目的：通过为青光眼患者提供安全、有效、经济、合理的规范化药学服务，探讨药物重整在青光眼患者中的临床应用价值，并评估药物重整服务在眼科专科用药方面的可行性。方法：采用前瞻性研究设计，纳入武汉大学附属爱尔眼科医院2023年8月-2024年1月青光眼住院患者308例, 临床药师通过收集用药史、医嘱审核、用药偏差纠正、用药教育等多种方式实施药物重整服务。结果：在308例患者中，104例患者存在需重整的用药问题，重整率为33.8%，重整医嘱共198条，在这些重整医嘱中，用药依从性问题占57.0%，用药安全性问题占18.1%，用药差错占24.9%。经过药物重整，患者用药依从性提升至95.1%(χ²=27.210，P<0.05)，安全性问题降至1.3%(χ²=22.565，P<0.05)，用药差错率降至1.9%(χ²=26.251，P<0.05)。结论：药物重整可提高青光眼患者的用药合理性及依从性，是保障患者用药安全、合理的有效药学服务手段。
Objective: To introduce medication reconciliation (MR) services for glaucoma patients, with the aim of delivering safe, effective, and cost-effective pharmaceutical care. This study also evaluates the clinical value of MR in glaucoma management and assesses its feasibility within ophthalmic specialized medication practices. Methods: In this prospective study, 308 hospitalized glaucoma patients were enrolled between August 2023 and January 2024. Clinical pharmacists conducted medication reconciliation using standardized procedures, which encompassed comprehensive medication history collection, medication order review, correction of discrepancies, and structured discharge counseling. Results: Among the 308 patients, MR interventions was required in 104 cases (33.80%), identifying 198 medication related issues. Of these, 57.0% pertained to medication adherence problems, 18.1% involved medication safety concerns, and 24.9% related to medication appropriateness. Following medication reconciliation, medication adherence improved to 95.1% (χ²=27.210, P<0.05), the incidence of adverse drug reactions declined to 1.3% (χ²=22.565, P<0.05), and medication appropriateness issues decreased to 1.9% (χ²=26.251, P<0.05). Conclusions: MR significantly enhances medication appropriateness and adherence in glaucoma management. This evidence-based pharmaceutical care model effectively ensures medication safety and therapeutic efficacy, offering practical insights for extending MR to other chronic ophthalmic conditions.
目的：调查神经眼科用药现状，并对其超说明书用药进行评价，探索科学有效的管理策略，为神经眼科的临床合理用药提供参考。方法：随机抽取2023年7—12月郑州市第二人民医院神经眼科处方，依据国家药品监督管理局核准的药品说明书、美国食品药品监督管理局(Food and Drug Administration, FDA)说明书及PubMed、Micromedex等循证医学数据库证据判断超说明书用药类型，并对其进行分类(包括超适应证、超剂量、超疗程、超给药途径等)。同时基于Thomson分级理论建立三级评价标准，分别为A级(高证据等级，仅需口头告知)，B级(中证据等级，需在病历或病程中详细记录)，C级(低证据等级，须患者签署书面知情同意书)。通过处方前置审核系统干预，对未纳入评价标准的超说明书用药进行实时拦截与分级警示，比较2023年下半年(干预前)与2024年下半年(干预后)超说明书用药处方的不合理率变化。 结果：干预前共抽取超说明书处方370张，超说明书类型主要为超适应证、超给药途径和超剂量及次。干预后，共抽取超说明书用药560张，超说明书用药不合理率从9.2%(34/370)降至2.9%(16/560)。结论：神经眼科超说明书用药普遍，主要源于视神经炎、缺血性视神经病变等复杂疾病的治疗需求与药品审批滞后之间的矛盾。基于循证医学证据构建分级管理体系，结合信息化实时干预，可有效规范超说明书用药行为，降低医疗风险。
Objective: To investigate the current status of medication use in neuro-ophthalmology, evaluate off-label drug use, and explore scientific and effective management strategies, providing references for rational drug use in neuro-ophthalmology clinical practice. Methods: We Randomly selected neuro-ophthalmology prescriptions from July to December 2023 in our hospital. By refering to the drug instructions approved by the National Medical Products Administration, FDA instructions, and evidence from evidence-based medical databases such as PubMed and Micromedex, we identified and classified the types of off-label drug use, including off-label indications, off-label doses, off-label courses, off-label administration routes, among others. Simultaneously, based on the Thomson classification theory, we established a threelevel evaluation standard: Level A (high evidence level, requiring only oral notification); Level B (medium evidence level, necessitating detailed records in the medical record or medical course); Level C (low evidence level, demanding patients sign a written informed consent form). Through the intervention of pre-prescription review system, we carried out real-time interception and classification warnings for off-label drug use not covered in the evaluation standards. We then compared the changes in the unreasonable rate of off-label drug use prescriptions from the second half of 2023 (before intervention) to the second half of 2024 (after intervention). Results: Before the intervention, a total of 1852 prescriptions were selected, with the proportion of off-label drug use at 19.98% (370 prescriptions), primarily involving off-label indications (90.27%). After the intervention, the unreasonable rate of off-label drug use decreased from 9.2% (34/370) to 2.9% (16/560). Conclusions: Off-label drug use is prevalent in neuro-ophthalmology, mainly due to the conflict between the treatment requirements for complex diseases such as optic neuritis and ischemic optic neuropathy and the delay in drug approval. By constructing a hierarchical management system based on evidence-based medical evidence and combing it with real-time information-based intervention, we can effectively regulate off-label drug use behavior and reduce medical risks.
