某三甲医院中药饮片处方中的配伍问题及改善对策

Incompatibility Problems of TCM Decoction Pieces Prescription in Grade A Tertiary Hospital and Countermeasures for Improvement

目的探讨三甲医院中药饮片处方配伍问题,并提出相应改善政策,为临床提供参考。方法自某三甲医院的医院信息系统(HIS)中每月按比例随机抽取2023年7月至2024年6月门诊患者的中药饮片处方6563张,均实施了中医处方药学服务;对纳入处方的基本情况进行分析,并对处方配伍禁忌、用药问题等等进行分析,并提出相应的改善政策。结果本组6563张中药处方主要涉及脾胃、肝胆、心血管等方面的病症,所开具的中药处方中,饮片种类数量均为12种,每剂药物总量为100 g以内占比72.04%。通过分析,共存在274张不合理处方,占比为4.17%,主要包括辨证不全、用药不适宜、特殊煎法错误、用法错误、毒性药物使用过量及配伍禁忌等,分别占到18.98%、15.33%、20.07%、16.42%、15.69%、13.50%,应根据实际需要制订改善对策。结论在临床应用中药饮片中,中药师需对处方进行点评,并可结合处方点评结果,通过针对性措施解决存在的处方问题,以确保用药有效性和安全性,提高医院中医医疗水平。

Objective To explore the prescription compatibility of TCM decoction pieces in grade A tertiary hospital,and put forward corresponding improvement policies,so as to provide reference for clinical practice.Methods From July 2023 to June 2024,6563 TCM decoction pieces prescriptions of outpatients were randomly selected from the information system(HIS)of grade A tertiary hospital every month,and the TCM prescription medicine service was implemented.The basic situation of the prescription was analyzed,and the prescription incompatibility and drug use problems were analyzed,and the corresponding improvement policies were put forward.Results The 6563 TCM prescriptions were mainly related to spleen and stomach,liver and gallbladder,cardiovascular diseases,etc.The number of TCM slices used in the prescription was 12,and the total dosage of each dose was less than 100 g,accounting for 72.04%.According to the analysis,there were 274 irrational prescriptions,accounting for 4.17%,which mainly included incomplete differentiation of syndromes,inappropriate drug use,special decoction errors,usage errors,toxic drug overuse and incompatibility,accounting for 18.98%,15.33%,20.07%,16.42%,15.69%,13.50%,respectively.Improvement measures should be formulated according to actual needs.Conclusions In the clinical application of TCM decoction pieces,TCM pharmacists need to review the prescription,and can solve the existing prescription problems through targeted measures based on the results of prescription review,so as to ensure the effectiveness and safety of medication and improve the level of TCM medicine in hospitals.