审方系统8016条严重配伍禁忌警告的深度回顾性分析

Retrospective Analysis of 8016 High-risk Incompatibility Warnings of the Prescription-reviewing System

目的:分析审方系统滤出的不合理医嘱与实际情况的相符性,为实现精准的临床用药事前干预提供依据。方法:选择2016年5月至2017年5月智能审方系统自动滤出的最严重级别警告,进行人工二次审核分析。按照审查类型细分,选择占比最大的"配伍禁忌"项深入研究。统计排名靠前的科室与药品,对系统警报结果进行分型和分析。结果:"配伍禁忌"严重警报8 016条,占严重级别问题医嘱的比例达到84%,占问题医嘱比例为4.06%,占总医嘱比例为0.07%。排名靠前的科室主要为外科手术科室,药品为临床使用较频繁且物化性质不稳定的注射剂。系统警报结果分为3类:核查无误类、循证证据不足或存在争议类、系统误报类。其中系统误报类2 360条,占比29.44%。结论:无效甚至错误的审核结果不利于临床安全合理用药的开展,智能系统亟需药师的深度参与,以提高数据的精准性。临床配伍禁忌问题需要行政干预、知识储备、医嘱规范录入、说明书完善等各方面的配合解决。

Objective: To analyze the conformance of irrational medical orders filtered out by the prescription-reviewing system and the actual situation, so as to provide evidence for precise prior intervention of clinical medication. Methods: We selected the high-risk warnings of the prescription-reviewing system in May 2016 to May 2017, and gave an artificial secondary analysis. According to the sort of problems, we chose the largest proportion of "incompatibility" to further study. The top 10 departments with the most warning lights were chosen to analyze the related drugs and content of warning message. Results: There were 8 016 irrational medication orders of "incompatibility", which accounted for 84% in high-risk warnings, 4.06% in irrational doctors' orders, 0.07% in the total doctors' orders. The top ranking departments were mainly surgical departments, and the related drugs were injections with unstable physicochemical properties and frequently used in clinical practice. The system warnings are classified into three categories: verification, insufficiency of evidence and false warnings. Among them, 2 360 were false warnings, accounting for 29.44%. Conclusion: Invalid or false warnings are not good for clinical rational drug use. It is essential that pharmacists deeply involved in the prescription-reviewing system to improve the accuracy of data. The problem of "incompatibility" requires the cooperation of administrative intervention, knowledge reserve, standardized medical order input, and drug instruction improvement.