我院医嘱事前审方信息系统的建立与应用结果分析
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摘要
目的:建设医嘱事前审方信息系统,保障临床安全、有效、经济和合理用药。方法:建立事前审方信息系统,制定审方规则,规范审方流程及审方规则修订流程,对问题医嘱进行分级。提取事前审方系统使用前2017年7～9月医嘱数据为对照组,2018年7～9月事前审方系统审核的医嘱数据作为观察组,比较两组问题医嘱数。统计并分析观察组问题医嘱及干预情况。结果:对照组问题医嘱总数42 805条,占比14. 86%;观察组问题医嘱总数22 290条,占比8. 62%。观察组共审核医嘱258 708条,拦截问题医嘱912条,拦截成功895条,拦截成功率98. 14%,其中系统设置自动拦截281条,药师干预拦截631条。拦截的问题医嘱中三级及以下问题医嘱598条(65. 57%),其中以用法用量不适宜最多见;五级问题医嘱281条(30. 81%),主要是高危药品的使用禁忌;四级问题医嘱33条(3. 62%),主要是超单次或单日极量。结论:医嘱事前审方信息系统具有明显的优越性,可减少问题医嘱并对其实现有效干预与拦截,显著提高了审方效率,有利于提升合理用药水平,保障患者用药安全。
Objective: To construct the prescription checking beforehand information system for medical orders to ensure clinical safe,effective,economical and rational use of drugs. Methods: The prescription checking beforehand information system was constructed,the review rules of medical orders were formulated,the review process and the procedure of rule revision were regulated,and the problem medical orders were classified. The medical order data from July to September 2017 before the use of the prescription checking beforehand information system were extracted as the control group,and those reviewed by the prescription checking beforehand information system from July to September 2018 were taken as the observation group to compare the number of problem medical orders between the groups. The problem medical orders and the interference in the observation group were statistically analyzed. Results: In the control group,there were 42,805 problem medical orders,which accounted for 14. 86%,and the total number of problem medical orders in the observation group was 22 290,which accounted for 8. 62%. A total of 258,708 medical orders in the observation group were reviewed,and 912 problem medical orders were intercepted,and among them,895 ones were successfully intercepted with the successful interception rate of 98. 14%. Among the 912 intercepted problem medical orders,281 ones were intercepted automatically by system settings,and 631 ones were intercepted by pharmacists. Among the intercepted medical orders,the number at or below level three was 598( 65. 57%),and the main problem was the inappropriate usage or dosage. The number at level five was 281( 30. 81%),and the main problem was the use contraindications of high-risk drugs. The number at level four was 33( 3. 62%),and the main problem was the excess of maximum single dose or dose for one day. Conclusion: The prescription checking beforehand information system has obvious advantages,which can reduce the number of problem medical orders,effectively intervene and intercept problem medical orders,and significantly improve the efficiency of prescription review. The system is beneficial to improving the level of rational drug use and ensuring the safety of drug use in patients.
Objective: To construct the prescription checking beforehand information system for medical orders to ensure clinical safe,effective,economical and rational use of drugs. Methods: The prescription checking beforehand information system was constructed,the review rules of medical orders were formulated,the review process and the procedure of rule revision were regulated,and the problem medical orders were classified. The medical order data from July to September 2017 before the use of the prescription checking beforehand information system were extracted as the control group,and those reviewed by the prescription checking beforehand information system from July to September 2018 were taken as the observation group to compare the number of problem medical orders between the groups. The problem medical orders and the interference in the observation group were statistically analyzed. Results: In the control group,there were 42,805 problem medical orders,which accounted for 14. 86%,and the total number of problem medical orders in the observation group was 22 290,which accounted for 8. 62%. A total of 258,708 medical orders in the observation group were reviewed,and 912 problem medical orders were intercepted,and among them,895 ones were successfully intercepted with the successful interception rate of 98. 14%. Among the 912 intercepted problem medical orders,281 ones were intercepted automatically by system settings,and 631 ones were intercepted by pharmacists. Among the intercepted medical orders,the number at or below level three was 598( 65. 57%),and the main problem was the inappropriate usage or dosage. The number at level five was 281( 30. 81%),and the main problem was the use contraindications of high-risk drugs. The number at level four was 33( 3. 62%),and the main problem was the excess of maximum single dose or dose for one day. Conclusion: The prescription checking beforehand information system has obvious advantages,which can reduce the number of problem medical orders,effectively intervene and intercept problem medical orders,and significantly improve the efficiency of prescription review. The system is beneficial to improving the level of rational drug use and ensuring the safety of drug use in patients.
引文
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9钟秀娟,蓝丽萍,高燕灵,等.合理用药监测系统及药师工作站在处方审核中的应用[J].中国药房,2014,25(42):4010-4012
10袁冬冬,杨玉玲,张寒娟,等.药事安全管理信息系统在医院处方审核中的应用[J].中国医院用药评价与分析,2016,16(1):118-121
11樊萍,高洋洋,黄跃洲,等.某院提升药师审方干预技能的效果评价[J].中国药房,2017,28(14):1998-2001
12阎澜,吕权真,王忠壮,等.面向审方岗位的临床药物治疗学教学改革[J].药学服务与研究,2016,16(1):70-73
2陶量,朱斌,王喆元,等.全程化药学服务对日间化疗患者合理用药的影响[J].中国药师,2014,17(10):1729-1731
3郭安平,方明.我院门诊药房事前审方系统的建立与应用[J].中国药房,2016,27(34):4823-4825
4李春华,郑晓娴,虞勋,等.医院中心审方辅助系统及审方药师对医嘱监测的结果分析[J].中国医院药学杂志,2017,37(12):1200-1203
5张惠芳,侯锐钢.医院信息化管理系统在事前审方的临床应用[J].中国药物与临床,2015,15(9):1362-1364
6谭波宇,韦鸿雁,罗奕,等.静脉药物调配中心(PIVAS)医嘱自定义审查模块的设计与实现[J].中国医院药学杂志,2015,35(4):344-346
7余志屏,李培红.临床静脉用药调配中心审方中不合理处方分析[J].中国临床研究,2016,29(10):1388-1389
8任珊,王向东,宋广福.医院静脉用药调配中心审方标准的编订及实施效果[J].中国药业,2015,24(12):86-88
9钟秀娟,蓝丽萍,高燕灵,等.合理用药监测系统及药师工作站在处方审核中的应用[J].中国药房,2014,25(42):4010-4012
10袁冬冬,杨玉玲,张寒娟,等.药事安全管理信息系统在医院处方审核中的应用[J].中国医院用药评价与分析,2016,16(1):118-121
11樊萍,高洋洋,黄跃洲,等.某院提升药师审方干预技能的效果评价[J].中国药房,2017,28(14):1998-2001
12阎澜,吕权真,王忠壮,等.面向审方岗位的临床药物治疗学教学改革[J].药学服务与研究,2016,16(1):70-73