门诊处方双重点评模式的建立与应用

The establishment and the application of the double evaluation model of outpatient prescriptions

目的探讨门诊处方双重点评模式的建立方法和应用效果。方法建立门诊处方双重点评模式:初评药师由门诊药师组成,包括高年资主管药师2人、低年资主管药师5人,药剂师5人;再点评药师由高年资药师组成,包括主任药师1人、副主任药师1人、高年资主管药师2人;回顾性分析蚌埠市第一人民医院2016年3～9月份270份处方的双重点评模式点评结果,包括适宜性类型的处方分布、不合理处方的科室分布及再点评组修正作用的总体情况、有修正作用处方的疾病分布。结果270份处方中,初评组、再点评组合理处方分别为0份(0. 00%)、50份(18. 52%),差异有统计学意义(χ2=55. 102,P <0. 001)。两组不合理处方的科室总体分布差异无统计学意义(χ2=5. 597,P=0. 976)。再点评组完全认同初评结果的处方有199份(73. 70%);修正初评处方71份(26. 30%),修正用药指征不适宜为用药指征适宜且发现新问题的有14份;对初评结果进行修正涉及的疾病主要为糖尿病22份(30. 99%)、心血管疾病17份(23. 94%)。结论门诊药师初评处方后,高年资药师再点评处方并反馈,形成门诊处方双重点评模式;该模式能提高处方点评质量,促进药师更好地开展处方点评。

Objective To explore the establishment and the application effect of the double evaluation model(DEM)of outpatient prescriptions.Methods The establishment of the DEM of outpatient prescriptions were briefly described.Evaluation results for 270 cases by DEM from March to September in 2016 were retrospectively analyzed.The initial evaluation date and the reevaluation date was respectively included into the initial evaluation group(IEG)and the reevaluation group(RG).For both groups,the prescription distribution of the appropriateness types of evaluation results and the department distribution of unreasonable cases were statisticed and analyzed.The overall situation of RG s correct functions and the disease distribution of corrected cases was also statisticed and analyzed.Results In 270 cases,there was respectively 0(0.00%)and 50(18.52%)reasonable cases in the IEG and the RG,with statistical significant difference(χ^2=55.102,P<0.001).There was no statistical significant difference between the department distribution of the appropriateness types of evaluation results of the two groups(χ^2=5.597,P=0.976).Initial evaluation results of 199 cases(73.70%)were totally accepted by the RG.71(26.30%)initial evaluated cases were corrected,of which 14 inappropriate medication indications cases were corrected as appropriate medication indications cases and also with new problems were found.Diabetes with 22 cases(30.99%)and cardiovascular disease with 17 cases(23.94%)were mainly diseases involved in corrected initial evaluation cases.The Pharmacists initial evaluation bias were related to lack of cognitive knowledge of the relevant diseases,and lack of clinical experience,and failed to combine with clinical practice to conduct a comprehensive analysis and others.Conclusion DEM of outpatient prescriptions is established on the initial evaluation of the prescription by the outpatient pharmacists and reevaluation and feedback by the senior pharmacists,which can improve the quality of prescription evaluation,and find out defects in the initial evaluation and promote the pharmacist to carry out prescription evaluation better.