评分制抗菌药物处方医嘱点评模式的建立与效果分析

Establishment of scoring review mode on antimicrobial prescription and its effect analysis

目的:探讨评分制抗菌药物处方医嘱专项点评的有效性,以建立抗菌药物处方医嘱点评的长效机制。方法:创建评分制处方点评表格及点评模式,采用此点评模式,对2011-2013年1-6月门诊处方共13 160张、急诊处方共3 340张,住院病历共2 541份进行点评,对抗菌药物使用率、使用强度、合理率、平均分进行对照研究。结果:从2012年实施评分制处方点评模式后,门诊、急诊处方和医嘱抗菌药物使用率分别从干预前33.3%,39.6%,61.1%降至18.3%,22.0%,39.7%;合理使用率分别从干预前79.2%,67.7%和55.0%提升到干预后的99.0%,96.1%和76.1%,使用强度从每百人天81 DDDs下降至37DDDs,处方平均分逐渐提高,同时评分制处方点评模式具有科学、客观性,可操作性强。结论:评分制抗菌药物处方专项点评模式的建立与实施,促进了抗菌药物合理使用,可作为抗菌药物临床应用管理的长效机制。

OBJECTIVE To explore the validity of the scoring review mode on antimicrobial prescription and establish a long-term mechanism.METHODS Prescription scoring form and review mode were constructed.Medical data including13 160 outpatient prescriptions,3 340 emergency prescription and 2 541 medical records from2011 January to 2013 June were reviewed to evaluate this review mode.The percentage of antimicrobial use,antimicrobial use density（AUD）,reasonable rate and average score were compared.RESULTS After scoring review system for prescription was adopted since 2012,usage of antimicrobial in outpatients,emergency and inpatient departments decreased from 33.3%,39.6% and 61.1% to 18.3%,22.0% and 39.7%,respectively;the reasonable rate raised from79.2%,67.7% and 55.0%to 99.0%,96.1% and 76.1%,respectively.AUD decreased from81 DDDs to 37 DDDs.The average score was increasing gradually.The scoring review mode was scientific,objective,and high operability.CONCLUSION The establishment and implementation of scoring review mode can promote rational use of antimicrobial agents.It may be used as a long-term mechanism to manage the clinical use of antibiotics.