目的：分析北京协和医院静脉药物配置中心实时干预的不合理医嘱，并探讨解决对策。方法：回顾性统计2018年我院静脉药物配置中心审方药师根据《临床药物治疗学》、药品说明书、MICROMEDEX及Up To Date等相关资料对长期医嘱和临时医嘱进行实时前置审核所发现的不合格医嘱类型与数量，计算干预率。结果：从实时审核医嘱中共发现不合理医嘱174份，主要涉及药物用法用量不适宜、录入错误、溶媒不适宜及药物浓度不适宜等，干预率达100%。结论：通过静脉药物配制中心药师对医嘱的实时审核和干预，能有效地降低和避免不合理用药的产生，促进临床合理用药。

Objective: To analyze the irrational medical orders in pharmacy intravenous admixture services discovered by real-time reviews and intervened in by the pharmacists and to put forward and discuss the countermeasures. Methods: Pharmacists from the pharmacy intravenous admixture services audit long-term and temporary medical orders every day before mixing. Irrational medical orders were intervened in by the pharmacists. Based on Clinical Drug Therapeutics, pharmaceutical instructions, MICROMEDEX, Up To Date and so on, irrational medical orders in 2018 were analyzed retrospectively and statistically. The intervention rate was calculated. Results: A total of 174 irrational medical orders were intervened in by the pharmacists in 2018. The irrationality types mainly included unsuitable dosage and usage, entry error, improper selection of solvent type, improper drug concentration and so on. The intervention rate was 100%. Conclusion: Proper reviews and intervention from the PIVAS can effectively reduce and avoid the irrational drug use so as to promote the clinical safety and rational use of drugs.