薬剤師による病棟での注射薬混合業務の定量的解析 （１） 骨髄移植を目的とした無菌病棟の場合

Abstract

We analyzed the mixing services performed by pharmacists in the aseptic ward at Tokyo University Hospital as a model case, in order to establish a new mixing service system in clinical wards. The average number of prescriptions for injection was 5 per day during the 5 day investigation, and the number of injections prescribed and mixed were 44.6±4.4 and 33.2±4.6 per day, respectively. The most common drugs for the mixed injections were antibiotics (41.6%), antineoplastic agents and immunosuppressants agents (both together 21.6%). The ratios of the ampule/vial was 5: 5, and solution/lyophilized powder was 7: 3. When two pharmacists with 3 months and 3 years of mixing experience, respectively, mixed drugs, the required time for the three processes of preparation, mixing, and checking were approximately 40, 40, and 10 min, respectively, and the total time required was 90 min. The average required time per injection was 2.7 min (90min/33.3 injections), and the mixing time per injection in the laminar air flow cabinet was 1.2 min (40 min/33.3 injections). Regarding the mixing experiment, the average time required for 5 ampules (10 mL solution) was shorter than that for 5 vials (lyophilized powder) in all groups tested. In the 3 years-experience group, the average time was approximately 7 min/5 ampules and 13 min/5 vials, and these values were half of that for beginners. In the 3 years-experience group, the time required for ampules was almost the same as for the 3 months-experience group, and that of vials decreased to 8 min. We propose that the data from these time study can be utilized to estimate the effectiveness of the mixing services in the ward, in the hope that the fee for such important aseptic techniques in the mixing service provided by pharmacists, the same as for IVH admixturing, will be authorized by the regulatory agency in the future.