某“三甲”医院住院患者质子泵抑制剂医嘱点评软件的设计及应用
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摘要
目的:设计质子泵抑制剂(PPI)医嘱点评软件,促进临床合理用药。方法:根据某"三甲"医院(以下简称"样本医院")住院患者PP(I以PPI注射剂为例)使用情况设计医嘱点评软件的点评流程,在此基础上,与计算机工程师协作开发住院患者PPI医嘱点评软件;以不合理用药检出率及人均耗时为指标,对比软件点评和人工点评的效果,并利用软件事前点评样本医院2018年2月静脉用药调配中心PPI注射剂摆药医嘱及回顾性点评2015年1月-2017年12月期间住院患者PPI注射剂不合理用药情况(均包括不合理的治疗用药、预防用药及无指征用药)。结果:设计的PPI医嘱点评软件包括用户和任务(定时点评)、系统设置、确认审核(对软件自动点评的结果进行复核)、报告导出4个模块。与人工点评相比,软件点评的不合理用药检出率(69.50%vs. 77.00%)无显著差异(P>0.05),人均耗时(9.25 min vs. 1.50 min)显著缩短(P<0.05);在事前点评应用中,不合理治疗用药27条(2.23%)、不合理预防用药318条(26.24%)、无指征用药602条(49.67%);在回顾性点评应用中,不合理治疗用药4 884条(2.68%)、不合理预防用药50 399条(27.67%)、无指征用药85 106条(46.72%)。结论:PPI医嘱点评软件的应用缩短了药师点评时间,提高了点评效率,促进了PPI临床合理用药。
OBJECTIVE:To design Proton pump inhibitor(PPI) medical order evaluation software,and to promote rational drug use in clinic. METHODS:According to the use of PPI(PPI injection as an example)of inpatients in a Third Grade Class A hospital(hereinafter referred to as "sample hospital"),the evaluation process of medical order evaluation software was designed.On this basis,medical order evaluation software for inpatients was developed in collaboration with computer engineers. Taking the detection rate of irrational drug use and the time consuming per capita as indicators,the effects of software evaluation and manual evaluation were compared. Dispensing medical orders of PPI injection in PIVAS of sample hospital was evaluated with the software pre-evaluation in Feb. 2018. Irrational use of PPI injection(including irrational medication for treatment,prevention and nonindication) in the inpatients was evaluated retrospectively during Jan. 2015-Dec. 2017. RESULTS:The software of PPI audit includes four modules:users and tasks(timing audit),system settings,confirmation of audit results(check the results audited by the software automatically) and reports exporting. Compared with manual evaluation, there was no significant difference in detection rate of irrational drug use in software audit(69.50% vs. 77.00%,P>0.05);the time consuming per capita was shortened significantly(9.25 min vs. 1.50 min,P<0.05). In the application of pre-evaluation,27(2.23%) were irrational for treatment,318(26.24%)were irrational for prevention and 602(49.67%)for non-indications. In the application of retrospective review,4 884(2.68%)were irrational medication for treatment,50 399(27.67%)irrational medication for prevention and 85 106(46.72%)medication without indications. CONCLUSIONS:The application of PPI medical order evaluation software shortens the time of pharmacist's evaluation, improves the efficiency of evaluation,and promotes the rational use of PPI in clinic.
