大型公立医院药事管理的精细化实践与探索

Refined practice and exploration of pharmaceutical management in large public hospitals

目的探索科学有效的医院药事管理措施,形成长效管控机制,促进合理用药,提升医院医疗质量和医疗安全。方法药学部合理用药管理小组以“优化药品结构”与“促进合理使用”为两大切入点,从“事前预控(用药结构调整及预算管理)-事中干预(药师审核及责任包干制)-事后考核(点评及12分驾照式管理)”实现全链条、精细化用药管理。结果临床药师科室用药指标“责任包干制”,促使工作由被动变主动;创新多维对比用药评价模式,有效提高临床接纳率;注重全方位利用信息手段,提高管理效率;考核结果采用12分“驾照式”管理,形成长效机制。医院各项药事管理指标明显提升,合理用药指标实现“三升一降”,即点评处方占比由4.99%提升至30.52%,门诊患者基本药物使用占比由51.26%提升到58.51%,住院患者基本药物使用率由94.93%提升到98.27%,集中采购中标药品使用占比由87.39%提升到88.42%,而抗菌药物使用强度由35.12降低到34.62,减轻了患者就医负担,提高了患者满意度,增强了医院的社会影响力。结论围绕合理用药进行持续改进,实践探索形成覆盖全链条、精细化药事管理机制,有助于促进医院合理用药高质量提升。

AIM To explore scientific and effective hospital pharmaceutical management measures,form a longterm control mechanism,promote rational drug use,and improve hospital medical quality and medical safety.METHODS The rational drug use management team of the department of pharmacy took"drug structure optimization"and"rational use promotion"as 2 starting points,and realized the whole chain and refined drug use management from"pre-control(drug structure adjustment and budget management)-intervention in the matter(pharmacist audit and responsibility system)-post-assessment(comments and 12-point driver's license management)".RESULTS The drug index of clinical pharmacists department"responsibility system"promoted the work from passive to active.The introduction of an innovative multidimensional comparative drug evaluation model effectively improved the clinical acceptance rate.Great emphasis was being placed on the full utilization of information methods to increase management efficiency.Assessment results were managed with 12-point driver's license management to form a long-term mechanism.Indicators of pharmaceutical management in the hospital improved significantly,and indicators of rational drug use achieved"three increases and one decrease".Specifically,the proportion of outpatient reviewed prescriptions had increased from 4.99%to 30.52%,the proportion of essential drugs use in outpatients had risen from 51.26%to 58.51%,the utilization of essential drugs in inpatients had improved from 94.93%to 98.27%,and the proportion of bid-winning drugs in centralized procurement had increased from 87.39%to 88.42%.Meanwhile,the intensity of antimicrobial use had decreased from 35.12 to 34.62.The above developments had collectively reduced the financial burden on patients seeking medical treatment,improved patient satisfaction levels,and enhanced the hospital's reputation and social influence within the community.CONCLUSION Continuous improvement around the rational use of medication,and the practical exploration to form a comprehensive and refined drug management mechanism covering the entire chain,helps to promote the highquality enhancement of rational medication use in hospitals.