目的：检索并总结开角型青光眼患者眼部用药规范化护理管理的最佳证据，为临床实践提供参考。方法：通过护理循证方法提出实践问题，按照循证证据检索数据库的“6S”分类模型，检索有关开角型青光眼患者眼部用药管理的所有证据资源类型，包括临床指南、最佳实践信息册、证据总结、系统评价和专家共识等。由2名循证护理研究员对纳入文献的质量进行独立评价并进行证据的归纳总结。结果：最终纳入12篇文献，包括4篇指南、3篇证据总结和5篇系统评价；汇总了19条有关开角型青光眼眼部用药管理的最佳证据，包括滴眼技术指导、依从性管理和信息提供3个方面。结论：总结开角型青光眼眼部用药管理的最佳证据，可为临床医务人员管理患者提供参考和借鉴，以达到患者规范用药、控制眼压和延缓疾病进展的目的。
Objective: To retrieve and summarize the best evidence on standardized ocular medication management among open-angle glaucoma patients. Methods: With evidence-based nursing method, practical problemswere identified. According to the “6S” pyramid model of evidence resource, studies on standardized ocular medication management among open-angle glaucoma patients were retrieved, including clinical guidelines, best practice information booklet, systematic reviews, and expert consensus. Two evidence-based nursing researchers independently evaluated the quality of the included literature and summarized the evidence. Results: A total of 12 articles were ultimately enrolled, including 4 clinical guidelines, 3 evidence summaries and 5 systematic reviews. Finally, 3 aspects including 19 pieces of best evidence were summarized, which were Eye drop technical instruction, medication adherence management and related information provision. Conclusion: The best evidence for the medication management of open-angle glaucoma patients were summarized, which provide reference for clinical medical staffs to manage patients, so as to achieve the purpose of standardizing medication,controlling intraocular pressure and preventing disease progression.
目的：探讨多元化宣教在提高眼科日间手术患者眼部用药正确率及满意度的应用效果。方法：采用便利抽样的方法，选取中山大学中山眼科中心2020年10至12月收治的200例眼科日间手术患者眼部用药的执行者为对象，将10至11月收治的100例日间手术患者眼部用药的执行者纳入对照组，将12月收治的100例日间手术患者眼部用药的执行者纳入试验组。对照组采取传统宣教方式，试验组应用多元化宣教模式进行健康教育。采用自制的健康教育需求调查表调查眼部用药执行者的健康教育需求，采用眼部用药执行评价表、健康宣教满意度调查表评价干预效果。结果：采用多元化宣教方式干预后，试验组患者眼部用药正确率(94%)高于对照组(35%)，差异具有统计学意义(P<0.05)。试验组对多元化宣教满意度得分明显高于对照组，差异具有统计学意义(P<0.05)。结论：多元化宣教模式可提高眼科日间手术患者眼部用药正确率，提高患者及家属的满意度，值得临床推广应用。
Objective: To explore the effect of diversified education on improving the accuracy and satisfaction of eye medication in patients undergoing ophthalmic ambulatory surgery. Methods: A total of 200 practitioners of administering eye medication after undergoing ambulatory surgery in Zhongshan Ophthalmic Center, Sun Yat-sen University from October to December 2020 were investigated by convenience sampling, 100 practitioners admitted from October to November were included in the control group, and 100 practitioners were included in the experimental group. The control group adopted the traditional method of education, while the experimental group applied diversified education mode to carry out health education. The health education needs of the patients were investigated by the self-made health education needs questionnaire, and the effect of intervention wasevaluated by the eye medication implementation evaluation form and health education satisfaction questionnaire. Results: After the intervention, the correct rate of eye medication in experimental group (94%) was higher than the control group (35%) with a statistical difference (P<0.05). The satisfaction score about diversified education in experimental group was significantly higher than the control group with a statistical difference (P<0.05).Conclusion: Diversified education model can improve the accuracy of administering eye medication in patientsundergoing ophthalmic ambulatory surgery, and the satisfaction in patients and their families is significantly improved. It is worthy of clinical application.