OBJECTIVE:To design Proton pump inhibitor(PPI) medical order evaluation software,and to promote rational drug use in clinic. METHODS:According to the use of PPI(PPI injection as an example)of inpatients in a Third Grade Class A hospital(hereinafter referred to as "sample hospital"),the evaluation process of medical order evaluation software was designed.On this basis,medical order evaluation software for inpatients was developed in collaboration with computer engineers. Taking the detection rate of irrational drug use and the time consuming per capita as indicators,the effects of software evaluation and manual evaluation were compared. Dispensing medical orders of PPI injection in PIVAS of sample hospital was evaluated with the software pre-evaluation in Feb. 2018. Irrational use of PPI injection(including irrational medication for treatment,prevention and nonindication) in the inpatients was evaluated retrospectively during Jan. 2015-Dec. 2017. RESULTS:The software of PPI audit includes four modules:users and tasks(timing audit),system settings,confirmation of audit results(check the results audited by the software automatically) and reports exporting. Compared with manual evaluation, there was no significant difference in detection rate of irrational drug use in software audit(69.50% vs. 77.00%,P>0.05);the time consuming per capita was shortened significantly(9.25 min vs. 1.50 min,P<0.05). In the application of pre-evaluation,27(2.23%) were irrational for treatment,318(26.24%)were irrational for prevention and 602(49.67%)for non-indications. In the application of retrospective review,4 884(2.68%)were irrational medication for treatment,50 399(27.67%)irrational medication for prevention and 85 106(46.72%)medication without indications. CONCLUSIONS:The application of PPI medical order evaluation software shortens the time of pharmacist's evaluation, improves the efficiency of evaluation,and promotes the rational use of PPI in clinic.
引文
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[2]HAMZAT H,SUN H,FORD JC,et al.Inappropriate prescribing of proton pump inhibitors in older patients:effects of an educational strategy[J].Drugs Aging,2012,29(8):681-690.
[3]HEIDELBAUGH JJ,GOLDBERG KL,INADOMI JM.Magnitude and economic effect of overuse of anti secretory therapy in the ambulatory care setting[J].Am J Manag Care,2010,16(9):e228-e234.
[4]刘翌,闫峻峰.省级药事质控中心在重点监控药品监管中的作用[J].中国药房,2017,28(4):458-462.
[5]何瑾,龙晓东,柳汝明,等.云南省医疗机构辅助治疗药品重点监控品种使用情况调查分析[J].中国药房,2017,28(8):1034-1037.
[6]LAHEIJ RJ,STURKENBOOM MC,HASSING RJ,et al.Risk of community-acquired pneumonia and use of gastric acid-suppressive drugs[J].JAMA,2004,292(16):1955-1960.
[7]YANG YX,LEWIS JD,EPSTEIN S,et al.Long-term proton pump inhibitor therapy and risk of hip fracture[J].JAMA,2006,296(24):1947-1953.
[8]DIAL S,DELANEY JAC,BARKUN AN,et al.Use of gastric acid-suppressive agents and the risk of community acquired clostridium difficile-associated disease[J].JA-MA,2005,294(23):1989-1995.
[9]KIEBOOM BC,KIEFTE-DE JONG JC,EIJGELSHEIMM,et al.Proton pump inhibitors and hypomagnesemia in the general population:a population-based cohort study[J].Am J Kidney Dis,2015.DOI:10.1053/j.ajkd.2015.05.012.
[10]MIN YW,LIM KS,MIN BH,et al.Proton pump inhibitor use significantly increases the risk of spontaneous bacterial peritonitis in 1965 patients with cirrhosis and ascites:a propensity score matched cohort study[J].Aliment Pharmacol Ther,2014,40(6):318-325.
[11]MAGGIO M,CORSONELLO A,CEDA GP,et al.Proton pump inhibitors and risk of 1-year mortality and prehospitalization in older patients discharged from acute care hospitals[J].JAMA Intern Med,2013,173(7):518-523.
[12]TERAMURA-GR?NBLAD M,BELL JS,P?YSTI MM,et al.Risk of death associateed with use of PPI in three cohorts of institutionalized older people in Finland[J].J Am Med Dir Asoc,2010.DOI:10.1016/j.jamda.2012.03.003.
[13]姚敏,徐艳艳,梅丹,等.2013-2015年我院质子泵抑制剂使用情况分析[J].中国医学创新,2016,13(29):76-79.
[14]李春彦,张杰,汪小惠,等.3005例住院患者质子泵抑制剂应用调查与分析[J].中国医院用药评价与分析,2017,17(3):406-409.
[15]楚建杰,樊婷婷,姚敏娜,等.我院骨科患者围术期质子泵抑制剂预防应激性溃疡的合理性分析[J].中国药房,2017,28(32):4483-4487.
