Hershey A G, Rosen G H, Foster M D, Johnson D S, Martir-Herrero M L, Krieger J, Oh S M
School of Pharmacy, University of Maryland, Baltimore.
Am J Hosp Pharm. 1991 Jan;48(1):104-7.
An audit of the use of ranitidine administered in parenteral nutrient (PN) solutions is reported. Pharmacists at a 747-bed teaching institution developed criteria addressing justification of the use of ranitidine in PN solutions, process indicators for monitoring, and outcome measures. All patients who received ranitidine in their PN solutions between October 29 and November 22, 1989, were included in the study. Data were collected on a standardized form. A total of 23 evaluable patients received ranitidine in PN solutions during the study period. No inappropriate uses of ranitidine were identified. Patients with renal impairment tended to be underdosed. There were no duplicate administrations of ranitidine by the i.v. minibag and PN solution routes. However, on four occasions the PN solution was interrupted for more than six hours; additional ranitidine by i.v. minibag was ordered for only one of these patients. Testing of nasogastric aspirates for pH was not performed in 17 of the 22 patients who needed this test. Gastrointestinal bleeding was observed in two patients, both of whom were not monitored for gastric pH and were underdosed. A program is being developed to promote the safe and effective use of ranitidine administered in PN solutions. An audit of the administration of ranitidine in PN solutions showed that the drug is usually used appropriately at the institution and that most of the patients had positive clinical outcomes.
本文报告了一项关于在肠外营养（PN）溶液中使用雷尼替丁的审计情况。一所拥有747张床位的教学机构的药剂师制定了相关标准，涉及雷尼替丁在PN溶液中使用的合理性、监测的过程指标以及结果测量。1989年10月29日至11月22日期间所有在PN溶液中接受雷尼替丁治疗的患者均纳入本研究。数据通过标准化表格收集。研究期间共有23例可评估患者在PN溶液中接受了雷尼替丁治疗。未发现雷尼替丁的不当使用情况。肾功能损害患者的用药剂量往往不足。雷尼替丁未通过静脉迷你袋和PN溶液途径重复给药。然而，有4次PN溶液中断超过6小时；其中只有1例患者通过静脉迷你袋额外开具了雷尼替丁。22例需要进行此项检查的患者中有17例未对鼻胃吸出物进行pH检测。观察到2例患者出现胃肠道出血，这2例患者均未监测胃pH值且用药剂量不足。目前正在制定一项计划，以促进雷尼替丁在PN溶液中的安全有效使用。对PN溶液中雷尼替丁给药情况的审计表明，该机构通常合理使用该药物，且大多数患者取得了积极的临床结果。
