医院发热门诊智慧药房探索实践

Exploration and Practice of Smart Pharmacy in Fever Clinic of a Hospital

目的 探讨数字化医疗与疫情常态化防控背景下建立智慧药房药学服务新模式的意义。方法 医院以发热门诊药房为试点,引入智慧化药品调剂模式,以智慧合理用药决策系统建立“人工+智能”处方审核模式,提供智慧化用药咨询,优化数字化调剂流程,逐步构建智慧药房。收集发热门诊2021年1月至12月的处方,从调配处方量、处方合理性、设备误差发生情况、人力成本、患者满意度5个方面分析智慧药房的应用效果。结果 收集发热门诊处方11 779张,其中自助发药机发药10 749张(91.26%),含抗菌药物/抗病毒药物处方3 914张(33.23%),含中成药处方1 657张(14.07%)。不合理处方248张(2.11%),其中不规范处方109张(43.95%),主要问题为临床诊断不全(40.32%);不适宜处方139张(56.05%),主要问题为抗菌药物的用法用量不适宜(32.66%)、联合用药不适宜(14.11%)、给药途径不适宜(9.27%);无超常处方。自助发药机不良事件共151件,出药差错原因主要为视觉系统识别故障(22.52%)、机器库存不足(19.21%)、库存盘点计数误差(18.54%)等。调剂流程优化后,患者取药平均等候时长由28.61 min缩短至9.38 min,就诊满意度评分由63.26分升至78.91分。结论 智慧药房有助于药学服务全流程的数字化,为数字医疗的发展提供了参考。

Objective To investigate the significance of constructing a new mode of pharmaceutical care in smart pharmacy under the background of digital medical care and regular epidemic prevention and control.Methods The fever outpatient pharmacy in the hospital was taken as a pilot,the smart drug dispensing mode was introduced,the"artificial+smart"prescription review mode was constructed by the smart rational medication decision-making system,the smart medication consultation was provided,the digital dispensing process was optimized,and the smart pharmacy was constructed gradually.The prescriptions of fever clinic from January to December 2021 were collected,and the application effect of smart pharmacy was analyzed from five aspects:quantity of prescription dispensing,rationality of prescription,incidence of equipment error,human cost and patient satisfaction.Results A total of 11779 prescriptions were collected from fever clinic,including 10749 prescriptions(91.26%)dispensed by the self-service dispensing machine,3914 prescriptions(33.23%)containing antibacterial/antiviral drugs and 1657 prescriptions(14.07%)containing Chinese patent medicine.There were 248 unreasonable prescriptions(2.11%),including 109 non-standard prescriptions(43.95%),with the main problem of incomplete clinical diagnosis(40.32%).There were 139 improper prescriptions(56.05%),and the main problems were improper usage and dosage of antibacterial drugs(32.66%),improper combination of drugs(14.11%)and improper route of administration(9.27%).There was no extraordinary prescription.There were 151 adverse events induced by the self-service dispensing machine,and the main causes of dispensing errors were identification failure of visual system(22.52%),insufficient inventory in machine(19.21%)and count error of inventory checking(18.54%).After the optimization of the dispensing process,the patients'average waiting time to get medicine decreased from 28.61 min to 9.38 min,and the satisfaction score of patients increased from 63.26 points to 78.91 points.Conclusion The constructing of smart pharmacy promotes the digitalization of the whole process of pharmaceutical care,which provide a reference for the development of digital medical care.