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以绩效考核为导向的合理用药管控机制探索与实践
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| 篇名： | 以绩效考核为导向的合理用药管控机制探索与实践 |
| TITLE： | Exploration and practice of rational drug use control mechanism based on performance appraisal |
| 摘要： | 目的 以绩效考核为导向进一步健全合理用药管控机制，探索药学服务新路径，推进临床合理用药管理向纵深发展。方法我院通过实施“处方行为管理十分制”，辅以“加强处方审核“”规范临床用药”等举措进行药事管理制度改革。通过实现人机结合前置审方、提升药师审方能力、实时优化审方机制、规范医师超说明书用药行为、完善药物评价机制等多项辅助措施，完成事前预控与事中干预。评价结果参考“处方行为管理十分制”纳入绩效考核，实现多维度全闭环的合理用药管理。比较管理前、后相关指标的统计结果以评价管理成效。结果与管理前比较，管理后我院2022年医嘱（处方）不合理率相较2020年同期呈明显下降趋势，住院医嘱不合理率从2020年的5.00%下降至2022年的2.69%，门诊处方不合格率由4.59%下降至2.48%；临床药师与医师沟通频率增加，受邀参加临床会诊的次数从16次上升至58次，不合理医嘱（处方）干预接受率从52％增加到87％，医师对临床药学服务有了深入了解与认可，临床合理用药意识有了显著提升。结论以绩效考核为导向的合理用药管控机制，进一步规范了处方及医嘱的开具，医药协作更为突出，实现了“事前审核，事中监督，事后评估”的闭环式药事管理，促进了临床合理用药。 |
| ABSTRACT： | OBJECTIVE To further improve the rational drug use control mechanism based on performance appraisal， explore new paths of pharmaceutical care and promote the rational clinical drug use management to deepen development. METHODS The reform of pharmaceutical management system in our hospital was performed through implementing the “ten-point system of prescription behavior management”， supplemented by the two carriages of “strengthening prescription review” and “standardizing clinical medication”. By implementing a number of auxiliary measures such as man-machine integration pre-prescription review， improving pharmacists’ prescription review ability， optimizing prescription review mechanism in real time， regulating physicians’ off-label drug use behavior， and improving drug evaluation mechanism， pre-control and in-process intervention were completed. The evaluation results were incorporated into performance assessment by referring to the “ten-point system of prescription behavior management”， so as to realize multi-dimensional and fully closed-loop rational drug use management. The effects of management were evaluated by comparing the statistical results of related indexes before and after the management. RESULTS Compared with before management， irrational rate of prescriptions and medical orders in our hospital in 2022 decreased significantly， compared to the same period in 2020； the irrational rate of inpatient medical orders decreased from 5.00% in 2020 to 2.69% in 2022， and that of outpatient prescriptions decreased from 4.59% to 2.48%； the frequency of communication between clinical pharmacists and physicians increased； the times of clinical consultations increased from 16 to 58， and doctors’ acceptance of intervention for irrational drug use had improved from 52％ to 87％ ； physicians had a deeper understanding and recognition of clinical pharmaceutical care， the awareness of clinical rational drug use had been significantly improved. CONCLUSIONS The rational drug use control mechanism guided by performance appraisal further standardizes the issuance of prescriptions and medical orders， and makes physician-pharmacist cooperation more prominent， so as to realize the closed-loop pharmaceutical management of “pre- review， in-process supervision and post-evaluation”， and promote rational drug use in clinical practice. |
| 期刊： | 2023年第34卷第13期 |
| 作者： | 周萍；闫晓萌 |
| AUTHORS： | ZHOU Ping，YAN Xiaomeng |
| 关键字： | 合理用药；绩效考核；管控机制 |
| KEYWORDS： | rational drug use； performance appraisal； control mechanism |
| 阅读数： | 177 次 |
| 本月下载数： | 8 次 |
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