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化疗药配制的安全防护管理
双击自动滚屏 发布者:admin 发布时间:2010/7/31 18:07:19 阅读:33763次 【字体:

化疗药配制的安全防护管理

Safety protection management of dispensing of chemotherapeutic drugs

黄敏.江庆华。周俐

Huang MinJiang QinghuaZhou Li(Tumor Hospitalof Sichuan ProvinceSichuan 610041 China)

中图分类号:R197323                      文献标识码:C

文章编号:10096493(2008)10A260702

护士在配制化疗药物的过程中将直接接触大量的化疗药物,一些药物成分町通过皮肤直接接触、经口或呼吸道吸入等途径进入人体,长期接触低剂量化疗药物,可导致染色体畸变,具有致癌、致畸及脏器损害等潜在的危险[1]。按一般药物的配制方法不仅可使配制人员接受化疗药物的危害,还可使周围环境受到化疗药物的污染,使更多的人受到健康威胁[2]。为了加强化疗药物在配制过程中的安全防护措施。尽量减少护理人员与化疗药物不必要的接触,减少化疗药物配制所致环境污染,我院成立了化疗药物配制中心。配备化疗药物专用安全配药柜.培训专业护士,对全院所需化疗药进行集中配制和管理,使化疗药物配制管理更加科学、规范,有效保护了工作环境的安全,也有利于肿瘤专科护士的身体健康。

1  化疗药配制防护现状

在接触化疗药物时不注意防护或防护措施不够等原因给健康人群带来的危害已引起人们的高度重视,但由于化疗专用安全配药柜价格昂贵.阻碍了它的广泛应用[3]。我院过去化疗药物配制分散在各临床科室,由病房护士自行配制,仅有简单的防护设施:佩戴一次性口罩、帽子,戴聚氯乙烯手套,外套一副乳胶手套,操作台面覆盖一次性治疗巾,医疗废物用贴有警示标志的化疗专用密封袋装袋处置。各科室分散备药。不仅使接触化疗药物的护士增加,也可能导致含有化疗药的毒性微粒或气溶胶在空气中弥散,造成环境污染,危害医护人员的健康。安全配药柜是针对化疗药物配制的专用设备,其操作柜内为百级净化的负压环境,垂直层流风速、操作窗口进风及排风三种风速可准确调节,以确保操作柜内有毒气溶胶及微粒不会溢出。另外。通风系统内的活性炭滤器提高了有毒化疗药物毒素的滤除效率,可对排出的空气进行清洁,避免了环境污染。配备化疗药物安全配药柜,实施化疗药物中心配制,避免了配药护士长期慢性吸入化疗药物带来的健康损害和对工作环境的污染。目前,我国仅有少数医院使用安全配药柜和在化疗药物中心配制。化疗药配制防护管理大都依据医院的实际情况进行管理,还处于探索中[4]。我院把配制中心的管理重点放在防治个人的化疗防护和配药安全管理上,收到较好的效果。

2  化疗药配制的防护管理

21  设立化疗药物配制中心减少化疗药物职业危害的一个重要措施就是施行化疗药物中心配制,建立独立的化疗药物配制中心.根据静脉药物配制中心的建设要求,化疗药物配制中心的地址选在僻静及人员流动相对少的地方,配药室分为操作问、缓冲间,另设办公室及卫生间。安全配药柜放置在配药室等操作间,对化疗药进行集中配制管理。

22  护士的专业培训美国USP(the United States Pharmacopeia)把配药人员的号业培训列在静脉药物配制中心(PIVAs)管理中最重要的环节,其观点认为,配药人员准确、规范的操作对药物治疗的安全作用要远大于最先进的设备[5]。进行化疗药物配制的护士必须经过严格专业培训,其培训内容包括:①操作规程及管理制度培训,即严格执行操作规程、熟悉化疗配制流程、严格执行三查七对制度、无菌技术操作等;②化疗药物知识培训,即化疗药物的药理基础理论知识、化疗药物分类及作用机制、化疗药物配制液选择及配伍禁忌、常见肿瘤的化疗方案及剂量,临床新药的使用和管理原则等;③化疗安全防护培训。即强化护士的职业防护意识,树立正确的职业防护理念。护士不仅要做好化疗药物配制中的自身防护,还要有环保意识。对化疗药配制过程中产生污物按相关要求规范处理,正确使用防护用具,掌握安全配药柜操作规程及维护方法;熟悉医院感染管理和医疗废物管理的相关知识;进行健康指导,鼓励个人加强营养和进行体育锻炼,增强机体免疫力。

