PDCA循环管理法持续改进门诊氯吡格雷使用评价

Continuous Improvement of Rational Use of Clopidogrel in Outpatient Department by PDCA Cycle Management

目的运用PDCA循环管理持续改进门诊氯吡格雷使用的合理性,探讨促进临床合理用药的方法。方法临床药师用PDCA循环管理对氯吡格雷在门诊使用进行4个阶段的干预,并结合说明书与权威指南,参与制订《芜湖市第二人民医院氯吡格雷合理用药评价细则》,为临床提供抗血小板治疗方案;在管理过程中发现问题并找出解决措施,加强与临床医师与患者的沟通;通过比较干预前阶段与干预后4个阶段氯吡格雷处方合格率,评价PDCA管理法在规范用药合理性中发挥的作用。结果经过4阶段PDCA循环后,门诊氯吡格雷处方合格率从干预前的95.37%提高至99.68%;存在的主要不合理问题如适应症不适宜、联合抗血小板无指征、用法用量不适宜及未从经济学原则选用药物较干预前均明显减少。结论PDCA循环管理可提高门诊氯吡格雷使用合理性,临床药师参与其中可提高临床合理用药水平。

Objective To continuously improve the rational use of clopidogrel in outpatient department by PDCA cycle management,and to explore the methods for promotion of the rational use of drugs in clinical practice.Methods Clinical pharmacists used PDCA cycle management to intervene the use of clopidogrel in outpatient department in four stages.Combined with instructions and authoritative guidance,clinical pharmacists participated in the formulation of“Detailed Rules for Evaluation of Rational Use of Clopidogrel in the Second People’s Hospital of Wuhu”to provide anti-platelet treatment programs for clinic.In the management process,the problems were identified and the solutions were found,and the communication with clinicians and patients were strengthened.By comparing the qualified rate of the prescriptions in the pre-intervention stage and the four post-intervention stages,the role of PDCA management in regulating the rationality of drug use was evaluated.Results After the four-stage PDCA cycle,the qualified rate of the prescriptions in outpatient department increased from 95.37% to 99.68%.The main problems such as inappropriate indications,no indication for combination with anti-platelet treatment,inappropriate usage and dosage,and selection of drug not from economic principles before intervention were significantly reduced.Conclusion PDCA cycle management can improve the rationality of clopidogrel use in outpatient department,and the participation of clinical pharmacists can improve the level of clinical rational drug use.