l c khdng co nhan day du va d i u la cac trudng hyp ra le. can bd ra le t h u i e ghi t h i l u ten t h u l c , hgn s u dyng cua thuoc.
Ban luan
K i t qua nghien cuu cho t h i y v l ca ban, hogt dflng d p phdt thuoc BHYT eho ngudi bpnh dieu trj ngogi tru tgi Benh vien Npi t i l t TW nam 2014 d u y c thye hipn nghiem tuc, chat che, d i m bao phdt dung thuoc, du t h u l c cho ngudi bpnh.
Trang qua trinh d p phat lufln cd s y k i l m tra cheo giua cdc nhdn vien cung nhu k i t hyp k i l m tra, d l i chieu vdi ngudi bdnh nham hgn ehe toi da nhdng sai sdt trong d p phat. Tuy nhidn, vipe t u v i n , hudng dan s u dyng t h u l c cho ngudi benh cfln ehua d u y c chu trpng. O i l u ndy cd the td do so luyng ngudi bpnh kha dflng trong khi n g u i n nhdn lyc cua Khoa D u y c hgn c h l . d i n g thdi, da so ngudi benh deu m i c bdnh mgn tinh, da s u dyng thuoc lau dai, cdc thong tin v l thdi diem dCing, edeh dCing, l i l u dung cung d u y c ghi r i t cy the tnang dan thuoc, nen d l gidm thdi gian c h d dyi cua ngudi benh, Khoa D u y c chu y l u tgp tnjng vdo khau c h u i n bj va phdt thuoc. Mpt d i l m hgn c h l nua trong hogt ddng d p phat do Id B^nh vipn chua cd quy trinh chuan cho hogt dpng d p phdt thuoc BHYT c^o ngudi bpnh d i l u trj ngoai tni. Hau h i t cac nhan vidn deu lam vi^c theo thdi quen, theo ky nang, kinh nghiem eua ban than. Vide xdy dyng vd dp dyng cac quy trinh c h u i n cho hogt dpng d p phat se giup cai thipn tinh t h i n g nhat va ndng cao c h i t l u y n g , hieu qua cua cflng vi§c '^. Vi vgy, Bdnh vipn ndn t i l n hdnh xdy dyng vd pho b i l n quy trinh chuan lidn quan d i n hoat d i n g nay.
Thdi gian d p phat thuoc tmng binh Id 1,95 ± 0,74 phut, ehu y l u Id t u 1 d i n 3 phCit nen g i n nhu khdng eo thdi gian d l t u v i n , hudng ddn s u dung thuoc cho ngudi b$nh. Khoang thdi gian ndy cao han so vdl k i t qud nghidn edu d Benh vipn TW quan ddi 108 nam 2012 (0,9 phut) ^ nhung t h i p han so vdi Bdnh vipn Ogi hpc Y Thdi Binh (190
± 90 gidy) ^ va Bdnh vipn Bao vp sue khoe tdm t h i n Quang Ninh (353,9 gidy) w. BJ^U ndy cung phu hpp vdi thyc trgng t u v i n s u dung t h u l c eua cdc b^nh vl0n: d Bpnh vipn TW quan dOi 108 cdc d u y c sT d p phdt cung chu y l u ehi d | n ngudi bpnh u i n g thuoc theo dan va vipe t u v i n chi d u y c
thyc hien khi ngudi benh hdi trong khi dfl tai Bpnh vien Oai hpe Y Thai Binh viec t u van, hudng dan s u dyng thuoc dirq/c thye hidn khd tdt, cfl tdi 80%
ngudi benh h i l u biet dung v l l i l u dung ngay sau khi nhgn d u y c dan thuoc P'.
So luyng thuoc BHYT d p phat cho nguW bpnh ngogi tru dgt 99,9% (chi cd mpt tardng hpp do l6i cua phan m i m va da d u y c khae phyc sau do va ngudi bdnh da d u y c nhgn du thuoc). Kit qua tuang t y n h u vdi cac bdnh vipn khac ^ *'.
Tuy nhien, do hien nay hau h i t cac bpnh vi§n d i u t r i l n khai ke dan tren phan m i m nen khi hit t h u i e eae bac sT se phai lya ehpn ke cdc thuoc khdc thay the. Vi vgy, ehi s l nay cung ed hgn chl n h i t djnh trong vide danh gia eong tdc dam bao cung ung du thuoc eho bdnh vidn.
Cfl 6 trudng hyp t h u l c d u y c ra le khi d p phdt (chilm 1,5 % t i n g so dan) thi d 6 truflng hyp deu khdng duye ghi nhan d i y diJ mac dCi d quay Iu6n ed s i n cdc nhdn phy phyc vy cho vipe ra I I thuoc.
Bdnh vipn d n phai cfl nhung bipn phdp d l cai thi$n d i l u nay. Ngodi ra, cung g i l n g nhu Bpnh vidn Ogi hpc Y Thai Binh va Bpnh vipn Cham sflc sue khoe tdm than Quang Nmh, viec ghi ten ngudi bdnh trfei tung nhdn thuoc vdn chua d u a c thyc hipn.
