目的：探讨药房中药饮片流通中风险因素。方法借助鱼骨图从人（班组长、上药工、调剂员、复核员）、机（机器）、环（配方间、二级库）、法（养护措施）、料（中药饮片）五个方面深入查找引发饮片质量问题的风险因素。结果2012年1月~2015年12月发生饮片质量问题212件，其中霉变、虫蛀、含水量大合计占比66.5%；4、12月份季节交替及7月份霉雨季节饮片发生质量问题件数明显增多。通过鱼骨图，归纳要因入下：（1）不了解饮片特性；（2）未做到“先进先出”；（3）温湿度读取不方便；（4）部分品种配备药斗数太多；（5）药斗储药量太大；（6）未采用正确养护方法；（7）未建立梅雨季养护制度；（8）不合格饮片未及时处理；（9）饮片破碎后变质。结论通过控制药房中药饮片流通中风险因素，有助于降低问题饮片发生率，提高患者用药安全。%Objective To investigate the risk factor in pharmacy Chinese herbal pieces during circulation. Methods With the aid of fishbone diagram, risk factors for the quality of decoction pieces were deeply looked from people (team leader, irrigation, industry and trade, dispatcher and reviewers), machine (machine), ring (formulation, secondary library), method (conservation measures), and material (Chinese herbal medicine). Results 212 pieces of quality problems happened from January 2012 to December 2015, including mildew, moth, large water content accounted for 66.5%. The number of pieces of quality problems increased significantly in April, December and July seasons. Through the fishbone diagram, inductions to the cause were:(1) Did not understand the characteristics of pieces;(2) Did not“Advance first out”;(3) Temperature and humidity were not convenient to read;(4) The varieties equipped with too much medicine a mouth;(5) The medicine bucket storage amount was too large;(6) Did not use correct maintenance methods;(7) Did not establish a rainy season maintenance system;(8) Unqualified treatment was not timely;(9) Only pieces of broken after modification. Conclusion By controlling the risk factors in pharmacy Chinese herbal pieces during circulation, it is helpful to reduce occurrence rate of problem pieces, which can improve the safety of drug use in patients.
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