增设禁忌规则提高处方前置审核干预效果的药师实践

Pharmacists′practice of adding taboo rules to improve the intervention effect of prescription pre audit

目的通过增设禁忌规则,优化处方前置审核系统规则库,提高处方前置审核的干预效果。方法根据处方前置审核系统应用情况及医嘱错误严重程度,将审核规则分为“无效规则”“提示规则”“人工审核规则”“禁忌规则”,审方药师在循证证据支持的情况下,同时与临床医生进行沟通和反馈,将部分错误明确的“人工审核规则”提升为“禁忌规则”,提高禁忌规则的占比。结果共对798种药品增设了约1900余条禁忌规则,使禁忌规则总拦截率65.76%(6420/9763)、住院医嘱审核率15.16%(70888/467542)、审核干预率13.77%(9763/70888)、干预成功率85.99%(8395/9763)均高于设置前(P<0.01)。结论增设禁忌规则不仅可提高医嘱审核率,也可显著提高处方前置审核的干预率和干预成功率,值得临床推广。

Objective To add taboo rules,optimize the rule base of prescription pre audit system,and improve the intervention effect of prescription pre audit.Methods According to the application of prescription pre audit system and the severity of doctor′s order errors in our hospital,the audit rules are divided into“invalid rules”“prompt rules”“manual audit rules”and“taboo rules”.With the support of evidence-based evidence,phar-macists communicate with clinicians to upgrade some“manual audit rules”with clear errors to“taboo rules”,In-crease the proportion of taboo rules.Results More than 1900 taboo rules were added to 798 kinds of drugs,which made the total intervention rate of taboo rules 65.76%(6420/9763),the review rate of inpatient orders 15.16%(70888/467542),the review intervention rate 13.77%(9763/70888)and the success rate of intervention higher 85.99%(8395/9763)than before(P<0.01).Conclusion Adding taboo rules can not on-ly improve the re-view rate of medical orders,but also significantly improve the intervention rate and success rate of prescription pre review,which is worthy of clinical promotion.