PDCA循环管理在某院门诊处方干预中的应用

Application of PDCA Cycle Management in the Outpatient Prescription Intervention of a Hospital

目的:评价PDCA循环管理在门诊处方干预中的应用效果。方法:选取某院2014年1-12月门诊处方895 360张(干预前组)和2015年1-12月门诊处方918 659张(干预后组),对实施PDCA循环管理前后的门诊不合理处方进行分析,并比较用法用量不适宜、临床诊断书写不全、医师处方未签名(章)或与留样不一致等核心指标改善情况。结果:干预前,不合理处方共2 347张,包括不规范处方1 401张、不适宜处方849张和超常处方97张。干预后,不合理处方共1 161张,包括不规范处方695张、不适宜处方425张和超常处方41张,分别较干预前组下降了50.53%、50.39%、49.94%和57.73%;用法用量不适宜、临床诊断书写不全、医师处方未签名(章)或与留样不一致、处方用纸不规范、适应证不适宜、处方修改未签名并注明修改日期或药品超剂量使用未注明原因和再次签名、无特殊情况门诊处方超7 d常用量或急诊处方超3 d常用量等占门诊处方总量的比例分别由干预前的0.72‰、0.57‰、0.45‰、0.27‰、0.20‰、0.19‰和0.15‰降至0.32‰、0.25‰、0.19‰、0.11‰、0.09‰、0.08‰和0.07‰。结论:PDCA循环管理用于门诊处方质量改进效果显著。该院门诊处方仍存在不合理现象,有待持续干预。

OBJECTIVE： To evaluate the application effects of PDCA cycle management in the outpatient prescription intervention. METHODS： A total of outpatient prescriptions （pre-intervention group） during Jan.-Dec. 2014 and 918 659 （intervention group） were selected during Jan.-Dec. 2015 were selected from a hospital. Irrational outpatient prescriptions were analyzed before and after the application of PDCA cycle management, and the improvement of main indexes were compared such as unsuitable usage and dosage, incomplete clinical diagnosis writing, no physicians＇ signature on the prescription or inconsistent with sample. RESULTS： Before intervention, there were 2 347 irrational prescriptions, including 1 401 nonstandard prescriptions, 849 unsuitable prescriptions and 97 abnormal prescriptions. After intervention, there were 1 161 irrational prescriptions, including 695 nonstandard prescriptions, 425 unsuitable prescription and 41 abnormal prescriptions, decreasing 50.53%, 50.39% 49.94% and 57.73%, respectively. The proportion of unsuitable usage and dosage, incomplete clinical diagnosis writing, no physicians＇ signature on the prescription or inconsistent with sample, nonstandard prescription paper, unsuitable indications, no signature and date for prescription revision or no reason and new signature for overdose use, outpatient prescriptions more than 7 d common dose or emergency prescriptions more than 3 d common dose without special situation in total amount of outpatient prescriptions decreased from 0.72‰, 0.57‰, 0.45‰, 0.27‰, 0.20‰, 0.19‰ and 0.15‰ before intervention to 0.32‰, 0.25‰, 0.19‰, 0.11‰, 0.09‰, 0.08‰and 0.07‰ after intervention. CONCLUSIONS： PDCA cycle management significantly improves the quality of outpatient prescriptions. There still are irrational outpatient prescriptions in this hospital, and it is to be intervened continuously.