医院2020年门急诊处方点评及帕累托图分析  

Comments and Pareto diagram analysis of outpatient and emergency prescriptions in hospitals in 2020

作　　者：李烨[1] 黎阳 尹兴伟 曹玮[1] LI Ye;LI Yang;YIN Xingwei;CAO Wei(Department of Pharmacy,Yunnan First People′s Hospital/Affiliated Hospital of Kunming University of Technology,Yunnan Province,Kunming 650032,China)

机构地区：[1]云南省第一人民医院/昆明理工大学附属医院药学部,昆明市650032

出　　处：《临床合理用药杂志》2022年第20期1-4,8,共5页Chinese Journal of Clinical Rational Drug Use

基　　金：云南省卫健委卫生计生政策研究课题(2015YNP06);云南省卫健委医学学科后备人才项目(H-2018078);云南省教育厅科学研究基金项目(2016ZDX022)。

摘　　要：目的回顾性分析和点评医院门急诊处方,采用帕累托图对不合理处方进行分析并提出管理策略,以促进临床合理用药,保障患者用药安全。方法随机抽取2020年10月云南省第一人民医院门急诊处方25000张。采用人工点评和系统点评相结合的方式对处方进行点评,分析不合理用药类型,利用帕累托图对结果中不合理处方的构成因素进行分析。结果抽取的25000张门急诊处方中门诊不合格处方数610张,急诊416张,其中包括不规范处方、用药不适宜处方和超常处方。在处方不合理项目中,适应证不适宜、用法用量不适宜为主要因素,临床诊断书写不全、给药途径不适宜为次要因素,其他则为一般因素。不合理处方用药类型中,抗菌药物、改善循环的药物、心血管系统用药、神经系统用药(包括麻醉药品和精神药品)、皮肤科及外用药品为主要因素,呼吸系统用药为次要因素,消化系统用药、泌尿生殖系统用药、内分泌系统用药为一般因素。结论在对不合理处方所涉及的问题进行全面客观的综合分析后,通过开展有针对性的药学干预,对主次要因素加以控制,以提高处方合格率,保障患者临床用药安全。Objective To comment on the outpatient and emergency prescriptions of the hospital,analyze the unreasonable prescriptions with Pareto diagram and put forward management strategies,so as to promote clinical rational drug use and ensure the drug safety of patients. Methods 25 000 outpatient and emergency prescriptions of Yunnan First People’ s Hospital in October 2020 were randomly selected. The prescription was commented by the combination of manual comment and systematic comment,the types of unreasonable drugs in the prescription were analyzed,and the constituent factors of unreasonable prescription in the results were analyzed by Pareto diagram. Results Of the 25 000 outpatient and emergency prescriptions selected,610 were outpatient and 416 were emergency. These include non-standard prescriptions,inappropriate prescriptions and abnormal prescriptions. In the unreasonable prescription items,“inappropriate indications”and“inappropriate usage and dosage”are the main factors,“incomplete writing of clinical diagnosis”and“inappropriate route of administration”are the secondary factors,and other factors are classified as general factors. Among the types of irrational prescription drugs,antibiotics,circulation improvement drugs,cardiovascular drugs,nervous system drugs( including narcotic drugs and psychotropic drugs),dermatology and topical drugs are the main factors,respiratory drugs are the secondary factors,and digestive system drugs, urinary and reproductive system drugs and endocrine system drugs are the general factors.Conclusion After a comprehensive and objective analysis of the problems involved in unreasonable prescriptions,we should carry out targeted pharmaceutical intervention to control the primary and secondary factors,so as to improve the qualified rate of prescriptions and ensure the safety of clinical medication.

关 键 词：处方点评 不合理处方 帕累托图 

分 类 号：R95[医药卫生—药学]