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基于循证证据的麻醉科处方前置审核规则精细化设置及效果评价
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| 篇名： | 基于循证证据的麻醉科处方前置审核规则精细化设置及效果评价 |
| TITLE： | Practice and effect evaluation of refined setting of evidence-based reference prescription pre-audit rules in anes-thesiology department |
| 摘要： | 目的 优化麻醉科处方前置审核规则，提高审方质量和合理用药水平。方法统计并分析2023年4月1日至30日青岛大学附属医院（以下简称“我院”）处方前置审核系统中麻醉科的住院医嘱，对不合理用药问题进行分类统计与循证查询，结合我院现执行的《麻醉科临床路径用药规范》，对审核规则进行精细化设置，并建立审核管理与沟通反馈流程。对规则精细化设置后（2023年5－12月）与设置前（2023年4月）的每月审核医嘱总数、预审弹窗医嘱数、系统拦截率、系统审核后医师修改率、药师审核率、医嘱合理率进行比较，对设置后与设置前（2022年5－12月）的麻醉科次均药费进行环比比较。结果麻醉科不合理用药问题主要包括适应证不适宜、给药途径不适宜、用法用量不适宜、配伍不适宜、特殊人群用药问题、围手术期不合理用药问题。规则精细化设置后，麻醉科预审弹窗医嘱数随时间延长明显减少，经过不断完善后逐步达到平稳状态。与设置前比较，规则精细化设置后系统拦截率显著提高（P＜0.001），系统审核后医师修改率显著提高（P＜0.001），药师审核率显著下降（P＜0.001）；2023年5－12月医嘱合理率与月份存在线性趋势（P＜0.001）。设置后与设置前相比，麻醉科次均药费由平均720.72元下降至平均528.21元，降幅为26.71%。结论基于循证证据精细化设置麻醉科处方前置审核规则，可显著提高处方审核质量，促进合理用药，节约患者医疗费用。 |
| ABSTRACT： | OBJECTIVE To optimize the pre-audit rules for anesthesia prescriptions， improve the audit quality and rational drug use. METHODS The inpatient medical orders of anesthesia department from prescription pre-audit system of the Affiliated Hospital of Qingdao University （hereinafter referred to as “our hospital”） were analyzed from April 1 to 30， 2023. The classification statistics and evidence-based inquiry were carried out for irrational drug use issues； combined with our hospital’s current implementation of the Anesthesiology Clinical Pathway Medication Standards， the audit rules were set in details， and audit management and communication feedback processes were established. The total number of monthly audited orders， the number of pre-audit pop ups， system interception rate， physician modification rate after system audit， pharmacist audit rate， and reasonable rate of medical orders after refined setting of rules （May-December in 2023） were compared with before setting （April in 2023）； the average medication cost per anesthesia session after refined setting of rules was also compared with before setting （May- December in 2022）. RESULTS Irrational drug use in the anesthesia department mainly included inappropriate indications， inappropriate administration routes， inappropriate usage and dosage， inappropriate compatibility， medication problems in special populations， and improper medication during the perioperative period. After the refinement of the rules， the number of pre-audit pop ups in the anesthesia department significantly decreased over time， and gradually reached a stable state after continuous improvement. Compared with before setting， the system interception rate after the refinement of rules （P＜0.001）， physician modification rate after system audit （P＜0.001） both increased significantly， while the pharmacist audit rate significantly decreased （P＜0.001）. There was a linear trend between the reasonable rate of medical orders and the month from May to December in 2023 （P＜0.05）. Compared with before the setting， the average medication cost of anesthesia per session decreased from 720.72 yuan to 528.21 yuan， with a decrease of 26.71%. CONCLUSIONS Based on evidence-based reference， refining pre-audit rules for anesthesia prescriptions can significantly improve the quality of prescription examination， promote rational drug use， and save patient’s medical expenses. |
| 期刊： | 2024年第35卷第14期 |
| 作者： | 邢晓敏；李祥鹏；王心怡；魏丽娜；李文静；李静 |
| AUTHORS： | XING Xiaomin，LI Xiangpeng，WANG Xinyi，WEI Lina，LI Wenjing，LI Jing |
| 关键字： | 处方前置审核；麻醉科；循证证据；审核规则；合理用药 |
| KEYWORDS： | prescription pre-audit； anesthesia department； |
| 阅读数： | 2 次 |
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