北京协和医院2015—2019年门急诊抗菌药物处方点评结果与分析

Assessment results and analysis on outpatient and emergency antimicrobial prescriptions in Peking Union Medical College Hospital from 2015 to 2019

目的探讨门急诊抗菌药物处方点评模式,为抗菌药物的使用和管理提供借鉴。方法采用处方点评软件随机抽取2015年2月—2019年8月某院门急诊抗菌药物处方,由调剂药师、临床药师初评和专家复评点评抗菌药物不合理处方及其涉及的问题,比较不同年度抗菌药物处方不合理情况,以及临床药师与专家点评不一致情况。结果门诊抗菌药物不适宜处方率从2015年的1.05%(372/35446)下降至2019年的0.18%(73/39719),急诊从2015年的0.43%(75/17432)下降至2019年的0.13%(24/18657),均呈逐年下降趋势(均P<0.05)。抗菌药物处方不适宜主要是用法用量不适宜(1209/1468,82.36%)。2015—2019年临床药师初评与专家复评不一致率为10.29%~12.46%。结论抗菌药物的管理工作颇有成效,后续可改进抗菌药物处方点评流程和方法。

Objective To explore the assessment modes of outpatient and emergency antimicrobial prescriptions,and provide reference for the use and management of antimicrobial agents.Methods Outpatient and emergency antimicrobial prescriptions in a hospital from February 2015 to August 2019 were randomly selected by prescription assessment software.The irrational prescriptions of antimicrobial agents and involved problems were initially assessed by dispensing pharmacists and clinical pharmacists and then re-assessed by experts,the irrational prescriptions of antimicrobial agents in different years and inconsistent assessment between clinical pharmacists and experts were compared.Results The inappropriate prescription rate of outpatient antimicrobial agents decreased from 1.05%(372/35446)in 2015 to 0.18%(73/39719)in 2019,and that in emergency department decreased from 0.43%(75/17432)in 2015 to 0.13%(24/18657)in 2019,presenting a downward trend year by year.The main inappropriate prescription of antimicrobial agents was inappropriate usage and dosage(1209/1468,82.36%).From 2015 to 2019,the inconsistency rates of initial assessment of clinical pharmacists and the re-assessment of experts were 10.29%-12.46%.Conclusion Management of antimicrobial agents is quite effective,and assessment process and method of prescription should be improved in the future.