重庆市16家市属医疗机构处方集中点评情况分析-中国药房

重庆市16家市属医疗机构处方集中点评情况分析

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篇名：	重庆市16家市属医疗机构处方集中点评情况分析
TITLE：
摘要：	目的：为改进重庆市医疗机构处方点评工作模式、提高合理用药水平提供参考。方法：由重庆市卫生和计划生育委员会组建处方点评专家组，采用等距离抽样法从16家市属医疗机构的呼吸内科、普外科和感染科中抽取2017年8月23日和9月13日的门急诊处方1 600余张、住院医嘱300余份。对门急诊处方的3项核心指标（抗菌药物使用率、抗菌药物联合使用率、辅助用药使用率）及其中的不规范处方、不适宜处方及超常处方，住院医嘱中的特殊使用级或价格昂贵的抗菌药物及辅助药物等使用情况开展专项点评。结果：门诊处方抗菌药物使用率为9.28％（低于20％），急诊处方抗菌药物使用率为23.83％（低于40％）；抗菌药物联合使用率为3.04％，辅助用药使用率为5.02％；不合理处方率为 21.03％，包括抗菌药物使用不合理、辅助用药使用不合理、临床诊断书写不全、适应证不适宜、遴选药品不适宜、给药途径不适宜、用法用量不适宜和联合用药不适宜等情况。住院医嘱碳青霉烯类、糖肽类、喹诺酮类、第三代头孢菌素类抗菌药物使用率分别为20.67％、3.33％、31.10％、30.03％；抗菌药物联合使用率为37.67％；使用特殊使用级抗菌药物的微生物标本送检率为87.08％；不合理医嘱率为49.67％，包括适应证不适宜、用药剂量不适宜、用药疗程不适宜、使用特殊使用级抗菌药物无会诊记录、使用特殊使用级抗菌药物无微生物标本送检记录、联合用药不适宜和使用抗菌药物无病程记录等情况。在点评工作中还发现各医疗机构的医院信息系统不统一，人工进行全处方集中点评效率较低，缺乏统一、权威的处方点评规则等问题。结论：建议建立统一规范的处方集中点评规则，整合不同的医院信息系统，并通过信息化手段提高点评工作效率，从而促进医疗机构整体用药水平的提高。
ABSTRACT：	OBJECTIVE： To provide reference for improving prescription review mode and the level of rational drug use in medical institutions of Chongqing. METHODS： The prescription review expert group was established by Chongqing Municipal Committee for Health and Family Planning， and 1 600 outpatient and emergency prescriptions and 300 inpatient medical orders were collected from respiratory department， general surgery department and infection department of 16 municipal medical institutions by equal distance sampling method in Aug. 23rd and Sept. 13th in 2017. Special prescription review was conducted for 3 core indexes （utilization rate of antibiotics， combined use and adjuvant drug） of outpatient and emergency prescriptions， non-standard prescriptions， unsuitable prescriptions and abnormal prescriptions， the use of antibiotics for special use or expensive antibiotics and adjuvant drugs in the inpatient medical orders. RESULTS： The utilization rate of antibiotics in outpatient prescriptions was 9.28％（＜20％）， and that of antibiotics in emergency prescriptions was 23.83％（＜40％）. The rate of combined use of antibiotics was 3.04％， and utilization rate of adjuvant drugs was 5.02％. The rate of irrational prescriptions was 21.03％， including irrational use of antibiotics， irrational use of adjuvant drugs， incomplete writing of clinical diagnosis， unsuitable indication， unsuitable drug selection， unsuitable route of administration， unsuitable dosage and usage and unsuitable drug combination. In the inpatient medical orders， the utilization rates of carbapenems， glycopeptides， quinolones and third-generation cephalosporins were 20.67％， 3.33％， 31.10％ and 30.03％， respectively. The rate of combined use of antibiotics was 37.67％； the microbiological specimen detection rate of antibiotics for special use was 87.08％. The rate of irrational inpatient medical orders was 49.67％， including unsuitable indication， unsuitable dosage， unsuitable medication course， no consultation record about antibiotics for special use， no microbiological specimen detection record about antibiotics for special use， unsuitable drug combination and no medical record about antibiotics use. There were some problems in prescription review， such as disunity of hospital information system， low efficiency of overall manual prescription review， absence of uniform and authoritative prescription review rules. CONCLUSIONS： It is suggested to establish uniform and normative centralized prescription review standard， integrate different hospital information systems， improve the efficiency of prescription review by means of informatization， so as to improve clinical drug use in medical institutions.
期刊：	2018年第29卷第18期
作者：	李小兵，白礼西，胡渝，金思岑
AUTHORS：	LI Xiaobing，BAI Lixi，HU Yu，JIN Sicen
关键字：	重庆；医疗机构；处方点评；集中点评；合理用药
KEYWORDS：	Chongqing； Medical institutions； Prescription review； Centralized review； Rational drug use
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本月下载数：	11 次

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