多学科合作与循证助力处方前置审核模式构建

Construction of pre-prescription review mode based on multi-disciplinary team and evidence

目的:探讨华中科技大学同济医学院附属同济医院进行处方前置审核模式构建的实践经验,为综合性公立医院的处方前置审核模式提供参考。方法:借助合理用药监测系统,该院药学部、医务处、门诊办公室、临床各科室以及信息科多向沟通,共同制定基于循证且符合该院临床实践的个性化审方规则库。内容包括超多日用量、剂量范围、超说明书用药、重复用药、相互作用以及不良反应等27个模块。结果:截至2020年8月,该院已经对27个模块合计62149条规则进行个体化制定,既提高了处方合理率,又减少了系统假阳性问题对临床开具处方的干扰。从2019年5月份开始,门诊慢病处方、抗菌药物和辅助用药管控陆续上线。2019年门诊次均药费较2018年同比下降4.8%;Ⅰ类切口预防性抗菌药物使用率和特殊级抗菌药物使用率环比下降11.41%和11.98%;全院辅助用药占比环比降幅达18.45%;医生对于系统审核规则的接受度逐渐提高,达到91.15%。结论:基于多学科协作和循证实践的模式是顺利推进处方前置审核工作的必要条件,处方前置审核在一定程度上促进合理用药,防范医疗风险,值得推广。

OBJECTIVE To explore the practice experience of pre-prescription review mode at our hospital and provide references for a pre-prescription review of public general hospitals.METHODS With the prescription automatic screening system,pharmacy department,medical affairs,outpatient office,clinical departments and information division jointly developed a personalized and evidence-based review rule base in line with institutional clinical practices.The rule base included 27 modules including ultra-multiple daily dosage,dosage range,off-label medication,repeated medication,interactions and adverse reactions,etc.RESULTS As of August 2020,a total of 62149 rules for 27 modules have been individually formulated.It not only improved the rationality rate of prescriptions,but also lowered the interference of false positives for clinical prescriptions.Since May 2019,the prescriptions for chronic outpatient diseases,antibiotics and adjuvant drugs have been gradually controlled.The average outpatient drug cost in 2019 decreased by 4.8%as compared with 2018.The proportion of prophylactic use of antibiotics for clean incision surgery and special-grade antibiotics decreased by 11.41%and 11.98%month-on-month respectively.The proportion of adjuvant drugs decreased by 18.45%month-on-month.Physician acceptance of system review rules gradually increased and reached 91.15%.CONCLUSION Multidisciplinary collaboration and evidence-based practice are necessary for smoothly advancing the pre-prescription review work.To a certain extent,it not only promotes rational drug use but also prevents medical risks.A wider popularization is recommended.