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基于MDT与循证助力处方前置审核系统适应症规则库优化与实践经验分享

Optimization of indication rule database in pre-prescription review systems supported by multidisciplinary teams and evidence-based medicine and practical experience sharing
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摘要 目的建立“本土化”的处方前置审核系统适应症规则库,总结实践经验,促进临床合理用药,为综合性公立医院的处方前置审核提供参考。方法通过对处方前置审核系统静默运行2个月(2022年7—8月)拦截的超适应症处方进行人工筛查,依据药品说明书、国内外临床指南和各专业循证医学证据制定适应症规则库。结果在系统上线预备期,审方公司按照“超适应症问题”将静默运行2个月55015条处方数据导出,提供本院药师进行人工审核,后经调整梳理思路“药品—适应症”,将导出的5万余条的问题处方简化为454个门诊药品对应的5387条超适应症问题,大幅度降低了药师人工筛查数量,提高筛查效率和质量。截至2023年8月,适应症规则共计维护31303条。经过规则优化,处方前置审核系统上线后,对比2022年静默运行的同期数据,2023年处方审核任务合格率由89.61%上升至92.63%。且随着处方前置审核系统的上线和规则的完善,处方审核任务合格率和药师干预有效率呈上升趋势,不合格任务数以及药师干预率呈下降趋势。结论在多学科合作与循证助力下,成功建立本院本土化的适应症规则库,为处方前置审核提供了技术支持。既能有效拦截不合理医嘱,又能避免过度干预,保障临床用药规范、合理,保障患者用药安全。 Objective To establish a“localized”indication rule database for pre-prescription review systems,summarize practical experience,promote rational clinical medication use,and provide a reference for pre-prescription audits in comprehensive public hospitals.Methods Through manual screening of over-indication prescriptions intercepted during the silent two-month operational period(July and August 2022)of the Prescription Pre-Audit System,rules were formulated based on package inserts and with reference to various professional evidence-based medical evidences,such as clinical guidelines at home and abroad.Results A total of 55,015 over-indication prescription data were intercepted during the two months of quiet operation of the prescription review system and submitted to senior pharmacists at our hospital for manual review.After adjusting the approach to sorting out unreasonable over-indication problems,the over fifty thousand over-indication issues were simplified to 5,387 over-indication issues corresponding to 454 outpatient medications,significantly reducing the number of manual reviews.As of August 2023,a total of 31,303 indication rules were maintained.The prescription review task pass rate increased from 89.61%to 92.63%in 2023 compared to the same period in 2022 after the implementation of the pre-prescription review system.Additionally,with the online implementation of the pre-prescription review system and the refinement of rules,the pass rate of prescription reviews and the effectiveness of pharmacist interventions have shown an upward trend,while the number of unqualified tasks and the rate of pharmacist interventions have shown a declining trend.Conclusions With the assistance of multidisciplinary collaboration and evidence-based support,a localized indication rule database for the pre-prescription review system was successfully established,providing technical support for pre-prescription reviews.This database can effectively intercept unreasonable prescriptions,avoid excessive intervention,ensure clinical medication is standardized and rational,and safeguard patient medication safety.
作者 李越然 李晓 李龙舟 余建国 栾家杰 Li Yueran;Li Xiao;Li Longzhou;Yu Jianguo;Luan Jiajie(Department of Clinical Pharmacy,the First Affiliated Hospital of Wannan Medical College,Wuhu,Anhui 241001,China)
出处 《齐齐哈尔医学院学报》 2024年第24期2369-2375,共7页 Journal of Qiqihar Medical University
基金 安徽省科技攻关计划面上项目(1604a0802097) 安徽省高校自然科学研究项目(KJ2021A0844)。
关键词 处方前置审核 适应症规则 循证实践 合理用药 Pre-prescribing review Indication rule Evidence-based practice Rational medication
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