“新医改”背景下重庆市医疗机构处方点评工作的创新与实践

Innovation and Practice of Prescription Comment in Medical Institutions of Chongqing under the Background of “New Medical Reform”

目的:探索"新医改"背景下重庆市医疗机构处方点评工作的新方法,为创新处方点评工作模式、促进临床合理用药提供参考。方法:通过分析处方点评工作创新实践探索的政策背景、借鉴其他地区的实践经验,开展重庆市、区(县)两级医疗机构的处方集中点评活动和处方点评信息化建设等,对取得的成效和存在的问题进行分析,并提出对策建议。结果与结论:集中点评了16家市级医疗机构处方,共计抽查病历300余份、处方/医嘱1 600余张;集中点评了135家区(县)级医疗机构处方,共计抽查病历3 100余份、处方/医嘱12 100余张;建成"重庆市医疗机构处方点评关键技术监测系统"。上述措施创新了处方集中点评模式、提升了处方点评质量、提高了处方点评信息化水平,但仍存在制度覆盖面不完全、考核流于形式、药师业务水平参差不齐等问题。建议通过建立合理用药计分管理制度、开展临床药师查房和处方前置审核等措施加强医疗机构内部质量控制,同时建立和完善第三方外部评价、监督机制,全方位提升处方点评人员的医药学知识水平,从而进一步规范医疗机构处方、促进临床合理用药。

OBJECTIVE：To explore new method of prescription comment in medical institutions of Chongqing under the background of＂New Medical Reform＂,and to provide reference for prescription comment innovation and promoting rational drug use in clinic. METHODS：Through analyzing policy background of prescription comment innovation and practice,referring to experience of other regions,the achievements and problems were analyzed by developing centralized prescription comment and prescription comment information construction in municipal and regional（county-level） medical institutions of Chongqing.The countermeasures suggestion was put forward. RESULTSCONCLUSIONS： The prescriptions of 16 municipal medical institutions were commented centrally,involving more than 300 medical records and 1 600 prescriptions or medical orders. The prescriptions of 135 regional（county-level）medical institutions were commented centrally,involving more than 3 100 medical records and 12 100 prescriptions or medical orders.＂Chongqing Medical Institution Prescription Comment Key Technology Monitoring System＂was established. Above measures innovated centralized prescription comment mode,improved the quality of prescription comment and promoted prescription comment informatization. There were still problems as incomplete coverage of the system,inspection to become a mere formality. It is suggested to strengthen internal quality control of medical institutions by establishing rational drug use scoring management system,developing clinical pharmacist ward round and prescription checking in advance; establish and improve third-party external comment and supervision mechanism; improve the knowledge of prescriptions comment staff in all directions so as to further standardize prescriptions and promote rational drug use in medical institutions.