帕累托图分析结合专项处方点评对门诊合理用药的促进作用

Promotion Effect of Pareto Diagram Analysis Combined with Special Prescription Comment on Outpatient Rational Drug Use

目的:研究帕累托图分析结合专项处方点评对门诊合理用药的促进作用,为优化门诊用药提供相应指导。方法:选取2022年1月—2024年2月唐河县卫生学校附属医院西药房3631张处方作为研究资料。将其中2022年1月—2023年7月优化前的1758张处方作为优化前组,2023年8月—2024年2月优化后的1873张处方作为优化后组。使用帕累托图分析结合专项处方点评优化前组处方不合理用药的因素,比较两组处方的医嘱合理率。结果:优化前,1758张处方中不合理用药处方77张,不合理处方率为4.38%。根据专项处方点评指南将其不合理用药处方的问题类型分为9类,其中适应证不适宜处方占比最高(40.26%),其次为临床诊断书写不全(22.08%)。帕累托图分析结果显示,适应证不适宜、临床诊断书写不全及用法用量不合适为主要因素,抗菌药物的开具不符合规定及临床诊断不规范为次要因素,联合用药不合适、药品剂型及给药途径不合适、遴选药物不合适、重复给药为一般因素。优化后,处方医嘱不合理率较优化前降低,差异有统计学意义(χ^(2)=29.450,P<0.05)。结论:结合帕累托图分析和专项处方点评可明确门诊用药的合理性,为促进合理用药奠定基础。

Objective:To study the promotion effect of Pareto diagram analysis combined with special prescription comment on department rational drug use,so as to provide guidance for optimizing outpatient drug use.Methods:A total of 3631 prescriptions from the pharmacy of Tanghe County Health School Affiliated Hospital from January 2022 to February 2024 were selected as the research data.1758 prescriptions from January 2022 to July 2023 and 1873 prescriptions from July 2023 to February 2024 were divided into before and after optimization group.Pareto diagram analysis combined with special prescription comment was used to analyze the factors that constituted irrational prescriptions,and the rational rate of prescription orders before and after optimization was compared.Results:There were 77 irrational prescriptions among 1758 outpatient prescriptions,and the irrational prescription rate was 4.38%.According to the special prescription comment guidelines,the problem types of irrational drug use prescriptions were divided into 9 categories.The proportion of inappropriate indications was the highest(40.26%),followed by incomplete clinical diagnosis writing(22.08%).Inappropriate indications,incomplete clinical diagnosis writing and inappropriate usage and dosage were the main factors.The non-compliance of the prescription of antibacterial drugs and the non-standard clinical diagnosis were the secondary factors.Inappropriate drug combination,inappropriate drug dosage form and route of administration,inappropriate selection of drugs and repeated administration were general factors.After optimization,the irrational rate of prescriptions was lower than that before optimization(χ^(2)=29.450,P<0.05).Conclusion:Pareto diagram analysis combined with special prescription comment can clarify the rationality of outpatient drug use,and lay a foundation for promoting rational drug use.