分析医院门诊中药饮片处方存在的问题与对策

Analysis of the problems and countermeasures of prescriptions of Chinese herbal pieces in hospital outpatient department

目的对本院门诊中药饮片的处方进行点评和分析。方法随机抽取2017年5月~2018年4月每月中一天的中药饮片处方,共4012张。统计分析所有处方的年龄分布、药味数量、点评不合理情况。结果4012张处方中,不规范及不合理处方共249张(6.21%)。其中,患者年龄18~30岁的处方共45张,占18.07%;31~48岁的处方共52张,占20.88%;49~60岁的处方共48张,占19.28%;>60岁的处方共104张,占41.77%。年龄>60岁患者不规范及不合理处方占比最高,其次为31~48岁、49~60岁患者,最低为18~30岁的患者。249张不规范及不合理处方中,2~6味药处方共35张,占14.06%;7~12味药处方共38张,占15.26%;13~18味药处方共79张,占31.73%;≥19味药处方共97张,占38.96%,不规范不合理处方与药味数量呈正相关,药味越多,处方中不规范不合理情况越多。点评不合理中药饮片处方中,未标明调剂煎煮要求的152张,占61.04%;无中医证型的51张,占20.48%;无中医诊断的8张,占3.21%;辨证与用药不符的17张,占6.83%;用药不适宜的6张,占2.41%;用量不适宜的6张,占2.41%;给药途径有误的6张,占2.41%;口服药与外用药开在同一张处方上的有3张,占1.20%。结论中药饮片不规范及不合理处方占一定的比例,需提高临床处方质量,促进临床合理用药。

Objective To comment and analyze the prescriptions of Chinese herbal pieces in hospital outpatient department.Methods From May 2017 to April 2018,the prescriptions were selected one day a month for evaluation.A total of 4012 prescriptions of Chinese herbal pieces were reviewed.The age distribution,number of herbs and unreasonable comments of all prescriptions were analyzed statistically.Results Of the 4012 prescriptions,249 prescriptions(6.21%)were non-standard and irrational,with 45 prescriptions for patients aged 18-30 years,accounting for 18.07%,52 prescriptions for patients aged 31-48 years,accounting for 20.88%,48 prescriptions for patients aged 49-60 years,accounting for 19.28%,104 prescriptions for>patients aged 60 years,accounting for 41.77%.Patients aged>60 years had the highest proportion of non-standard and irrational prescriptions,followed by patients aged 31-48 years,49-60 years,and the lowest patients aged 18-30 years.Among 249 non-standard and irrational prescriptions,35 prescriptions had 2-6 kinds of herbs,accounting for 14.06%;38 prescriptions had 7-12 kinds of herbs,accounting for 15.26%;79 prescriptions had 13-18 kinds of herbs,accounting for 31.73%;97 prescriptions had≥19 kinds of herbs,accounting for 38.96%.Non-standardized and irrational prescriptions were positively correlated with the number of drugs.The more number of herbs there were,the more non-standard and irrational situations in the prescription.Among the irrational prescriptions for Chinese herbal pieces,152 prescriptions did not indicate the requirements for dispensing,accounting for 61.04%;51 prescriptions without traditional Chinese medicine syndrome types,accounting for 20.48%;8 prescriptions without traditional Chinese medicine diagnosis,accounting for 3.21%;17 prescriptions were found to be inconsistent between dialectics and medication,accounting for 6.83%;6 prescriptions with inappropriate medication,accounting for 2.41%;6 prescriptions with inappropriate dosage,accounting for 2.41%;6 cases with incorrect administration routes,accounting for 2.41%;3 prescriptions had oral and topical drugs in the same sheet,accounting for 1.20%.Conclusion The irrational prescriptions of Chinese herbal pieces account for a certain proportion.It is necessary to improve the quality of clinical prescriptions and promote rational clinical drug use.