门诊处方双重点评模式的建立与应用
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摘要
目的探讨门诊处方双重点评模式的建立方法和应用效果。方法建立门诊处方双重点评模式:初评药师由门诊药师组成,包括高年资主管药师2人、低年资主管药师5人,药剂师5人;再点评药师由高年资药师组成,包括主任药师1人、副主任药师1人、高年资主管药师2人;回顾性分析蚌埠市第一人民医院2016年3～9月份270份处方的双重点评模式点评结果,包括适宜性类型的处方分布、不合理处方的科室分布及再点评组修正作用的总体情况、有修正作用处方的疾病分布。结果270份处方中,初评组、再点评组合理处方分别为0份(0. 00%)、50份(18. 52%),差异有统计学意义(χ2=55. 102,P <0. 001)。两组不合理处方的科室总体分布差异无统计学意义(χ2=5. 597,P=0. 976)。再点评组完全认同初评结果的处方有199份(73. 70%);修正初评处方71份(26. 30%),修正用药指征不适宜为用药指征适宜且发现新问题的有14份;对初评结果进行修正涉及的疾病主要为糖尿病22份(30. 99%)、心血管疾病17份(23. 94%)。结论门诊药师初评处方后,高年资药师再点评处方并反馈,形成门诊处方双重点评模式;该模式能提高处方点评质量,促进药师更好地开展处方点评。
Objective To explore the establishment and the application effect of the double evaluation model(DEM) of outpatient prescriptions. Methods The establishment of the DEM of outpatient prescriptions were briefly described. Evaluation results for 270 cases by DEM from March to September in 2016 were retrospectively analyzed. The initial evaluation date and the reevaluation date was respectively included into the initial evaluation group(IEG) and the reevaluation group(RG). For both groups,the prescription distribution of the appropriateness types of evaluation results and the department distribution of unreasonable cases were statisticed and analyzed. The overall situation of RG's correct functions and the disease distribution of corrected cases was also statisticed and analyzed.Results In 270 cases,there was respectively 0(0. 00%) and 50(18. 52%) reasonable cases in the IEG and the RG,with statistical significant difference(χ2= 55. 102,P < 0. 001). There was no statistical significant difference between the department distribution of the appropriateness types of evaluation results of the two groups(χ2= 5. 597,P = 0. 976). Initial evaluation results of 199 cases(73. 70%) were totally accepted by the RG. 71(26. 30%) initial evaluated cases were corrected,of which 14 inappropriate medication indications cases were corrected as appropriate medication indications cases and also with new problems were found. Diabetes with 22cases(30. 99%) and cardiovascular disease with 17 cases(23. 94%) were mainly diseases involved in corrected initial evaluation cases. The Pharmacists initial evaluation bias were related to lack of cognitive knowledge of the relevant diseases,and lack of clinical experience,and failed to combine with clinical practice to conduct a comprehensive analysis and others. Conclusion DEM of outpatient prescriptions is established on the initial evaluation of the prescription by the outpatient pharmacists and reevaluation and feedback by the senior pharmacists,which can improve the quality of prescription evaluation,and find out defects in the initial evaluation and promote the pharmacist to carry out prescription evaluation better.
Objective To explore the establishment and the application effect of the double evaluation model(DEM) of outpatient prescriptions. Methods The establishment of the DEM of outpatient prescriptions were briefly described. Evaluation results for 270 cases by DEM from March to September in 2016 were retrospectively analyzed. The initial evaluation date and the reevaluation date was respectively included into the initial evaluation group(IEG) and the reevaluation group(RG). For both groups,the prescription distribution of the appropriateness types of evaluation results and the department distribution of unreasonable cases were statisticed and analyzed. The overall situation of RG's correct functions and the disease distribution of corrected cases was also statisticed and analyzed.Results In 270 cases,there was respectively 0(0. 00%) and 50(18. 52%) reasonable cases in the IEG and the RG,with statistical significant difference(χ2= 55. 102,P < 0. 001). There was no statistical significant difference between the department distribution of the appropriateness types of evaluation results of the two groups(χ2= 5. 597,P = 0. 976). Initial evaluation results of 199 cases(73. 70%) were totally accepted by the RG. 71(26. 30%) initial evaluated cases were corrected,of which 14 inappropriate medication indications cases were corrected as appropriate medication indications cases and also with new problems were found. Diabetes with 22cases(30. 99%) and cardiovascular disease with 17 cases(23. 94%) were mainly diseases involved in corrected initial evaluation cases. The Pharmacists initial evaluation bias were related to lack of cognitive knowledge of the relevant diseases,and lack of clinical experience,and failed to combine with clinical practice to conduct a comprehensive analysis and others. Conclusion DEM of outpatient prescriptions is established on the initial evaluation of the prescription by the outpatient pharmacists and reevaluation and feedback by the senior pharmacists,which can improve the quality of prescription evaluation,and find out defects in the initial evaluation and promote the pharmacist to carry out prescription evaluation better.
