我院门诊药房退药处方的原因分析及对策

Reasons Analysis and Countermeasures of Drug-repercussion Prescriptions in Outpatient Pharmacy of our Hospital

目的探讨影响医院门诊药房退药处方的原因并制定预防对策。方法回顾性分析2017年9月-2017年12月门诊药房退药情况,对所退药物类别、退药科室、退药原因进行统计分析,根据退药情况制定门诊退药预防对策。结果 (1)2017年9月-2017年12月共收集到退药处方613张,约占门诊总处方数0.41%,涉及退药金额4.62万元,共涉及20个科室;(2)月平均退药处方数最高的三个科室分别是综合内科门诊、内科门诊和急诊内科;(3)门诊药房退药剂型以口服药为主,退药类别占比前三分别是抗菌药物、循环系统用药、解热镇痛抗炎药;(4)门诊药房退药原因中患者因素总构成比较高,为50.08%;构成比前三是患者拒绝用药、医保限报、更改治疗方案。结论患者拒绝用药、医保限报、更改治疗方案是门诊药房退药的主要原因,规范医生合理用药、加强医患沟通、加强门诊处方前置审核等有利于降低退药发生率。

Objective To explore reasons of drug-repercussion prescriptions in outpatient pharmacy of a hospital and to formulate preventive countermeasures. Methods A retrospective analysis was done to look statistically into the drug repercussion situations of the outpatient pharmacy from September 2017 to December 2017,including categories,departments and reasons. And preventive countermeasures for outpatient drug repercussion were made according to the drug repercussion situations. Results From September 2017 to December 2017,613 drug-repercussion prescriptions were collected,which accounted for approximately 0. 41 % of total prescriptions and amounted to 46. 2 thousand yuan and involved 20 departments.The three departments with the highest monthly average drug-repercussion prescriptions were the comprehensive internal medicine clinic,internal medicine department and emergency medical department. The drug repercussion of outpatient pharmacy was mainly related to oral drugs,and the top three categories were antimicrobial,circulatory system,and antipyretic-analgesic and anti-inflammatory drugs. The total composition of patient factors for drug repercussion in the outpatient pharmacy was as high as 50. 08%. The top three composition ratios were refusal by patients,limited reimbursement of medical insurance,and change of treatment regimen. Conclusion Refusal by patients,limited reimbursement of medical insurance,and change of treatment regimen are the main reasons for drug repercussion in outpatient pharmacy. It＇s necessary to regulate rational drug use of physicians,strengthen communication between doctors and patients,and enhance the check of outpatient prescriptions so as to help reduce the incidence rate of drug repercussion.