住院医嘱前置审方异步模式的构建与实践效果

Construction of an Asynchronous Mode of Inpatient-Order Pre-Prescription Review and Its Application Effect

目的构建住院医嘱前置审方异步模式(简称异步审方模式),并评价其实践效果。方法审方中心联合医务部、护理部、信息科等部门,根据住院医嘱开具及流转的特点,在门诊同步审方模式基础上,增加护士站审核环节,构建同一条医嘱分为“护士站”和“审方中心”的异步审方模式。选取医院2022年10月至12月(同步审方模式)和2023年1月至9月(异步审方模式)的审方系统数据,比较审方模式改进前后医嘱审方流程变化,包括问题医嘱是否锁定、药师审核医嘱数量、系统审核超时通过(简称超通)时限、药师审方时间、问题医嘱超通数量;统计异步审方模式下审方质量控制数据的变化,包括药师审核医嘱数量、干预修改率、假阳性问题医嘱拦截率和假阴性问题医嘱拦截率,并对问题医嘱的干预类型及其原因进行分析。结果与同步审方模式比较,异步审方模式药师审方时问题医嘱暂存在护士站;药师审方时间显著更长(P<0.001);问题医嘱超通率显著更低(2.25%比12.63%,P<0.001)。实施异步审方模式后,系统主要审核模块由5个增至9个,药师审核医嘱数从412条/月升至1154条/月,干预修改率由75.39%升至80.86%,假阴性问题医嘱拦截率由0.091%降至0.030%,但假阳性问题医嘱拦截率由14.00%升至15.54%。干预问题医嘱类型中,用法用量和重复用药问题占比较高(分别为40.73%,20.36%);诊断与用药问题、联合用药不适宜的干预修改率较低,分别为58.57%,61.18%。结论异步审方模式可帮助医师流畅地开具医嘱,协助药师更好地开展合理用药工作,提升住院医嘱审方工作质量。

Objective To construct an asynchronous mode of inpatient-order pre-prescription review(referred to as asynchronous prescription review mode),and to evaluate its application effect.Methods The prescription review center combined with the medical department,nursing department,information department,and other departments,based on the characteristics of inpatient order issuance and circulation,a nurse station review process was added to the synchronous mode of inpatient-order prescription review,and an asynchronous prescription review mode with"nurse station"and"prescription review center"was constructed.The hospital prescription review system data from October to December 2022(synchronous prescription review mode)and January to September 2023(asynchronous prescription review mode)were selected,the changes in the prescription review process before and after the improvement of the prescription review mode were compared,including whether problem orders are locked,the number of orders reviewed by pharmacists,the time limit of system review timeout(referred to as timeout),pharmacists′prescription review time,and the number of problem orders passed after timeout.Statistical analysis was conducted on the changes in quality control data of prescription review under asynchronous prescription review mode,including the number of pharmacist review orders,intervention modification rate,and order interception rates of false positive and false negative problems.The intervention types and reasons for problem orders were analyzed.Results Compared with the synchronous prescription review mode,the asynchronous prescription review mode temporarily stored problematic medical orders in the nurse station during pharmacist prescription review.The pharmacists′prescription review time was significantly longer(P<0.001),and the pass rate of problem orders was significantly lower(2.25%vs.12.63%,P<0.001).After implementing the asynchronous review mode,the main review modules of the system increased from 5 to 9,the number of pharmacists′reviews orders increased from 412 to 1154 per month,the intervention modification rate increased from 75.39%to 80.86%,the interception rate of false negative orders decreased from 0.091%to 0.030%,but the interception rate of false positive orders increased from 14.00%to 15.54%.Among the types of intervention problem orders,the proportion of usage and dosage(40.73%),and repeated medication(20.36%)was relatively high.The intervention modification rates for diagnosis and medication issues(58.57%),and inappropriate combination therapy(61.18%)were relatively low.Conclusion Asynchronous prescription review mode can help physicians toissue medical orders more smoothly,assist pharmacists in carrying out rational drug use work better,and improve the quality of inpatient prescription review work.