某院43200张门急诊处方点评及不合理处方原因的帕累托图分析  

Pareto Chart Analysis on 43 200 Prescriptions of Outpatient and Emergency and Reasons for Unreasonable Medication

作　　者：张桂芬[1,2] 殷卫清 魏菊红[1,2] 唐慧 汤晨[1,2] 陆敏 朱爱国 ZHANG Gui-fen;YIN Wei-qing;WEI Ju-hong;TANG Hui;TANG Chen;LU Min;ZHU Ai-guo(Department of Rational Drug,Changshu No.1 People's Hospital,Changshu Jiangsu 215500,China;departm ent of Rational Drug,Changshu Hospital Affiliated to Suzhou University,Changshu Jiangsu 215500,China)

机构地区：[1]常熟市第一人民医院合理用药科,江苏常熟215500 [2]苏州大学附属常熟医院合理用药科,江苏常熟215500

出　　处：《抗感染药学》2020年第5期662-667,共6页Anti-infection Pharmacy

摘　　要：目的:分析医院门急诊处方用药现状及不合理用药的原因及其管理对策。方法:抽取2018年9月—2019年11月间门急诊处方43200张,依据药品说明书和相关法规等要求,点评与分析其用药的合理性,采用帕累托图分析不合理处方原因,找到造成不合理处方的主要、次要及一般因素以及管理对策。结果:43200张处方中,不合理用药处方2054张,其不合理率为4.75%;在不合理处方中,其不合理之处2235例次;不合理的主要因素为开具处方未写临床诊断或临床诊断书未写全(626例次,占28.01%)、联合用药不适宜(340例次,占15.21%)、用法用量含糊不清(276例次,占12.35%)、单张门急诊处方超过5种药品(190例次,占8.50%)以及未按照《抗菌药物临床应用指导原则》管理规定开具抗菌药物处方(185例次,占8.28%)等;处方不合理的次要因素为适应证不适宜(124例次,占5.55%)、医师签名与签章不规范或与留样不一致(118例次,占5.28%);处方不合理的一般因素为用法用量不适宜(99例次,占4.43%)等。结论:医院应依据不合理处方类型制订行之有效的管理措施,加大行政干预和处方点评力度,规范处方用药行为,以促进临床合理用药、确保医疗安全。Objective:To analyze the current situation of outpatient,emergency medication prescription and the reason of unreasonable medication,and its management countermeasures.Methods:43200 prescription of outpatient and emergency were selected from September 2018 to November 2019.According to the requirements of"Drug Instructions"and relevant laws and regulations,the rationality of drug usage were commented and analyzed,Pareto chart was used to analyze the causes of unreasonable prescription,and the main,secondary and general factors causing unreasonable prescription and the management countermeasures were found.Results:Among the 43200 prescriptions,2054 were unreasonable,and the irrationality rate was 4.75%.Among the unreasonable prescriptions,2235 cases were found to be unreasonable.Unreasonable main factors was that they did not write clinical diagnosis or clinical diagnosis was not perfect(626 cases,accounted for 28.01%),the combination of drugs was not unsuited(340 cases,accounted for 15.21%),the usage and dosage were vague(276 cases,accounted for 12.35%),one prescription included more than 5 kinds of drugs(190 cases,accounted for 8.50%),the prescription including antimicrobial agents was not in accordance with guidelines for clinical application of antimicrobial agents(185 cases,accounted for 8.28%),etc..The secondary factors of unreasonable prescription were inappropriate indications(124 cases,accounted for 5.55%),irregular signature and seal of doctors or inconsistent with retention samples(118 cases,accounted for 5.28%).The general factors of unreasonable prescription were improper usage and dosage(99 cases,accounted for 4.43%).Conclusion:The hospital should formulate effective management measures according to unreasonable prescription types,strengthen administrative intervention and prescription comment,and standardize prescription medication behavior,so as to promote clinical rational medication and ensure medical safety.

关 键 词：处方点评 不合理处方 帕累托图 管理对策 合理用药 

分 类 号：R969.3[医药卫生—药理学]