中药饮片在处方前置审核系统的精细化管理实践及效果评价  

Practice and effectiveness evaluation of refined management of traditional Chinese medicine decoction pieces in the pre-prescription review system

作　　者：李霞 朱宝强 吴思迷 罗守萍 李婷婷 万小燕 唐海龙 林海霞 Li Xia;Zhu Baoqiang;Wu Simi;Luo Shouping;Li Tingting;Wan Xiaoyan;Tang Hailong;Lin Haixia(Department of Pharmacy,the First People's Hospital in Shuangliu District/West China Airport Hospital,Sichuan University,Chengdu 610200,China)

机构地区：[1]成都市双流区第一人民医院/四川大学华西空港医院药学部,四川成都610200

出　　处：《实用药物与临床》2024年第12期952-957,共6页Practical Pharmacy and Clinical Remedies

基　　金：2022年四川省成都市医学科研课题(2022562);2024年四川省中医药管理局面上项目(2024MS600)。

摘　　要：目的探索我院中药饮片处方前置审核系统的精细化管理,促进临床中药饮片的规范使用。方法在中药饮片处方前置审核系统运行时段内,随机抽取成都市双流区第一人民医院(2022年12月至2023年5月)的门/急诊中药饮片处方,通过开展处方点评,分析不合理用药原因,完善中药饮片规则库,对系统实施精细化管理,并比较精细化管理前(2022年12月-2023年5月)及管理后(2023年7-12月)的处方点评合格率。结果我院中药饮片不合理处方问题主要包括特殊煎煮方法脚注未注明、有毒饮片剂量相关拦截级别不合理、配伍禁忌过于严格、中医诊断不规范、缺少特殊人群用药规则、中药饮片遴选不适宜(主要表现在建曲的不合理使用)。针对上述问题,本院明确了特殊煎煮方法和中医诊断的要求、提高有毒饮片拦截级别、降低了配伍禁忌拦截级别、增加了特殊人群的处方拦截标准、规范风热感冒时建曲的使用。随机抽取管理前后各20000张处方进行分析。管理后,中药饮片处方合理率从58.60%(11719/20000)上升至94.90%(18979/20000),差异具有统计学意义(P<0.05)。结论本院前置审方系统中药饮片规则库的优化和精细化管理,可有效提高中药饮片的处方合理率,保障中药饮片临床用药安全合理。Objective To explore the refined management of the pre-prescription review system for traditional Chinese medicine(TCM)decoction pieces in our hospital,and promote the standardized use of clinical decoction pieces of TCM.Methods During the operation period of the pre-prescription review system for prescriptions of TCM decoction pieces,outpatient/emergency TCM prescriptions from the First People's Hospital of Shuangliu District,Chengdu(December 2022 to May 2023)were randomly selected,and the refined management of the system was implemented by conducting prescription reviews,analyzing the reasons for irrational drug use,and improving the rule of TCM decoction pieces.The pass rates of prescription reviews were compared before refined management(December 2022 to May 2023)and after management(July 2023 to December 2023).Results The unreasonable prescription problems in our hospital mainly included the lack of footnotes for special decoction methods,unreasonable interception level related to toxic TCM decoction pieces dosage,overly strict compatibility contraindications,irregular TCM diagnosis,the lack of medication rules for special populations,and inappropriate selection of TCM decoction pieces(mainly manifested in the irrational use of Jianqu).In response to the above issues,our hospital clarified the requirements for special decoction methods and TCM diagnosis,increased the interception level for toxic TCM decoction pieces,reduced the interception level for compatibility contraindications,added prescription interception level for special populations and standardized the use of Jianqu during common cold with wind-heat syndrome.Totally 20000 prescriptions were randomly selected before and after management respectively for analysis.After management,the rationality rate of TCM decoction pieces increased from 58.60%(11719/20000)to 94.90%(18979/20000),with statistical differences(P<0.05).Conclusion The optimization and refined management of the rule library for TCM decoction pieces in the pre-prescription review system o

关 键 词：中药饮片 处方前置审核 精细化管理 处方点评 合理用药 

分 类 号：R288[医药卫生—中药学]