某中医院门诊不合理处方分析

Analysis of unreasonable outpatient prescriptions in a Chinese medicine hospital

目的分析某三级甲等中医院门诊西药、中成药、中药饮片处方,了解门诊处方开具情况,提高处方的规范性及合理性。方法抽取2017年1—12月某三级甲等中医院门诊西药、中成药、中药饮片处方各1 200张(共3 600张),对抽取的不合理处方进行分类和统计分析。结果不合理处方共1 400张(38.89%),其中西药处方占15.36%(215/1 400),中成药处方占12.43%(174/1 400),中药饮片处方占72.21%(1 011/1 400)。不规范处方共1 192张,占所有不合理处方的85.14%;用药不适宜处方共191张,占比13.64%;超常处方共152张,占比10.86%。中药饮片处方不合理原因主要为:①无特殊情况下门诊处方超7 d用量,急诊处方超3 d用量,慢性病、老年病或特殊情况下需延长用药时间时未注明理由;②未写中医诊断及证型或书写不全;③未写煎服方法或书写不全、不规范;④无正当理由开具“大处方”。此4项原因占比共88.04%。结论该院门诊处方仍存在较多问题,其中中药饮片处方存在问题最多,应加强管理,提高处方质量。

Objective To analyze the outpatient prescriptions of Western medicine,Chinese patent medicine and traditional Chinese medicine decoction pieces prescriptions in a grade-Ⅲlevel-A Chinese medicine hospital,to understand the prescriptions of outpatients,and to improve the standardization and rationality of prescriptions.Methods A total of 3 600 outpatient prescriptions(1 200 Western medicine prescriptions,1 200 Chinese patent medicine prescriptions and 1 200 traditional Chinese medicine decoction pieces prescriptions)from January to December in 2017 were collected from the hospital.The unreasonable prescriptions were classified and statistically analyzed.Results Unreasonable prescriptions totaled 1 400(38.89%),of which Western medicine prescriptions accounted for 15.36%(215/1 400),proprietary Chinese medicine prescriptions accounted for 12.43%(174/1 400),and traditional Chinese medicine decoction pieces prescriptions accounted for 72.21%(1 011/1 400).Nonstandard prescriptions accounted for 85.14%(1 192/1 400)of all unreasonable prescriptions,13.64%(191/1 400)for unsuitable prescriptions,and 10.86%(152/1 400)for over-prescriptions.The reasons for the unreasonable prescription of traditional Chinese medicine decoction pieces were as follows.①Outpatient prescription was more than 7-day dose or emergency prescription was more than 3-day dose when there was no special case.No reason was given when needing to extend medication time for patients with chronic disease,geriatric disease or other special cases.②Chinese medical diagnosis was not written or not whole.③Decoction method was not entirety and normatively written.④“Big prescription”was issued without justified reasons.Conclusions There are still many problems in the outpatient prescriptions of this hospital.Prescriptions of Chinese medicine decoction pieces have the most problems.It is necessary to strengthen management and improve the quality of prescriptions.