按病种分类进行用药医嘱点评模式初探

Primarily Exploration of Medical Orders Evaluation Mode According to Disease Classification

目的:考察按病种分类进行用药医嘱点评新模式的应用效果。方法:从我院各科室中共选择16个常见病种,每个病种分别随机抽取2016年1月1日-12月31日医院信息系统中的各10份、总计160例患者的电子病历,对各患者住院期间的10 720条用药医嘱从合理性方面进行回顾性点评,对不合理用药医嘱中用法用量不适宜、辅助用药占比、适应证不适宜等相关指标进行统计和分析,建立按病种分类进行用药医嘱点评的新模式;收集点评新模式实施及进行相关干预后(2017年4-5月)相同病种的9 862条用药医嘱,点评其不合理率,评价新模式的应用效果。结果:在2016年的样本中,共点评出751条不合理用药医嘱,以用法用量不适宜情况最多(414条,55.12%),其中尤以在脑出血病种中最多(69条,16.67%),此病种下以单次给药用量过大最多(31条,44.92%);辅助用药占病种药品总费用比排序前3位的病种依次为肾肿瘤手术(39.43%)、急性脑梗死(非手术)(37.03%)和椎间盘突出手术(35.26%);适应证不适宜用药有70条(9.32%)。应用按病种分类的点评模式及进行相关干预后,医嘱不合理率由点评前的7.00%(751/10 720)下降至点评后的2.95%(291/9 862),降幅为57.86%。结论:应用按病种分类的点评模式管理用药医嘱不合理率取得了一定的成效,该模式有助于促进临床合理用药。

OBJECTIVE:To investigate the effects of new mode of medical orders evaluation according to disease classification.METHODS:Totally 16 kinds of common diseases were selected from each department of our hospital.Each 10 electronic medical records of each disease were randomly selected from 160 patients in the hospital information system from Jan.1 to Dec.31,2016.The rationality of 10 720 medical orders were evaluated retrospectively during hospitalization.Statistical analysis was made on the relevant indicators such as unsuitable usage and dosage,the proportion of auxiliary drugs and unsuitable indications in medical orders of irrational drug use,and a new mode of prescription comment was established according to the classification of diseases.9 862 medical orders of same disease types were collected after the implementation(from Apr.-May,2017)of new mode and intervene to evaluate the irrational rate of them so as to evaluate the effects of new mode.RESULTS:In the samples in 2016,a total of 751 medical orders of irrational drug use were evaluated,the most of them were unsuitable usage and dosage(414 items,55.12%),especially in the intracerebral hemorrhage diseases(69 items,16.67%);under this kind of disease,most of irrational drug use was excessive dosage of single dosing(31 items,44.92%).The top three disease types in the list of the ratio of adjuvant drug cost in total drug cost were surgery for renal tumors(39.43%),acute cerebral infarction(non-surgery)(37.03%)and intervertebral disc herniation surgery(35.26%).70 medical orders of irrational drug use were unsuitable indications(9.32%).After the application of evaluation mode according to classification of disease types and intervene,the irrational rate of medical orders decreased from 7.00%(751/10 720)before evaluation to 2.95%(291/9 862)after evaluation,decreasing by 57.86%.CONCLUSIONS:The application of evaluation mode according to classification of disease types can achieve good results in controlling the irrational rate of medical orders and contribute to rational drug use in clinic.