对出院带药中西医结合处方的用药干预

Intervention of Discharge Prescriptions of Integrated Traditional Chinese and Western Medicine on Medication

目的:考察对出院带药中西药结合处方进行临床用药干预的效果。方法:选择某院2017年1—12月出院带药处方中的中西药结合处方,从适应证、用药量、配伍和用药禁忌等方面考察处方的合理性,对不合理处方采用临床用药干预,纠正其不合理之处。观察指标:临床用药干预前后处方不合格率,分析不合理处方的主要问题。结果:共纳入3 056张中西药结合处方,分析结果显示,处方不合格率为3.99%(122/3 056),不合理处方问题主要是:1)处方不规范91张,占74.59%,主要为处方书写不规范,表现为字体潦草、药房人员无法辨认;医师签章/签名有简写或略写的现象,容易造成相同姓氏医生处方的混淆。2)用药不当:31张,占25.41%(31/122),主要为药品用量与说明书不符,单张处方费用超出医保规定的结算金额;中西药的药物配伍不合理、部分中西药作用有重叠。经临床用药干预后,处方不合格率为1.05%(32/3 056);不合理处方问题主要是处方书写不规范(字体潦草)。用药干预前后处方不合格率比较,差异有统计学意义(χ2=19.170,P=0.000<0.05),表明通过临床用药干预有效降低了处方不合格率。结论:对不合理处方进行有效干预,以提高临床医师合理用药水平,保证患者用药安全。

Objective： To investigate the effect of intervention of discharge prescriptions on the integrated traditional Chinese and western medicine on clinical medication. Methods： The combination prescriptions of traditional Chinese and western medicine of one hospital were selected from January to December in 2017.The rationality of the prescription was investigated in terms of indication,dosage,compatibility and contraindications,and clinical medication intervention was used for the irrational prescription to correct its irrationality.The unqualified rate of prescriptions before and after intervention was compared as the observation indexes,and the main problems of irrational prescriptions were analyzed. Results： A total of 3 056 prescriptions were analyzed,and the unqualified rate of prescriptions was 3.99% （122/3 056）.The problems of irrational prescriptions were nonstandard and improper drug use.There were 91 （74.59%） non-standard prescriptions,and the characteristics were too illegible for the pharmacist to recognize,and the signature of the doctors was abbreviated and sketched,which easily led to confusion between prescriptions of doctors with the same family name.There were 31 prescriptions of improper drug use,accounting for 25.41% （31/122）,and the main problems were that the dosage of drugs did not conform to the instructions,and the cost of single prescription exceeded the settlement amount of medical insurance.The combination of Chinese and western medicine is unreasonable,and some functions in Chinese and western medicine overlapped.After clinical intervention,the unqualified prescription rate was 1.05% （32 / 3 056）.The difference of unqualified rate of prescriptions before and after intervention was statistically significant （χ^2=19.170, P =0.000〈0.05）,which indicated that the rate of unqualified prescriptions was effectively reduced by clinical intervention. Conclusion： It is necessary to improve the level of rational use of drugs and to ensure the safety of drug use in patients.