药师维护门诊处方前置审核系统自定义规则的实践与讨论

Praxis and discussion of Pharmacists’Sustainable Improvement of the Customized Rules for Outpatient Prescription Pre-review System

目的:构建处方前置审核系统自定义规则库,提升门诊处方质量,促进合理用药。方法:引进处方前置审核软件,通过后台运行收集基于系统规则库的审方数据,药师利用循证方法,对“剂量范围”、“药物禁忌证”等模块进行精细化维护,构建该院特色的自定义规则库。分析前置审方上线后对该院门诊处方合格率、系统审核处方不合理后医师主动返回修改率、审方药师对不合理处方干预率的影响。结果:2022年1月至12月,药师共维护自定义规则5885条。门诊处方合格率由2022年4月份(前置审方上线前)的84.8%上升至2022年12月份(前置审方上线后8个月)的99.3%,医师在系统审核处方不合理后主动返回修改率由2022年1月份的3.47%上升至2022年12月份的67.21%,药师事前对不合理处方干预的成功率由2022年5月份的43.70%上升至2022年12月份的91.55%。结论:药师基于循证药学理论,持续维护前置审方自定义规则,能够有效提升门诊处方质量。

Objective:To establish a customized rule set for a prescription pre-review system to improve the quality of outpatient prescriptions and promote rational use of medicine.Methods:The prescription pre-review software was introduced to collect prescription review data based on a system rule base running in the background.Evidence-based methods were employed to fine-tune the maintenance of modules such as dose range and drug contraindications to build a rule set customized to the needs of the hospital.The impact of the pre-review prescription system on the hospital outpatient prescription qualification rate,the rate of physicians returning prescriptions for modification after system review of inappropriate prescriptions,and the rate of prior intervention by the prescribing pharmacist on irrational prescriptions were analyzed.Results:From January 2022 to December 2022,pharmacists maintained a total of 5885 customized rules.The pass rate for outpatient prescriptions increased from 84.8%in April 2022(before the launch of the pre audit party)to 99.3%in December 2022(after 8 months of the launch of the pre audit party),the rate of physician-initiated return for revision after system review of inappropriate prescriptions increased from 3.47%in January 2022 to 67.21%in December 2022,and the success rate of pharmacist prior intervention on irrational prescriptions increased from 43.70%in May 2022 to 91.55%in December 2022.Conclusion:Continuous maintenance and revision of the pre-view customized rules based on evidence-based pharmacy theory is an effective approach for pharmacists to promote the quality of outpatient prescription.