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医疗机构中药处方前置审核规则的优化与实践
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| 篇名： | 医疗机构中药处方前置审核规则的优化与实践 |
| TITLE： | Optimization and practice in pre-review rules of traditional Chinese medicine prescription in medical institutions |
| 摘要： | 目的 改善医疗机构处方前置审核系统对中药处方的审核适用性，提高中药处方审核质量和合理用药水平。方法总结我院合理用药监测系统在中药处方前置审核中存在的审核规则不适宜问题，并针对性地修订审核规则、规范审方流程。抽取2020年第2季度（审核规则优化前）和2021年第4季度（审核规则优化后）我院门急诊的全部中成药和中药饮片处方的审核数据，比较审核规则优化前后的处方合理率和干预有效率并统计不合理问题。结果我院审方系统对中药处方的审核适用性较差，存在审方系统与医院信息系统中的中药饮片名称不统一或不规范、剂量范围设置不合理、重复用药的审核逻辑过于机械化“、十八反“”十九畏”审核过于严格、特殊人群用药安全警示缺乏的问题。针对上述问题，我院规范了中药饮片名称，优化了中药饮片的剂量范围、中成药用法用量、重复用药、药物相互作用、特殊人群用药禁忌等审核规则。审核规则优化后，我院中成药处方合理率从97.38％上升至98.17％（P＞0.05），干预有效率从42.86％提高至79.71％（P＜0.05）；中药饮片处方合理率从47.98％上升至79.29％（P＜0.05），干预有效率从11.17％提高至29.13％（P＜0.05）。我院平均每月中药超多日用量、超剂量范围、药物相互作用、特殊人群药物禁忌不合理问题数均显著下降（P＜0.05）；重复用药不合理问题数组间比较差异虽无统计学意义（P＞0.05），但有下降趋势。不合理问题总数也大幅减少（P＜0.05）。结论我院的审核规则优化措施能改善审方系统对中药处方的审核适用性，提高处方审核质量和合理用药水平。但用药适应证的相关审核规则和中药处方干预有效率有待进一步完善和提高。 |
| ABSTRACT： | OBJECTIVE To improve the a pplicability of the prescription pre-review system to traditional Chinese medicine （TCM），and improve the quality of prescription review and rational drug use. METHODS The inappropriate pre-review rules of TCM prescription in prescription automatic screening system of our hospital were summarizd ，review rules were revised and the review process was standardized purposefully. The data of prescription review of Chinese patent medicine and TCM decoction pieces were collected from outpatient and emergency department of our hospital in the second quarter of 2020 （before the optimization of review rules ）and the fourth quarter of 2021（after the optimization of review rules ）. The reasonable rate of prescription and effective rate of intervention before and after the optimization of review rules were compared，and unreasonable problems were counted. RESULTS In our hospital ，the pre-review system had poor applicability in reviewing TCM prescriptions. There were some problems ，such as inconsistent or nonstandard names of TCM decoction pieces ，unreasonable dosage range settings，mechanical review of repeated drug use ，excessively strict review of “eighteen incompatible medicaments ”and“nineteen medicaments of mutual restraint ”and lack of safety warnings for special populations. In view of the above problems ，our hospital standardized the name of TCM decoction pieces ，and optimized the review rules such as dose range of TCM decoction pieces ， usage and dosage of Chinese patent medicine ，repeated medication ，drug interaction ，drug taboos for special people ，etc. After the revision of the rules ，the qualification rate of Chinese patent medicine prescriptions increased from 97.38％ to 98.17％（P＞0.05）， and the rate of effective intervention increased from 42.86％ to 79.71％（P＜0.05）；the qualification rate of TCM decoction pieces prescriptions increased from 47.98％ to 79.29％（P＜0.05），and the rate of effective intervention increased from 11.17％ to 29.13％（P＜0.05）. The number of unreasonable problems such as excessive daily dosage of TCM ，excessive dosage range ，drug interaction and drug contraindications for special groups decreased significantly in our hospital （P＜0.05）. There was no statistical significance in the number of unreasonable problems of repeated medication between 2 groups （P＞0.05），but there was a downward trend. T he total number of unreasonable problems had also decreased significantly （P＜0.05）. CONCLUSIONS The optimization measures of review rules in our hospital canimprove the applicability of the review system for TCM prescriptions，and improve the quality of prescription review and the level of rational drug use. However ，review rules of indications and the effectiveness of prescription intervention still needs to be further improved. |
| 期刊： | 2022年第33卷第12期 |
| 作者： | 张婷，顾婕，丁兰萍，马祝悦，张杜枭，袁红宇 |
| AUTHORS： | ZHANG Ting，GU Jie，DING Lanping ，MA Zhuyue ，ZHANG Duxiao ，YUAN Hongyu |
| 关键字： | 处方前置审核；中药；中药饮片；中成药；审核规则；合理用药 |
| KEYWORDS： | pre-review of prescription ；traditional Chinese medicine ；traditional Chinese medicine decoction pieces ；Chinese |
| 阅读数： | 438 次 |
| 本月下载数： | 12 次 |
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