[16]袁洪.湖南省质子泵抑制剂的临床应用指导原则(试行)[J].中南药学,2016,14(7):673-683.
[17]国家卫生健康委员会办公厅.关于印发医疗机构处方审核规范的通知[EB/OL].(2018-07-10)[2018-11-03].http://www.nhfpc.gov.cn/yzygj/s7659/201807/de5c7c9116b547-af819f825b53741173.shtml.
[2]HAMZAT H,SUN H,FORD JC,et al.Inappropriate prescribing of proton pump inhibitors in older patients:effects of an educational strategy[J].Drugs Aging,2012,29(8):681-690.
[3]HEIDELBAUGH JJ,GOLDBERG KL,INADOMI JM.Magnitude and economic effect of overuse of anti secretory therapy in the ambulatory care setting[J].Am J Manag Care,2010,16(9):e228-e234.
[4]刘翌,闫峻峰.省级药事质控中心在重点监控药品监管中的作用[J].中国药房,2017,28(4):458-462.
[5]何瑾,龙晓东,柳汝明,等.云南省医疗机构辅助治疗药品重点监控品种使用情况调查分析[J].中国药房,2017,28(8):1034-1037.
[6]LAHEIJ RJ,STURKENBOOM MC,HASSING RJ,et al.Risk of community-acquired pneumonia and use of gastric acid-suppressive drugs[J].JAMA,2004,292(16):1955-1960.
[7]YANG YX,LEWIS JD,EPSTEIN S,et al.Long-term proton pump inhibitor therapy and risk of hip fracture[J].JAMA,2006,296(24):1947-1953.
[8]DIAL S,DELANEY JAC,BARKUN AN,et al.Use of gastric acid-suppressive agents and the risk of community acquired clostridium difficile-associated disease[J].JA-MA,2005,294(23):1989-1995.
[9]KIEBOOM BC,KIEFTE-DE JONG JC,EIJGELSHEIMM,et al.Proton pump inhibitors and hypomagnesemia in the general population:a population-based cohort study[J].Am J Kidney Dis,2015.DOI:10.1053/j.ajkd.2015.05.012.
[10]MIN YW,LIM KS,MIN BH,et al.Proton pump inhibitor use significantly increases the risk of spontaneous bacterial peritonitis in 1965 patients with cirrhosis and ascites:a propensity score matched cohort study[J].Aliment Pharmacol Ther,2014,40(6):318-325.
[11]MAGGIO M,CORSONELLO A,CEDA GP,et al.Proton pump inhibitors and risk of 1-year mortality and prehospitalization in older patients discharged from acute care hospitals[J].JAMA Intern Med,2013,173(7):518-523.
[12]TERAMURA-GR?NBLAD M,BELL JS,P?YSTI MM,et al.Risk of death associateed with use of PPI in three cohorts of institutionalized older people in Finland[J].J Am Med Dir Asoc,2010.DOI:10.1016/j.jamda.2012.03.003.
[13]姚敏,徐艳艳,梅丹,等.2013-2015年我院质子泵抑制剂使用情况分析[J].中国医学创新,2016,13(29):76-79.
[14]李春彦,张杰,汪小惠,等.3005例住院患者质子泵抑制剂应用调查与分析[J].中国医院用药评价与分析,2017,17(3):406-409.
[15]楚建杰,樊婷婷,姚敏娜,等.我院骨科患者围术期质子泵抑制剂预防应激性溃疡的合理性分析[J].中国药房,2017,28(32):4483-4487.
[16]袁洪.湖南省质子泵抑制剂的临床应用指导原则(试行)[J].中南药学,2016,14(7):673-683.
[17]国家卫生健康委员会办公厅.关于印发医疗机构处方审核规范的通知[EB/OL].(2018-07-10)[2018-11-03].http://www.nhfpc.gov.cn/yzygj/s7659/201807/de5c7c9116b547-af819f825b53741173.shtml.