新建医院前置审方系统的建立和效果分析

Establishment and Effect Analysis of the Pre-review Prescription System in New Hospital

目的 结合苏州市独墅湖医院(苏州大学附属独墅湖医院)前置审方系统的建立及运行实践,探讨和分析前置审方系统在医疗机构合理用药方面的作用,并对运行中存在的问题进行分析和讨论,为医疗机构处方前置审核系统的完善提供理论及数据支持,促进临床合理用药。方法 通过苏州市独墅湖医院信息系统和审方系统分别调取2021年4~9月的门诊处方和住院医嘱(审方系统使用前)以及2022年4~9月的门诊处方和住院医嘱(审方系统使用后),比较系统运行前后的处方/医嘱合格率、主要不合理问题类型占比、处方干预成功率;分析评价前置审方系统在规范医生用药行为、促进临床合理用药中的效果,并对审方系统在运行中存在的问题进行分析总结。结果 (1)前置审方运行后,显著提高处方合理率,门诊处方合理率由86.92%上升至93.08%;(2)显著降低用法用量问题占比,由46.96%降为15.63%,而适应症、选择不适宜和重复用药问题占比显著增加;(3)显著升高住院病历医嘱合理率,由77.42%上升至83.79%;(4)显著提高处方干预成功率,由20.02%提高至80.48%。结论 前置审方系统可显著提高处方和医嘱合理率,提高干预成功率,实现高效快速审核,促进临床合理用药,但在审方系统运行当中也展现出一些不足,尚需不断完善和改进。

OBJECTIVE Based on the establishment and operation practice of the Pre-review prescription system in Suzhou Dushu Lake Hospital(Dushu Lake Hospital Affiliated to Soochow University),to explore and analyze the role of the Pre-review prescription system in rational drug use in medical institutions.Through the analysis and discussion of the existing problems in the operation,so as to provide theoretical and data support for the improvement of the pre-prescription review system in medical institutions and promote rational drug use in clinical practice.METHODS The outpatient prescriptions and inpatient medical orders from April to September 2021(before pre-review)and the outpatient prescription1s and inpatient medical orders from April to September 2022(after pre-review)were obtained through the Suzhou Dushu Lake hospital information system(HIS)and the Pre-review prescription system respectively.By comparing the qualified rate of prescription/medical orders,the proportion of major unreasonable problem types and the success rate of prescription intervention before and after system operation.To analyze and evaluate the effect of Pre-review prescription system in regulating doctors′drug use behavior and promoting clinical rational drug use,and to analyze and summarize the problems existing in the operation of Pre-review prescription system.RESULTS①After the pre-review prescription system was put into operation,the prescription qualification rate has increased from 86.92%to 93.08%.②The proportion of unreasonable prescriptions with usage and dosage were markedly reduced from 46.96%to 15.63%,while the proportion of unreasonable prescriptions with indications,unsuitable selection and repeated medication were significantly increased.③The medical order rationality rate of inpatient medical records was increased significantly from 77.42%to 83.79%.④The success rate of prescription intervention was significantly increased from 20.02%to 80.49%.CONCLUSION The pre-review prescription system can markedly improve the rational rate of prescriptions and medical orders,improve the success rate of prescription intervention,realize efficient and rapid review,and promote clinical rational drug use.However,there are also some defects in the operation of the pre-review prescription system,which need to be continuously improved.