围术期质子泵抑制剂质控模式的建立及效果

Quality control model of perioperative proton pump inhibitor:establishment and effect

目的建立围术期质子泵抑制剂(PPI)质控模式,并评价其应用效果。方法通过“处方前置审核、病历点评、PDCA循环法及行政辅助”的四维管理,建立围术期PPI的质控模式。分析实施质控后围术期PPI问题医嘱数量及不合理用药类型的变化。结果2019年7~12月期间,围术期PPI的医嘱从1230条减少至766条,下降37.72%;提示医嘱从717条减少至316条,下降55.93%;临床医生对问题医嘱主动修改率从17.71%(127/717)提高到33.54%(106/316),问题医嘱占比从47.97%(590/1230)下降至27.42%(210/766);围术期PPI不合理用药病历从7月的98份下降到12月的35份,下降幅度为64.29%;不合理用药类型主要为预防用药不适宜及给药途径不适宜。结论通过建立有效的围术期PPI质控模式,对其持续循环改进,加强医学与药学不同知识领域的相互补充,利用医学信息化数据的管理和支持,能更好地促进围术期PPI合理用药。

Objective To establish the quality control model of perioperative proton pump inhibitor(PPI),and to assess its application effect.Methods Through the four-dimensional management of"prescription pre-audit,medical record review,PDCA cycle method and administrative assistance",the quality control model of perioperative PPI was established.Changes in the number of defective physician orders and the category of non-rational use of drug involving PPI during perioperative period were analyzed after the implementation of quality control.Results From July to December,2019,the number of perioperative physician orders involving PPI dropped from 1230 to 766 by 37.72%;the number of prompt orders dropped from 717 to 316 by 55.93%;in clinicians the proactive modification rate of defective physician orders increased from 17.71%(127/717)to 33.54%(106/316),and the proportion of defective physician orders decreased from 47.97%(590/1230)to 27.42%(210/766);the number of medical records concerning perioperative non-rational use of PPI dropped from 98 copies in July to 35 copies in November,with a decrease rate of 64.29%.The majority of non-rational use of drug was unadvisable prophylactics and unadvisable medication approaches.Conclusion Promoting perioperative rational use of PPI preferably is achieved by establishing a model of effective perioperative PPI quality control,carrying out continuous cycle improvement,strengthening the mutual complementation of different knowledge areas of medicine and pharmacy,and utilizing the management and support of medical information data.