基于结构-过程-结果(SPO)模型的处方前置审核系统的建立及其应用效果  

Establishment and application effect of prescription pre-audit system based on structure-processoutcome(SPO)model

作　　者：邢晓敏[1] 李祥鹏[1] 全香花[1] 王心怡 王文晓 李静[1] Xing Xiaomin;Li Xiangpeng;Quan Xianghua;Wang Xinyi;Wang Wenxiao;Li Jing(Department of Pharmacy,the Affiliated Hospital of Qingdao University,Shandong Province,Qingdao 266000,China)

机构地区：[1]青岛大学附属医院药学部,青岛266000

出　　处：《药物不良反应杂志》2024年第9期551-556,共6页Adverse Drug Reactions Journal

基　　金：国家卫健委医院管理研究所医院药学高质量发展研究项目(NIHAYS2308)。

摘　　要：目的基于结构-过程-结果(SPO)模型在青岛大学附属医院(我院)建立处方前置审核系统,并探讨其应用效果。方法基于SPO模型结构维度,建立处方前置审核系统的组织架构、药学小组、药学审方管理制度和审核环境。基于SPO模型的过程维度,建立审核流程、用药知识库和审核规则库,实施质量监测与控制,并对相关人员进行培训。基于SPO模型的结果维度,验证处方前置审核系统上线后处方/医嘱审核的审核率、人工审核率、临床医师对处方审核的接受率、门急诊处方点评合格率和住院医嘱干预率。结果我院的处方前置审核系统于2021年3月首先在主院区上线,至2023年5月达到全院5个院区的全覆盖。门急诊处方及住院医嘱的审核率在2021—2023年逐年升高,并于2023年均达到了预期的99%以上。与2021年相比,2023年门急诊处方和住院医嘱提交至人工审核的处方/医嘱占比降低[1.2%(112206/9509430)比2.9%(16214/549672),2.9%(206258/7152620)比3.9%(147679/3814929)],人工未能及时审核的处方和医嘱在总处方/医嘱量中的占比下降[0.7%(62382/9509430)比1.4%(7429/549672),0.3%(22816/7152620)比2.2%(83303/3814929)],临床医师对门急诊处方和住院医嘱审核的接受率上升[76.1%(2421/3180)比57.0%(339/595),94.3%(1000/1060)比70.7%(797/1128)],差异均有统计学意义(均P<0.001),但仍有部分需要人工审核的处方/医嘱未能及时审核而漏审。较2021年,2023年门诊和急诊处方点评合格率上升[96.7%(924558/956252)比92.2%(983827/1067357),98.7%(518307/525227)比98.0%(181296/185069)],住院医嘱的干预率下降[0.7%(196522/26751992)比0.9%(195660/22631289)],差异均有统计学意义(均P<0.001)。结论应用SPO模型可健全处方前置审核系统的组织管理,保障系统顺利上线和安全运行。经验证,审方系统的运行速度和药师处方审核速度均可基本满足临床需要,医院合理用药指标有所改善,药师专业技术能力有Objective To establish a prescription pre-audit system based on the structure-process-outcome(SPO)model in the the Affiliated Hospital of Qingdao University and explore its application effect.Methods Based on the structural dimension of SPO model,the organizational structure,pharma-ceutical team,management system of pharmaceutical prescription audit,and audit environment of the pre-scription pre-audit system were established.Based on the process dimension of SPO model,the pre-audit process,medication knowledge base,and audit rule base were established,quality monitoring and control were implemented,and relevant personnel training were conducted.Based on the outcome dimension of SPO model,the review rate,manual review rate,clinician acceptance rate of prescription review,reasonable rate of outpatient and emergency prescription comments,and intervention rate of inpatient medical order were verified after the prescription pre-audit system application.Results The prescription pre-audit system was first launched in the main hospital area of the Affiliated Hospital of Qingdao University in March 2021,and achieved full coverage in all five hospital areas by May 2023.The review rates of outpatient and emergency prescriptions and inpatient medical orders had been increasing year by year from 2021 to 2023,and all reached more than 99%of the expected rates in 2023.Compared with 2021,the proportions of outpatient and emergency prescriptions and inpatient medical orders submitted to manual review decreased in 2023[1.2%(112206/9509430)vs.2.9%(16214/549672),2.9%(206258/7152620)vs.3.9%(147679/3814929),the proportions of prescriptions that failed to be reviewed in time decreased[0.7%(62382/9509430)vs.1.4%(7429/549672),0.3%(22816/7152620)vs.2.2%(83303/3814929)],and the accep-tance rates of outpatient and emergency prescription review and inpatient medical orders review by clinicians increased[76.1%(2421/3180)vs.57.0%(339/595),94.3%(1000/1060)vs.70.7%(797/1128)],with statistically significant differences(all P<0.001).But there were

关 键 词：处方药监测程序 前置审核系统 质量管理 药学服务 结构-过程-结果模型 

分 类 号：R95[医药卫生—药学]