上海市某医院中药饮片处方点评

Prescription review of Chinese herbal pieces in a hospital in Shanghai

目的点评中药饮片不合理处方,分析原因并提出相应对策,为中药饮片的合理使用提供依据。方法收集该院在2016年全年药师审方时发现的不合理中药饮片处方,汇总并分析不合理处方数、中药饮片不合理处方类型及部分含毒性药品炮制品处方的使用情况。结果 2016年,该院中药饮片不合理处方数占2.1%(313/14 724),不合理处方类型主要有用量过多(占72.52%)、用量过少(占25.88%)、配伍禁忌(占0.96%)、重复用药(占0.32%)、用法错误(占0.33%)。含毒性药品炮制品的处方中,制半夏的超量较为常见。结论中药饮片用量不适宜多为电脑误操作引起,大部分可以避免;其余超量多为经验用药,亦是行业内普遍现象;配伍禁忌、重复用药和用法错误等情况虽然较少,但可能导致严重的后果,需药师严格把关。建议加强中医临床药师的培养,提高中药师的中医基础知识以及中药专业知识水平,从而提高中药饮片审方的质量,以期为患者的合理用药提供更专业的服务与指导。

Objective To analyze the causes of unreasonable prescriptions of Chinese herbal pieces by a review on the prescriptions,then to put forward the corresponding countermeasure,so as to provide a basis for reasonable use of Chinese herbal pieces. Methods All the unreasonable prescriptions of Chinese herbal pieces,which were founded in the prescription verification in 2016 by pharmacists from our hospital,were collected for summarizing and analyzing the issues including the number of unreasonable prescriptions,unreasonable prescriptions types of Chinese herbal pieces,and prescriptions of some processed products containing toxic drugs. Results In 2016,unreasonable prescriptions of Chinese herbal pieces in our hospital accounted for 2. 1%（313/14 724）,and the common types of unreasonable prescriptions included inappropriate dose-overdose（72. 52%）,inappropriate dose-too low dose（25. 88%）,drug incompatibility（0. 96%）,repeated medication（0. 32%）,and error usage（0. 33%）. In the prescription of processed products containing toxic drugs,the excess usage of Pinellia Tuber was common. Conclusion Most of the inappropriate dose cases caused by computer operating errors can be avoided,the rest overdose cases belong empirical medication,which is a common intra-industry phenomenon; thought drug incompatibility,repeated medication and error usage cases are less,which may lead to serious consequences and should be strictly controlled by the pharmacists. It is suggested to strengthen the training of clinical pharmacists of traditional Chinese medicine,and improve the pharmacists＇ levels of basic knowledge of traditional Chinese medicine and professional knowledge of Chinese medicine,thus improving the prescription verification quality of Chinese herbal pieces. And thereby more professional services and guidance are available for patients＇ receiving reasonable medication.