某三级综合医院住院医嘱前置审核模式实践效果评价研究

Research on the Practice Effect Evaluation of the Pre-checking Mode of Inpatient Medical Orders in a Tertiary General Hospital

目的:探讨某三级综合医院住院医嘱前置审核模式运行实践经验,旨在为其他医院开展住院医嘱前置审核工作提供参考。方法:通过采取不断优化信息系统、审方药师资质与能力、药品规则维护等多维度措施,比较优化前后人工审核漏审率及医嘱合理率,评价处方前置审核实践效果。结果:优化后漏审医嘱由34.27%下降至10.72%(P<0.01);医嘱合理率由99.27%上升至99.31%(P<0.01);不合理医嘱类型排名前3的分别为用法用量、配伍禁忌、给药途径,用法用量超说明书用药现象存在,药师较难干预。结论:我院优化后的住院医嘱前置审核工作模式,提高了我院人工审核处方比例,减少了不合理住院医嘱漏审率,完善了医嘱前置审核工作和制度,提高了医院合理用药水平,运行效果较好;住院医嘱超说明书用药现象较为普遍,有待进一步规范。

Objective:To explore the operational experience of pre-checking mode of inpatient medical orders in a tertiary comprehensive hospital,in order to provide reference for the development of pre-checking of inpatient medical orders in other hospitals.Methods:Through taking multidimensional measures such as constantly optimization of the information system,reviewing the qualification and ability of pharmacists,maintaining drug rules,the rate of manual check missed review and the qualified rate of medical orders before and after optimization were compared,and the practice effect of prescription pre-checking was evaluated.Results:Compared with the control group,missed review medical orders in the intervention group decreased,from 34.27%to 10.72%(P<0.01).The qualified rate of medical advice increased from 99.27%to 99.31%(P<0.01).The top 3 types of unreasonable medical orders were usage and dosage,incompatibility and administration route,respectively.The phenomenon of off-label use of usage and dosage exists,and it is difficult for pharmacists to intervene.Conclusion:The optimized pre-checking of inpatient orders can in our hospital has improved the proportion of manual review of prescriptions,reduced the rate of missed review of unreasonable inpatient medical orders,improved the pre-checking work and system of medical orders,and improved the level of rational drug use in the hospital,and the operation effect is significant.The phenomenon of off-label drug use in inpatient orders is relatively common,which needs to be further standardized.