Ket luan
Khao sdt vipe d p phat t h u l c BHYT cho 400 ngudi bpnh d i l u trj ngoai tru cho t h i y hogt d^ng d p phat thuoc tgi Bpnh vidn Npi t i l t TW d u p c ; thyc hipn nghidm tuc, dam bao dOng vd dij thulc.
Thdi gian d p phdt t h u l c tmng binh la 1,95 ± 0,74 phut. Vide k i l m tra dan t h u l c ve l i l u dung, thdi d i l m dung, t u a n g tac t h u l c trong dan cung nhu cdc hogt dpng t u van s u dung t h u l c v i n c6n hgn e h i . Ty Id thuoc d u y e d p phdt thyc te tgi benh vipn dgt 99,9%. Ty 1$ thuoc d u y c ghi nhSn day dli la 99.7%.
o l cai thipn c h i t l u y n g , hipu qua cua hogt dpng d p phat t h u l c BHYT cho ngudi b§nh dieu tn ngogi tm, Bdnh vidn Npi t i l t TW d n :
- Xdy d y n g quy trinh chuan d p phdt thu6c BHYT cho n g u d i benh dieu tri ngogi fru;
- Pho b i l n , tap h u l n quy trinh cho toan bO nhan vidn Khoa D u y c ;
- B l sung thdm nhan lyc, trang bj thdm edccff so vdt e h i t de t h y c hien tot vipe t u van, hudng ddn ngudi bpnh s u dyng thuoc.
T A P r H i T > i r r f r H n r - i i / 2 f i i s r s 6 4 7 S N A M 5 5 l L J
• Nghien CIFU - Ky thuat
T a i l i e u t h a m k h a o 4. Hoang Thj Thu Huang (2013), "Phin tich hoat 1. Benh viin Noi tiit TW (2015), B^o cao thyc ddng ton trii cip phat va ca cau thuoc duoc SLP dung hi§n nhi^m vu cua B$nh vi§n N6i tilt TW nam 2014 va i^' S^"^ " ^ n Sio ve sue khoe tim thin Quang Nmh".
phuang hudng k l hogch nam 2015. Lugn van Duyc sT Chuyen khoa d p i , Trudng Dai hpc 2 Dodn Thj Mmh Hue (2014), "Phan tich hoatd^ng Duyc Ha Npi
tin tru, cip phit vi sd dung thuSc ngo^i tnj tai B$nh 5. pgui Spivey (2012). Ensuring good dispensing vi$n Dai hpc Y Th^i Binh nSm 2013". Lu^n vSn Duyc
sT Chuy&n khoa d p I, Trudng Dgi hpc Duyc Ha N^i practices. In MDS-3: Managing Access to Medicines and Health Technologies. Arlington, VA: Management 3. VQ Thi ThuHuyen (2013), -Phon tloh ho,t d0ng ^^.^^^ ,^ 30.5-30.10.
quin ly ton tru. cap phat vd huang dan su dung thuoc
tai Khoa Du^c B$nh vien Tnjng uang Quan doi 108 6. Worid Health Organization (1993), "How to nam 2012". Lu|n van Thge sT Duyc hgc, Trudng Dgi investigate drug use in health facilities: selected drug hpc Duyc Hi Npi. use indicators", p. 17-22.
(Ngiy nhin bii: 03/08/2015 - Ngiy duyjt ding: 02/11/2015)
^Phan tich dac diem benli than
• • •
r
do thuoc can quang chua iod su dung trong ch4n doan hinh anh
tai Benh vien Bach Mai
• • • •
Bui Thi Ngoc Thuc'*, Vii Dinh HdaS Pham Minh Thong' Tran Nhan Thdng', Ducmg Due Hung', C4n T\iyet Nga' Nguyen Thu Minh', Nguyen Hoang Anh^
' Khoa Duac. B^nh vi^n Bach Mai
^Truong Bgi hpc Du^c Hd Nqi 'E-mail: [email protected] S u m m a r y
The incidence and risk factors associated with contrast-induced nephropathy (CIN) in patients undergoing contrast-enhanced CT and diagnostic coronary angiography (CAG) or percutaneous coronary intervention at Bach Mai hospital from 12/2014 to 04/2015 were assessed. The studied cohort consisted of 566 patients being exposed to contrast media. CIN was defined as an increase in serum creatinine greater than 0.5mg/dl or 25 % from the baseline 3 days after contrast media exposure. Overall, CIN occurred In 40 (7.1 %) patients. Incidences of CIN were 6.6 % and 7.4 % in patients undergoing contrast-enhanced CT and diagnostic coronary angiography (CAG) and/or percutaneous coronary intervention, respectively. Incidence of clinically significant CIN (CSCIN) was 1.1 % and that of acute kidney injury was 2.8% on RIFLE and AKIN criteria. Multiple logistic regression analysis identified the older age (>70). reduced GFR (< 30 ml/min/1.73 m^) and large volume media (> 200ml) as independent predictors of CIN. In conclusion, these findings would be helpful to careful consideration in the use of contrast media.
Keywords: Contrast media, contrast-induced nephropathy (CIN).
TAP CHI ni Iftr H n r . n n m * /cr» Alc: *