引文
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[17]朱雪娟,丁俊琴,严丽,等.不同口腔护理液在预防肝移植患者术后口腔真菌感染中的应用[J].护理实践与研究,2016,13(18):50-51.
[18]曾晓燕,周维,张波.碳酸氢钠液含漱预防放疗患者口腔真菌感染的效果研究[J].中华医院感染学杂志,2015,25(17):4025-4027.
[19]郑利光,韩蕊,赵电红,等.门诊口腔黏膜病患者超说明书用药调查与分析[J].中国医院用药评价与分析,2016,16(2):262-264.
[20]戴立波,方平飞,蔡骅琳,等. P-糖蛋白与中枢抑制药物相互作用的体外研究[J].中国医院药学杂志,2012,32(12):919-923.
[21] HIEMKE C,BAUMANN P,BERGEMANN N,et al. AGNP精神科治疗药物监测共识指南:2011[J].实用药物与临床,2016,19(10):1193-1218.
[2]中华医学会糖尿病学分会.中国2型糖尿病防治指南(2013年版)[J].中国糖尿病杂志,2014,22(8):2-42.
[3]黄丽,罗圣平,罗晓波,等.某医院2型糖尿病住院患者调脂药物应用情况分析[J].安徽医药,2016,20(12):2356-2359.
[4] GARCIA-RAMREZ M,HERNNDEZ C,PALOMER X,et al.Fenofibrate prevents the disruption of the outer blood retinal barrier through downregulation of NF-κB activity.[J]. Acta Diabetol,2016,53(1):109-118.
[5]陈素芳,李亨辉,邵毅,等.非诺贝特在糖尿病性黄斑水肿中的临床研究[J].眼科新进展,2016,36(2):136-138,142.
[6]孔晓明,孙艳,张丽,等.老年期与非老年期抑郁症患者客观睡眠状况研究[J].安徽医科大学学报,2015,50(9):1330-1333.
[7]刘洋,张伟波,蔡军.初中生焦虑抑郁情绪与生活方式的关系[J].中国心理卫生杂志,2017,31(3):235-240.
[8]冯建秀,李晓玲,刘文辉,等.三甲医院呼吸内科慢性疾病患者抑郁症状现况调查[J].中国心理卫生杂志,2017,31(4):278-282.
[9]中华中医药学会血液病分会.肿瘤相关抑郁状态中医诊疗专家共识[J].中华中医药杂志(原中国医药学报),2015,30(12):4397-4399.
[10]马国重,蒋晓江,乐发国,等.原发性失眠与抑郁症伴发失眠患者觉醒水平比较[J].重庆医学,2013,42(7):746-748.
[11]《中国高血压基层管理指南》修订委员会.中国高血压基层管理指南(2014年修订版)[J].中华高血压杂志,2015,23(1):24-43.
[12]吴联合,王砚池,张申,等.阿司匹林和氯吡格雷分别用于冠状动脉内膜剥脱并冠状动脉搭桥术后血管再狭窄的预防效果和安全性比较[J].中国药房,2017,28(6):762-765.
[13]苏微微,饶世俊,肖丽萍,等.脑梗死二级预防中阿司匹林抵抗现象及干预随访[J].实用医学杂志,2014,30(23):3797-3799.
[14]刘潇潇,殷为勇,张秀华.缺血性脑卒中二级预防中阿司匹林与氯吡格雷致消化道不良反应调查[J].医药导报,2014,33(5):684-685.
[15]程艳,季丹,陈丽丽.疱疹性口腔炎优化口腔护理及疗效观察[J].实用临床医药杂志,2013,17(8):120-121.
[16]周彩霞,李俊红,王静,等.碳酸氢钠口腔干预护理预防危重患者口腔感染的效果[J].中华医院感染学杂志,2016,26(7):1671-1673.
[17]朱雪娟,丁俊琴,严丽,等.不同口腔护理液在预防肝移植患者术后口腔真菌感染中的应用[J].护理实践与研究,2016,13(18):50-51.
[18]曾晓燕,周维,张波.碳酸氢钠液含漱预防放疗患者口腔真菌感染的效果研究[J].中华医院感染学杂志,2015,25(17):4025-4027.
[19]郑利光,韩蕊,赵电红,等.门诊口腔黏膜病患者超说明书用药调查与分析[J].中国医院用药评价与分析,2016,16(2):262-264.
[20]戴立波,方平飞,蔡骅琳,等. P-糖蛋白与中枢抑制药物相互作用的体外研究[J].中国医院药学杂志,2012,32(12):919-923.
[21] HIEMKE C,BAUMANN P,BERGEMANN N,et al. AGNP精神科治疗药物监测共识指南:2011[J].实用药物与临床,2016,19(10):1193-1218.