FOCUS-PDCA模式在管理门急诊给药途径不合理处方中的应用

The application of FOCUS-PDCA model in the management of irrational drug delivery route in outpatient and emergency department

目的应用FOCUS-PDCA[find(发现)、organize(组织)、clarify(澄清)、understand(理解)、select(选择)-plan(计划)、do(实施)、check(检查)、action(处理)]管理工具降低门急诊处方中给药途径不合理发生率。方法采取分层随机抽样方法,抽取2020年1~3季度门急诊处方,通过药师三级点评,确定给药途径不合理的处方,通过鱼骨图分析探寻造成给药途径不合理的原因。2020年第4季度进行FOCUS-PDCA循环管理,对不合理处方通过院周会公示、专项点评反馈、完善电子信息系统、加强培训等方式进行干预。与2021年1~3季度数据进行对比,对于有效的解决对策,纳入医院管理制度并持续改进。结果2020年1~3季度共抽处方20059张,其中给药途径不合理处方32张,给药途径不合理率发生分别为0.09%(5/5,734)、0.14%(9/6,550)和0.23%(18/7,775),分析发现可能影响给药途径不合理的因素包括人员、药品、系统、管理和环境等几个方面。实施解决对策后,2021年1~3季度的给药途径不合理率为0.08%(7/8,983)、0.15%(14/9,342)、0.12%(11/9,133),与2020年同期相比,整体有所下降。在医生的认知不足和不同级别药师审核两方面差异有统计学意义(P<0.001)。结论运用FOCUS-PDCA管理工具在降低门急诊处方给药途径不合理发生率中初见成效。

Objective To lower the rate of irrational drug delivery route in outpatient and emergency department by applying the FOCUS-PDCA model(find,organize,clarify,understand,select&plan,do,check,action).Methods Stratified random sampling was used to select outpatient and emergency prescriptions from the first to third quarters of 2020.The irrational drug delivery routes were determined through the three-level comments of pharmacists,and the reasons for irrational drug delivery routes were explored through fishbone diagram analysis.In the fourth quarter of 2020,FOCUS-PDCA model was carried out to intervene irrational prescriptions through publicity of hospital weekly meetings,special comments and feedback,improvement of electronic information system and strengthening of training.Compared with the data from the first quarter to the third quarter of 2021,effective solutions were incorporated into the hospital management system and continuously improved.Results From the first quarter to the third quarter of 2020,a total of 20,059 prescriptions were collected.A total of 32 prescriptions with unreasonable route of administration were identified,with the rate of irrational drug delivery route in the first,second and third quarter of 2020 of 0.09%(5/5,734),0.14%(9/6,550)and 0.23%(18/7,775),respectively.Personnel,drug,system,management and environment were risk factors for irrational drug delivery route.After the implementation of the countermeasures,the irrational rate of drug delivery route in the first,second and third quarter of 2021 was 0.08%(7/8,983),0.15%(14/9,342),and 0.12%(11/9,133),respectively,showing an overall decrease compared with the same period in 2020.There were significant differences in the cognitive deficiency of doctors and review by pharmacists at different levels(P<0.001).Conclusion The application of FOCUS-PDCA model has achieved an initial success in reducing the irrational rate of outpatient and emergency prescription.