基于帕累托图及鱼骨图分析的医院中药饮片代煎服务质量提升的探索与实践  

Exploration and practice of improving service quality of TCM decoction pieces in hospital based on Pareto and Fishbone diagram

作　　者：吕艳艳 吴晓龙 王昭 吉建 LYU Yanyan;WU Xiaolong;WANG Zhao;JI Jian(Dept of Pharmacy,Luoyang Orthopedic Traumatology Hpapital(Orthopedics Hpapital of Henan Province),Luoyang,Henan 471002,China)

机构地区：[1]河南省洛阳正骨医院(河南省骨科医院)药品调剂科,河南洛阳471002

出　　处：《安徽医药》2022年第12期2541-2544,共4页Anhui Medical and Pharmaceutical Journal

基　　金：河南省中医药科学研究专项课题(2019ZY2097)。

摘　　要：目的探索帕累托图及鱼骨图分析法在提升医院中药饮片代煎服务质量中的作用。方法制作医院中药饮片代煎服务质量问题登记表,统计河南省洛阳正骨医院2020年1—6月(整改前)的中药代煎服务过程中出现的质量问题及类型,利用帕累托图及鱼骨图分析法,确定中药代煎服务质量问题的主要类型,找出根本原因,制定相关整改措施,持续质量改进。比较整改前与2020年7—12月(整改后)服务质量差异。结果整改前中药代煎服务处方7106张,出现服务质量问题479例,整改后中药代煎服务处方9879张,出现服务质量问题184例,帕累托图分析显示,中药代煎服务问题的主要类型为:煎药量误差(24.22%)、药味/颜色差异(18.16%)、未核对处方药物(15.87%)、特殊煎煮方法未标识(11.06%)、未对病人进行用药指导(10.23%);经整改后,中药代煎服务人次增加,服务质量问题发生率由管理前的6.74%下降为1.86%,各类型服务质量问题发生率均有下降,其中下降最为明显的为煎药量误差;煎药人员中药代煎综合服务能力评分由管理前的(7.58±2.43)分提升为管理后的(11.17±1.34)分(P<0.01)。结论利用帕累托图及鱼骨图分析方法可以有效提高煎药人员工作技能及效率,保障中药饮片代煎服务质量。Objective To explore the role of Pareto and fishbone diagram in improving the service quality of TCM decoction pieces in hospital.Methods The registration form of service quality problems of TCM decoction pieces in hospital was made,and the types of quality problems were counted from January to June 2020(before rectification).The main types of quality problems were determined,and the root causes were found out by Pareto and fishbone diagram.Then,the relevant rectification measures were formulated for con⁃tinuous quality improvement.Compare the difference of service quality before and after the rectification(July to December).Results There were 7106 prescriptions of TCM decoction pieces service before the rectification(January to June),including 479 cases of service quality problems.After the rectification(July to December),there were 9879 prescriptions of TCM decoction pieces,including 184 cases of service quality problems.Pareto diagram showed that the main types of service problems were decocting amount error(24.22%),taste/color difference(18.06%),no checking drugs(15.87%),special decocting methods not marked(11.06%),and no medication guidance for patients(10.23%);The number of TCM decoction pieces service increased.But the rate of service quality prob⁃lems decreased from 6.74%to 1.86%.The incidence of various types of service quality problems decreased,and the most obvious de⁃crease was in the error of decocting quantity;The comprehensive score of TCM decoction pieces service ability of decocting personnel increased from 7.58±2.43 to 11.17±1.34,and the difference was statistically significant(P<0.01).Conclusion Using Pareto and fish⁃bone diagram analysis can effectively improve work efficiency and ensure TCM decoction pieces service quality.

关 键 词：药学服务 药用溶液 中草药 药剂学管理 处方不当 帕累托图 鱼骨图 中药饮片 代煎服务 质量 

分 类 号：R197.32[医药卫生—卫生事业管理]