某院门急诊处方前置审核系统不合理医嘱拦截情况分析

Analysis of Interception of Irrational Medical Orders by the Prescription Pre-Review System of Outpatient and Emergency in a Hospital

目的 促进临床安全、合理用药。方法 收集首都医科大学附属北京积水潭医院2022年11月至2023年10月的门急诊处方前置审核系统审核的西药医嘱,分析不合理医嘱发生情况。结果 共收集医嘱3 230 289条,其中不合理医嘱68 730条(2.13%),不合理医嘱的主要类型为适应证不适宜(49 162条,71.53%),次要类型为重复用药(9 629条,14.01%),其余均为一般类型(包括用法用量不适宜、配伍禁忌/不良药物相互作用、遴选药品不适宜、药品剂型/给药途径不适宜、多重因素不适宜等)。适应证不适宜医嘱较多的原因包括部分医师对医院新增药品的适应证欠熟悉,系统判断受到假阳性干扰等;重复用药医嘱较多的原因包括某些复方制剂药品有效成分、功能主治相对复杂,部分医师尚不完全熟悉,以及序贯治疗方案引起的假阳性情况等。结论 处方前置审核系统的应用可有效避免用药错误的产生,减少不合理药费支出。针对系统判定结果中存在的假阳性、假阴性情况,需不断更新完善系统数据库,药师也应不断提升自身的专业知识,同时与医师紧密配合,不断提升医嘱审核的质量,促进临床合理用药。

Objective To promote the safe and rational use of drugs in clinical practice.Methods The medical orders involving western medicines reviewed by the prescription pre-review system of outpatient and emergency in the Beijing Jishuitan Hospital,Capital Medical University from November 2022 to October 2023 were collected,and the rationality of medical orders was analyzed.Results A total of 3230289 medical orders were collected,of which 68730 were irrational(2.13%);the irrational medical orders were mainly induced by inappropriate indications(49162 cases,71.53%),followed by repeated medication(9629 cases,14.01%),and the others were all induced by general irrationality,including inappropriate usage and dosage,incompatibility of drugs/adverse drug-drug interactions,inappropriate drug selection,inappropriate drug dosage form/administration route and inappropriate multiple factors.The inappropriate indications were mainly induced by some physicians′unfamiliarity with the indications of newly-added drugs in the hospital and false positives in the system judgment.The repeated medication were mainly induced by some physicians′unfamiliarity with the active ingredients,functions and indications of some compound preparation due to their complexity and the false positives caused by sequential treatment regimen.Conclusion The application of prescription pre-review system can effectively avoid the medication errors and decrease the irrational medication costs.For the false positives and false negatives in the system judgment,hospitals need to constantly update and improve the database;pharmacists should continuously increase their professional knowledge,and closely cooperate with physicians to continuously improve the quality of medical order review and promote the rational drug use in clinical practice.