处方专项前置审核促进门诊合理使用抗菌药物的实践

Practice of Promoting Rational Use of Antibiotics in Outpatient Department by Special Prescription Pre-review

目的:为药师参与门诊抗菌药物管理以及促进门诊合理使用抗菌药物提供参考。方法:药师通过对我院使用的“逸曜合理用药管理软件”(简称“审方软件”)原有的抗菌药物使用规则进行梳理,并根据对抗菌药物处方进行事后点评发现的问题,重新设置用药规则、划分不合理用药等级、制定警示信息内容、建立轻-中度非复杂感染诊断数据库,然后采用系统审核与人工审核相结合的方式对门诊抗菌药物处方进行专项前置审核,并通过审方软件分别统计实施专项前置审核前(2020年第一季度)和实施专项前置审核后(2020年第二、三、四季度)门诊抗菌药物处方的相关数据。药师分别对2019年12月(实施专项前置审核前)和2020年12月(实施专项前置审核后)的抗菌药物处方进行事后点评,以评价抗菌药物处方专项前置审核对促进门诊合理使用抗菌药物的效果。结果:与2020年第一季度实施专项前置审核前相比,2020年第二季度实施专项前置审核后审方软件对抗菌药物处方的提示率显著降低、拦截率显著升高(P<0.05)。与2019年12月实施专项前置审核前比较,2020年12月实施专项前置审核后门诊抗菌药物处方在所有门诊处方中的占比以及抗菌药物二联处方在当月所有抗菌药物处方中的占比、适应证不适宜处方在当月所有抗菌药物处方中的占比均显著降低(P<0.01),而抗菌药物使用合理的处方在当月所有抗菌药物处方中的占比显著升高(P<0.01)。结论:药师结合院情实际建立门诊合理使用抗菌药物的规则,借助审方软件对门诊抗菌药物处方实施专项前置审核,可促进门诊合理使用抗菌药物。

OBJECTIVE:To provide reference for the participation of clinical pharmacists in outpatient antibiotics management so as to promote the rational use of antibiotics in outpatient department. METHODS:The pharmacist reset medication rules,classified irrational medication levels,formulated warning contents,and established a diagnosis database of mild to moderate noncomplex infections,according to the problems found in the post review of outpatient antibiotics prescription through sorting out the previous rules of antibiotics use in the Yiyao Rational Drug Use Management Software(called"review software"for short)in our hospital. The special pre-review was performed by using combination of system review and manual review. Pharmacists used the review saftware to count the data of outpatient antibiotics prescriptions before(the first quarter of 2020) and after(the second,third and fourth quarters of 2020)the implementation of special pre-review. The post review for antibiotics prescriptions in Dec.2019(before the implementation of special pre-review)and Dec. 2020(after implementation of special pre-review)were performed by pharmacists to evaluate the impact of the implementation of special pre-review on promoting rational use of outpatient antibitics.RESULTS:Comared with before the implementation of special pre-review in the first quarter of 2020,the prompt rate of the review software for antibiotics prescriptions was decreased,and the interception rate was increased after the implementation of special pre-review in the second quarter of 2020(P<0.05). Compared with before the implementation of special pre-review in Dec.2019,the proportion of outpatient antibiotics prescriptions in all outpatient prescriptions,the ratio of bi-antibiotics prescriptions in all antibiotics prescriptions in the same month,the ratio of prescriptions with unsuitable indications in all antibiotics prescriptions in the same month were all decreased significantly(P<0.01), while the ratio of prescriptions with rational antibiotics use in all antibiotics prescriptions in the same month was increased significantly(P<0.01).CONCLUSIONS:Pharmacists establishing a rule for rational use of antibiotics in outpatient department based on the hospital’s situation,implementing a special pre-review for antibiotics prescriptions with the help of review software,can promote the rational use of antibiotics in outpatient department.