OBJECTIVE To establish the precise management model for the centralized preparation of cytotoxic drugs in pharmacy intravenous admixture services （PIVAS）， and evaluate the effects of its application. METHODS Pharmacists in PIVAS established the precise management model by soliciting clinical opinions and consulting literature on the centralized preparation of cytotoxic drugs and continuously refining every step of the preparation of cytotoxic drugs， based on data feedback from the information closed-loop management system and the limit of stability time of finished solutions. The indicators such as the preparation time， delivery time， the storage time of finished infusion solutions after preparation， and the completion rate of infusion within the stability time limit were analyzed before the implementation （January to December 2023） and after the implementation （January to December 2024） of this model， to evaluate its application effectiveness. RESULTS The overall framework for the precise management model included upgrading the functions of the prescription review system， improving the prescription review database， providing specialized training for PIVAS pharmacists， managing dynamic batch decision for drug preparation， managing special drugs， managing finished infusion distribution， and establishing a continuous improvement mechanism. Compared with before implementation， the average preparation time of the second and third batches of cytotoxic drugs with more concentrated morning preparation tasks in this model was significantly shorter than before implementation （P＜0.05）； the delivery time of finished infusion after implementation （[ 11.49±2.92） min] was significantly shorter than the delivery time before implementation （[ 22.11±5.03） min] （P＜0.001）； the storage time of some drugs with shorter stable time limit and carboplatin in combination regimens （paclitaxel or docetaxel+carboplatin） was significantly shortened compared to before implementation （P＜0.05）， and the completion rate of infusion within the stability time limit was significantly improved compared to before implementation （P＜0.05）. CONCLUSIONS Our hospital has successfully established a precise management model for the centralized preparation of cytotoxic drugs in PIVAS. This mode can significantly shorten the preparation time of each batch of PIVAS in the morning， make batch decisions more reasonable and improve the infusion completion rate within the stable time limit of the finished product.

Abstract OBJECTIVE To analyze the characteristics of drug poisoning in children, and to explore the diverse pharmaceutical services that pharmacists can provide in the process of prevention and treatment. METHODS The 47 children diagnosed as drug poisoning in Ningbo Women and Children's Hospital from January 1, 2020 to June 30, 2023 were retrospectively enrolled. Combined with the actual situation of Ningbo Women and Children's Hospital, pharmaceutical services were discussed. RESULTS The majority of children with drug poisoning were adolescent girls. The main cause of poisoning was intentional drug ingestion for suicide, accounting for 33 cases(70.21%). Additionally, 12 cases(25.53%) were accidental ingestion by children and 2 cases(4.26%) of drug overdose were caused by parents misreading the dosage of drugs. The clinical symptoms included drowsiness and/or lethargy(28 cases), dizziness(16 cases), nausea and/or vomiting(14 cases), and abdominal pain(11 cases). The majority of toxic substances were psychiatric drugs, accounting for 39 cases(82.98%). After hospitalization, 40 patients(85.11%) were treated with gastric lavage, and 11 patients(23.40%) were treated with blood purification. Diuresis and catharsis were also applied to remove poison. In addition, specific drug antidotes were selected according to the type of poisons. Meanwhile, symptomatic and supportive therapies were used. Finally, all 47 patients improved or cured after hospitalization. CONCLUSION Based on the characteristics of drug poisoning in children, pharmacists can actively participate in prevention and treatment, in order to reduce the occurrence of drug poisoning and improve the prognosis of poisoned children. In terms of prevention, pharmacists should provide medication instructions and education when dispensing drugs, especially for psychotropic drugs and drugs with easily confused dosage. In the treatment, clinical pharmacists can provide comprehensive pharmaceutical care for poisoned children from various aspects such as drug detection and analysis, removal of toxics, selection of specific antidotes, and inquiry of drug dosage for children.