行政干预对医嘱点评质量的影响及其对不合理用药的原因分析

Influence of Administrative Intervention on Quality of Pediatric Doctor's Advice Evaluation and Analysis on Unreasonable Medication

目的:探究医院住院患者医嘱点评工作的实施效果,分析行政干预对改善不合理用药的影响。方法:收集2016年10月—2017年9月间住院病例医嘱377份,统计医嘱中不合理用药情况,同时根据对点评结果干预与否将其分为行政干预前189份和行政干预后188份,比较和分析不合理医嘱产生的原因。结果:377份医嘱中,干预前不合理用药医嘱67份(占35.45%),干预后不合理用药医嘱45份(占23.94%);不合理用药类型前3位分别为超说明书用药、抗菌药物使用不合理、用药频次不合理;干预后不合理率显著低于干预前(23.94%vs 35.45%,P<0.05)。结论:医嘱中超说明书用药、抗菌药物使用不合理是医院住院患者医嘱用药不合理的主要类型,医嘱点评与行政干预措施相结合有助于降低住院患者医嘱用药的不合理率,确保患者用药的合理性和安全性。

Objective:To explore the implementation effect of inpatients'medical advice omment,and to analyze the influence on administrative intervention in the improvement of unreasonable drug use.Methods:377 inpatient orders were collected from October 2016 to September 2017,and the unreasonable medication was collected.At the same time,it was divided into 189 cases before administrative intervention and 188 cases after administrative intervention according to the evaluation results,the causes of unreasonable medical orders were compared and analyzed.Results:Among the 377 doctor's orders,67 were 35.45%for unreasonable medication before intervention,and 45 were 23.94%for unreasonable medication after intervention.The TOP 3 unreasonable drug use types were off-label drug use,unreasonable use of antibacterial drugs and unreasonable use frequency.The unreasonable utilization rate after intervention was significantly lower than before intervention(23.94%vs 35.45%).The difference was statistically significant(P<0.05).Conclusion:Off-label medication and unreasonable usage of antibacterial drugs are the main types of unreasonable usage of medical orders for inpatients in hospitals.The use of comments on medical orders and administrative intervention measures can help to reduce the unreasonable rate of medication ordered by inpatients and to ensure the rationality and safety of medication for patients.