门诊处方审核系统规则库药师维护实 践

Practice and Discussion of Pharmacists’ Continuous Refinement of the Rule Settings inthe Prescription Review System for Outpatient Service

目的探讨门诊药师处方审核工作持续改进方法。方法北京市某三甲综合医院门诊药师通过对处方审核从药品适应证与用法用量、给药途径与用法用量、禁忌证、重复用药、超适应证以及医院信息系统(HIS)中药品规格单位与处方审核系统限量单位匹配等途径,实施基础规则库持续自主维护。分析持续改进6个月对门诊处方不合格率、处方审核药师干预不合理处方成功率、处方审核系统假阳性率的影响。结果该院门诊药师对处方审核系统基础规则库进行自主维护修订6个月以来,共修订审核规则137条,涉及的主要规则类型为“用法用量”(24.8%)、“禁忌证”(21.9%)、“重复用药”(17.5%)和“适应证”(16.1%)等;门诊处方不合格率从0.54%降至0.22%(降幅近60.0%),并呈现持续下降趋势;药师事前通过处方审核系统干预不合理处方成功率由84.0%上升至92.0%,系统审核假阳性率从78.0%下降至45.0%。结论药师对处方审核软件基础规则库进行持续自主维护修订是提升门诊处方审核工作质量的有效方法。

Objective To explore the methods for continuous improvement of the prescription review system for outpatient service.Methods The pharmacists in a large hospital in Beijing provided continuous maintenance of the basic rule database of the prescription checking system,such as setting refinements in the indications-usage,administration route-usage,contraindications,repeated medication,and off-label use of drugs.And the drug prescription units in the Health Information System(HIS)system were matched with the limit dose units set by the prescription audit system.The influence of the continuous improvement on the irrational rate of outpatient prescription,the success rate of irrational prescription intervention by the pharmacists via the system,and the false positive rate of the system checking for 6 months was analyzed.Results The pharmacists in the hospital has independently maintained and revised a total of 137 basic rules of the prescription review system over the past six months.The main rule types involved were usage(24.8%),contraindications(21.9%),repeated medication(17.5%)and indications(16.1%).The irrational rate of outpatient prescription dropped from 0.54%to 0.22%(a decrease about 60.0%),and showed a continuous downward trend.The success rate of irrational prescription intervention by the pharmacists via the system increased from 84.0%to 92.0%,and the false positive rate of the system decreased from 78.0%to 45.0%.Conclusion Continuous and independent maintenance,and revision of the basic rule database of the prescription review system is an effective method for pharmacists to improve the quality of the prescription review for outpatient.