区域性抗菌药物处方交叉点评体系的建立与不合理处方分析

Construction of Regional Antimicrobial Prescription Cross-Review System and Analysis of Irrational Prescriptions

目的 通过建立区域性处方交叉点评体系,对不合理处方进行分析整改,提高处方合理率。方法 在番禺区卫生健康局的行政干预下,抽取番禺区14家公立医院2019~2021年间5个季度抗菌药物处方/医嘱共20 426份进行医院间分组交叉点评,以2019年第4季度作为干预前组,对不合理处方进行帕累托图分析,2020年第2、4季度和2021年第2、4季度作为干预后组,利用PDCA管理模式追踪整改并使用卡方检验对比干预前后处方不合理率。结果 干预前组主要存在问题为“遴选的药品不适宜”“无适应证用药”“用法、用量不适宜”,与干预后不合理率进行对比,差异有统计学意义(P<0.05);各季度处方总体不合理率干预前后对比,差异有统计学意义(P<0.05)。结论 通过建立区域性专项处方点评体系,对不合理处方分析、总结和改进,可提高医生用药水平,促进药师学习掌握专业技能,从而降低处方不合理率,保障用药安全。

OBJECTIVE To establish a cross-review system of regional prescriptions to analyze and rectify unreasonable prescriptions,improving the rational rate of prescriptions.METHODS Under the administrative intervention of Panyu District Health Bureau,a total of 20 426 antimicrobial prescriptions/medical orders were selected from 14 public hospitals in Panyu District in five quarters from 2019 to 2021 for cross-review among hospitals.The fourth quarter of 2019 was used as the pre-intervention group to conduct Pareto diagram analysis for irrational prescriptions,the second and fourth quarters of 2020 and the second and fourth quarters of 2021 were used as the post-intervention group to track the rectification using PDCA management model and compare the irrational rate of prescriptions before and after the intervention using Chi-square test.RESULTS The main problems in the pre-intervention group were "inappropriate selection of drugs","no indication of medication","inappropriate usage and dosage",which were compared with the unreasonable rate after intervention,and the difference was statistically significant(P<0.05).The overall irrational rate of prescriptions in each quarter was compared before and after the intervention,and the difference was statistically significant(P<0.05).CONCLUSION The establishment of a regional special prescription review system can improve the unreasonable prescription analysis,summary and improvement,improve the level of doctors' medication,promote pharmacists to learn professional skills,so as to reduce the irrational prescription rate and ensure the safety of medication.