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基于循证证据的我院出院带药处方前置审核系统的运行实践
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| 篇名： | 基于循证证据的我院出院带药处方前置审核系统的运行实践 |
| TITLE： | Evidence-based Operation Practice of Pre-audit System of Discharged Prescriptions in Our Hospital |
| 摘要： | 目的：为提高医院出院带药处方的合理性提供参考。方法：根据福建医科大学附属协和医院（以下简称“我院”）出院带药处方前置审核系统（以下简称“审核系统”）中常出现的系统判断为禁用与不推荐的处方（包括剂量与疗程不合理、超说明书用药、药物相互作用、用药适宜性、给药剂型等方面），结合实际病例分析，由临床药师寻找循证证据并进行评价，与医师沟通反馈，对拦截处方中误判的内容进行实时维护，并据此设置相关审方规则至审核系统，对效果进行评价并就提高出院带药处方前置审核结果的科学性和准确性提出建议。结果与结论：针对系统判断为禁用与不推荐的处方，例如癌病患者盐酸吗啡片日限定剂量、甲状腺切除术后碳酸钙D3的日最大剂量、直肠恶性肿瘤化疗后甲地孕酮的超适应证用药、产后维生素B6超说明书用药、颅内感染后硫酸氢氯吡格雷与奥卡西平的联用、肠梗阻后肠内营养粉剂的临床禁忌、房颤术后达比加群酯胶囊的剂量不适宜等，临床药师寻找到相应循证证据、进行分析后与临床医师进行沟通，对处方进行相应处置并将相关规则实时更新至审核系统。整体而言，审核系统提高了工作效率和审核结果的科学性、准确性，但仍需要通过提高药师自身专业知识水平、对循证证据的查找及运用能力、审核系统的准确性以及医师对审核结果的接受度和认可度，从而提高出院带药处方的合理性，减少用药安全风险。 |
| ABSTRACT： | OBJECTIVE：To provide reference for improving the rationality of discharged prescriptions. METHODS：According to the prescriptions that were often judged as forbidden or not recommended （such as irrational dosage and course of treatment ， off-label drug use ，drug interaction ，medication suitability ，dosage form ） in the pre-audit system of discharged prescriptions （hereinafter referred to as the “audit system ”）of Union Hospital Affiliated to Fujian Medical University （hereinafter referred to as the“our hospital ”），combined with actual case analysis ，the clinical pharmacists looked for evidence-based evidence and evaluate it，communicated with the clinician for feedback ，maintained the content of misjudgment in the intercepted prescription in real time，set up the relevant rules of audit in the audit system ，evaluated the effect and put forward suggestions to improve the scientificity and accuracy of the audit results of the discharged prescription. RESULTS & CONCLUSIONS ：For prescriptions that were judged to be forbidden or not recommended by the system ，such as the limited daily dose of Morphine hydrochloride tablet in patients with cancer pain ，the daily maximum dose of calcium sulfate D 3 after thyoidetomy ，hyper-indication use of megestrol acetate after chemotherapy for rectal cancer ，off-label usage of vitamin B 6 after postpartum delivery ，the combined use of clopidogrel bisulfate and oxcarbazepine after intracranial infection ，clinical contraindication of enteral nutrition powder after intestinal obstruction ，unsuitable dose of Dabigatran ester capsule after atrial fibrillation surgery and so on ，the clinical pharmacist looked for evidence-based evidence ，evaluated and communicated with the clinician . The relevant rules were updated to the audit system in real time. On the whole ，the audit system improves the work efficiency and the scientificity and accuracy of the audit results，but it is necessary to improve the professional knowledge level of the pharmacists ，the ability to find and use evidence-based evidence ，the accuracy of the audit system and the acceptance and recognition of the audit results by doctors ，so as to enhance the rationality of the discharged prescription ，reduce medication security risks. |
| 期刊： | 2020年第31卷第15期 |
| 作者： | 魏娜，吴朝阳，陈伦灼，郑斌，李娜，吴小萍，王燕南，刘茂柏 |
| AUTHORS： | WEI Na，WU Zhaoyang ，CHEN Lunzhuo ，ZHENG Bin，LI Na，WU Xiaoping ，WANG Yannan ，LIU Maobai |
| 关键字： | 循证证据；出院带药处方；处方前置审核系统；实践；合理用药 |
| KEYWORDS： | Evidence-based evidence ；Discharged prescription ；Pre-audit system ；Practice；Rational drug use |
| 阅读数： | 497 次 |
| 本月下载数： | 23 次 |
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