23  安全配药柜的管理

231  定期进行性能监测每半年对安全配药柜空气微粒、沉降菌落计数、送风口及出风口风速、噪音等指标进行测试,定期更换活性炭滤器和过滤网,保证安全配药柜的正常使用。

232  使用后清洁消毒每日配药完毕后,用清水及75%乙醇溶液纱布擦拭安全配药柜工作台、风机、顶部、两壁及台面,并检查各设备部件是否完好。

24  化疗药配制窀的工作管理

241  化疗药配制流程在建立化疗药物配制中心前即开始设置化疗药物配制中心的工作流程,并广泛征求各科室意见来不断完善,最后形成流程方案,即临床科室根据病人的医嘱送化疗治疗单、处方和药物,并与药剂师查对药品,配制中心护士再次杏对一柜内配制一再查对一传递窗传出,送到病房。将制订好的下作流程抄送各临床科窜,增强科室与配制中心的衔接和配合。

242  终末用物处置所有废弃物按《医疗废物管理条例》进行分类存放,一次性针头置锐器盒内,配药注射器、安瓿等医疗废物用专用袋装好封[1,并贴上警示标识,医疗废物转运时与接受人在医疗废物转运联单上进行双签字。

25  化疗安全防护管理

251  化疗药配制护十的健康管理化疗药物配制中心的护士上岗前需进行健康体检,并建立个人健康档案,配备的护士均为专业培训考核合格、已婚育的护士。每半年进行1次体检,包括肝肾功能、胸透、白细胞及II}L小板等指标测定,一旦出现毒副反应征象,立即进行人员调整,使其危险降到最低限度。

252  安全防护措施执行管理准备问配备一次性口罩、N95口罩、帽子、眼罩、洗手农裤、一次性防渗透隔离衣、聚氯乙烯手套、乳胶手套、一次性注射器、防护垫、污物专用袋及封闭式污物电经验荟萃电桶等。为了加强抗肿瘤药物使用过程中的安全防护措施和集中式管理,从而达到药物处理中心化,要求非配制人员不得进入配制室,配制人员进人室内要戴好帽子、N95口罩、洗手衣裤及隔离衣、拖鞋,并要求配药前将所需药品、物品在准备室备好,通过传递窗送人配制室。配液时尽量减少人员流动,配制完毕由专用窗口递出,以使药物污染缩小到最小范围。

3 小结

我院化疗药物配制中心在2年的运行中,通过规范化管理不仅减少了护士与化疗药物的零距离接触,减少化疗药所致环境污染,而且有效保证了药物配制的安全性。经对临床科室医护人员的调查结果显示,对化疗防护的满意率达100%,防护中心工作人员满意率也在90%以上;2年中未发生1例药物配制的差错事故和因配制措施导致的不良事件。从已经收集的配制中心工作人员健康检查结果来看,还未发现工作人员健康受损的情况。目前,我们还在继续进行丁作人员健康监测方面的工作,配制中心也根据临床病人的治疗需求不断完善工作流程和管理措施,以取得更满意的效果。

参考文献:

[1]张惠兰,陈荣秀.肿瘤护理学[M].天津:天津科学技术出版社,2000181

[2]陈倩超.黄红兵,季晓萍,等.肿瘤专科医院细胞毒静脉药物配置中心的运作[J].广东药学.200515(1)57

[3]任俊辉,程兰,王东.肿瘤化疗药物对护十的职业危害和化疗防护现状及对策[J].第三军医大学学报,2006215

[4]郭秀泉,陈倩超。高瑞珍.浅谈静脉化疗药物配制室的管理[J].护理研究,200519(7A)1202

[5]Michael SanbornCore competencies in hospital pharmacyintravenous admixtures[J]Hospital Pharmacy200641(4)377

作者简介    黄敏(1965),女,四川省成都人,护理部主任,副主任护师,本科.从事肿瘤护理及护理管理工作.工作单位:610041,四JII省肿瘤医院;江庆华、周俐工作单位:610041,四川省肿瘤医院。

摘自:护理研究200810月第22卷第10期上句版(总第264)

 
 

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