某院1467张门急诊抗菌药物处方不合理用药因素的帕累托分析

Pareto Analysis of Unreasonable Medication of 1467 Prescriptions of Antibiotics in Outpatient and Emergency in a Hospital

目的:分析医院门急诊抗菌药物不合理使用的原因与特点,促进合理用药。方法:抽取2016年—2018年3年间诊疗的TOP 50医生开具的抗菌药物处方(10张/人,每月500张,计18000张),点评其用药的合理性,并将不合理用药处方按照不合理用药类型采用帕累托图找出其原因与对策。结果:18000张门急诊抗菌药物处方中,1467张处方存在不合理用药因素,其中遴选的药品、剂型、给药途径和用法用量不适宜(1046张占71.30%),次要因素为序贯选药不适宜(94例占6.41%)、无特殊情况下未优先选用基本药物(76例占5.18%)及治疗用抗菌药物合理疗程大于3 d(含3天以上()69例占4.70%)。结论:采用帕累托图分析导致不合理用药的主要因素,有效干预并制定改进方案,从而提高了门急诊抗菌药物临床用药的合理性。

Objective:To analyze the reasons and characteristics of unreasonable use of antibiotics in outpatient and emergency department,and to promote the rational use of antibiotics.Methods:The TOP 50 prescriptions of antibiotics issued by doctors in the three years from 2016 to 2018(10 prescriptions per person,500 prescriptions per month,a total of 18,000)were selected to comment on the rationality of their use,and the reasons and countermeasures of unreasonable prescriptions were found by using Pareto Chart according to the types of irrational medication.Results:18000 copies of this antimicrobial prescription,1467 drug prescription had unreasonable factors,including the selection of drugs,dosage form,drug delivery and usage;dosage was not suitable for 71.30%(1046),the secondary factor for sequential medicine choice was not suitable for 94 cases(6.41%),not in the absence of any special priority selection of essential medicines 76 cases(5.18%)and therapeutic use of antimicrobial agents was greater than the reasonable treatment 3 d(contain more than 3 days)69 cases(4.70%).Conclusion:The main factors that led to unreasonable drug use were analyzed by Pareto Chart,intervention and improvement plan was effectively made,so as to improve the rationality of clinical antibiotics medication of outpatient and emergency.