区域性专项处方交叉点评体系的构建和点评结果分析

Construction of regional special prescription crossr-eview system and analysis of review results

目的通过建立区域性处方交叉点评体系,整体提升区域内医疗机构处方合理率。方法通过番禺区卫生健康局的行政支持,将区内14家医院分成三组每季度进行专项处方交叉点评。利用PDCA管理手段,抽取2019年第四季度至2022年第一季度各医院处方/医嘱进行抗菌药物专项、重点监控药品专项点评,并追踪整改。结果抗菌药物专项、重点监控药品专项处方不合理率干预前后各季度对比,差异有统计学意义(P<0.05)。干预后14家医院不合理率均有下降,抗菌药物专项结果显示10家医院干预前后各季度的不合理率比较,差异有统计学意义(P<0.05);重点监控药品专项结果显示11家医院干预前后各季度的不合理率比较,差异有统计学意义(P<0.05)。抗菌药物专项主要存在问题为“遴选的药品不适宜”“无适应证用药”“用法、用量不适宜”,干预后各问题出现率的比较,差异有统计学意义(P<0.05);重点监控药品专项主要存在问题为“无适应证用药”“适应证不适宜”“重复用药”,干预后各问题出现率的比较,差异有统计学意义(P<0.05)。结论利用PDCA管理模式建立区域性专项处方交叉点评体系,可以有效提升区域内医疗机构处方合理率,促进临床合理用药。

Objective To improve the overall prescription rationalization rate of medical institutions in the region by establishing a regional prescription cross-review system.Methods Through the administrative support of Panyu District Health and Health Bureau,14 hospitals in the region were divided into three groups to conduct special prescription cross-reviews every quarter.Using PDCA management tools,prescriptions/medical advice from the fourth quarter of 2019 to the first quarter of 2022 were selected from each hospital for special reviews of antimicrobial drugs and special reviews of key monitored drugs,and follow-up for rectification.Results The irrational rate of special prescriptions of antibiotics and key monitored drugs before and after intervention was compared in each quarter,and the difference was statistically significant(P<0.05).After the intervention,the irrational rate decreased in all 14 hospitals.The results of the special project of antibacterial drugs showed that the irrational rates of the 10 hospitals before and after the intervention were statistically significant(P<0.05).The results of the special project for key monitored drugs showed that the irrational rates of 11 hospitals before and after the intervention were compared in each quarter,and the difference was statistically significant(P<0.05).The main problems in the special area of antimicrobial drugs were"inappropriate selection of drugs""use of drugs without indications"and"inappropriate usage and dosage".The incidence of problems after intervention was compared,and the differences were statistically significant(P<0.05).The main problems in the special focus on monitoring drugs are"use without indication""inappropriate indication"and"repeated medication".The incidence of problems after intervention was compared,and the difference were statistically significant(P<0.05).Conclusion The use of PDCA management model to establish a regional special prescription cross-review system can effectively improve the prescription rationality rate in regional medical institutions and promote rational clinical use of drugs.