某院提升药师审方干预技能的效果评价

Evaluation of Improvement Effects about Prescription Checking and Intervention Skills of Pharmacists in a Hospital

目的:评价药师审方干预技能的提升整改效果。方法:采用回顾性调查方法,抽取某院2015年10-12月(提升整改前组)、2016年1-3月(提升整改后组)门诊处方各2 417、1 698张,以《处方管理办法》、《处方点评管理规范(试行)》、药品说明书等规范、指南和参考文献为依据,对优化医院信息系统、提高药师综合技能、强化药师观念、建立反馈机制等提升整改措施实施前后不合理用药情况和药师审方干预技能进行比较。结果:提升整改措施实施后,该院适应证不适宜、临床诊断与用药不符、无指征使用抗菌药物、用法用量不适宜、联合用药不适宜和总体不合理用药的现象均有所减少,重复用药的情况略有增加,但差异均无统计学意义(P>0.05);药师审核的不规范处方和不适宜处方数量均有所减少,但差异均无统计学意义(P>0.05);药师遗漏审核、过度审核的发生率及审核错误的总发生率分别由提升整改前的2.40%、0.99%和3.39%下降至0.47%、0.29%和0.77%,差异均有统计学意义(P<0.05)。结论:该院的提升整改措施可提高药师审方干预的综合技能;但该院不合理用药的情况仍有待进一步规范。

OBJECTIVE： To evaluate the improvement and rectification effects about prescription checking and intervention skills of pharmacists. METHODS： By retrospective investigation, 2 417 outpatient prescriptions and 1 698 outpatient prescriptions were respectively selected from some one hospital during Oct.-Dec. 2015 （before improvement and rectification） and Jan.-Mar. 2016 （after improvement and rectification）. According to standards, guidelines and references as Prescription Administrative Poli- cy, Prescription Review Management Standard （trial） and drug instructions, irrational drug use and prescription checking and inter- vention skills of pharmacists were compared before and after the implementation of rectification measures as optimizing hospital in- formation system, improving comprehensive skills of pharmacists, strengthening pharmacists＇ concept, establishing feedback mech- anism. RESULTS： After the implementation of rectification measures, unsuitable indications, clinical diagnosis inconsistent with medication, antibiotics use without indications, unsuitable usage and dosage, unsuitable drug combination and irrational drug use were all decreased, but repeated drug use was increased, without statistical significance （P〉0.05）. The number of non-standard prescriptions and unsuitable prescriptions checked by pharmacists were decreased, without statistical significance （P〉0.05）. The in- cidence of checking missing, excessive checking and checking error were all increased from 2.40%, 0.99%, 3.39% before improvement and rectification to 0.47%, 0.29%, 0.77%, with statistical significance （P〈0.05）. CONCLUSIONS： The improvement and rectification measures of the hospital can improve comprehensive prescription checking and intervention skills of pharmacists. Irrational drug use should be further standardized.