我院不合理处方与医嘱分析及干预措施

Study on the Irrational Prescription and Medical Orders and Interventions in Our Hospital

目的:促进临床合理用药。方法:随机抽取2013年我院处方与医嘱,门急诊处方的抽样率不少于总处方量的1‰,且每月点评处方数不少于100张;病房(区)医嘱单的抽样率(按出院病历数计)不少于1%,且每月点评出院病历数不少于30份,按照合理用药评价指标进行统计、分析,对不合理处方与医嘱采取"即时干预"及"行政干预"的方式处理。结果:2013年门诊处方平均合格率为97.86%,不规范处方占0.92%,不适宜处方占1.20%,超常处方占0.01%。不规范处方下半年比例降低,差异有统计学意义(P<0.05),用法用量不适宜未得到有效控制。医嘱平均合格率为96.30%,更换药物无依据和诊断不完全的不合理情况下半年比例降低,差异有统计学意义(P<0.05)。抗菌药物急诊使用率为41.51%,其他指标基本达标。麻醉药品和精神药品处方合格率为81.60%,不规范处方占不合理处方的88.37%。结论:"即时干预"与"行政干预"均取得了一定成效,"即时干预"主要降低了不规范处方量,"行政干预"使得一些具体不合理用药情况得到控制。

OBJECTIVE：To promote rational drug use clinically. METHODS：Sampling rate of prescriptions in outpatient and emergency departments was no less than 1‰ of total prescriptions and no less than 100 prescriptions were reviewed every month;the sampling rate（according to the hospital records of discharge）of ward（district）doctor＇s advice was no less than 1% and no less than 30 prescriptions were reviewed every month. According to drugs evaluation indicators of rational drug use,the prescriptions were analyzed statistically,immediate intervention and administrative intervention were adopted for irrational prescriptions and medical orders. RESULTS：The average qualified rate of outpatient prescriptions was 97.86% and 0.92% was non-standard prescriptions,1.20% was inappropriate prescriptions and 0.01% was extraordinary prescriptions. The non-standard prescriptions in the second half year were significantly lowered,with statistical significance（P〈0.05）. The inappropriate usage and dosage was not effectively controlled. The average qualified rate of medical orders was 96.30% and drug replacement withont any reference and incomplete diagnosis in the second half year were significantly lowered,with statistical significance（P〈0.05）. The utilization rate of antibiotics in emergency department was 41.51% and the other indicators were basic standard. The qualified rate of Majing drugs＇ prescriptions was 81.60% and non-standard prescriptions accounted for 88.37% in the irrational prescriptions. CONCLUSIONS：Immediate intervention and administrative intervention have achieved some success. Immediate intervention has mainly reduced the non-standard prescriptions and administrative intervention has controlled some specific irrational prescriptions.