基于帕累托图-鱼骨图分析宁波大学附属妇女儿童医院2023年门急诊处方点评情况  

Analysis of outpatient and emergency prescription review in Women and Children′s Hospital of Ningbo University in 2023 based on Pareto diagram-fishbone diagram

作　　者：鲍雅清 陈波[1] 吴燕华 沈珑慧 BAO Yaqing;CHEN Bo;WU Yanhua;SHEN Longhui(Department of Pharmacy,Women and Children's Hospital of Ningbo University,Zhejiang Province,Ningbo 315000,China)

机构地区：[1]宁波大学附属妇女儿童医院药剂科,浙江宁波315000

出　　处：《中国当代医药》2025年第1期118-122,共5页China Modern Medicine

基　　金：浙江省宁波市医疗卫生高端团队重大攻坚项目(2022020405)。

摘　　要：目的调查分析宁波大学附属妇女儿童医院2023年门急诊不合理处方情况,针对性地提出改进措施及建议,促进临床合理用药,提高用药安全性。方法采用回顾性分析方法,随机抽取宁波大学附属妇女儿童医院2023年全年门急诊处方共312914张,采用人工点评方式对处方进行点评,分析不合理用药类型,采用帕累托图和鱼骨图对不合理处方的构成因素及可能的原因进行分析。结果抽取的处方中合理处方为307092张,合理率为98.14%。不合理处方为5822张,不合理率为1.86%。帕累托图分析显示,主要的不合理处方类型为处方前记书写不规范(n=3088,50.22%)、抗菌药物使用不合理(n=889,15.27%)、诊断与用药不相符(n=747,12.83%)、用法用量不适宜(n=574,9.86%),次要不合理处方类型为分方(n=347,5.96%)、超量(n=268,4.60%),一般不合理类型为成分重复(n=28,0.48%)、相互作用(n=23,0.40%)、精神类处方(n=18,0.31%)、超说明书用药(n=4,0.07%)。结论帕累托图可直观表现处方不合理的主要类型,如处方前记书写不规范、抗菌药物使用不合理等。对相关原因通过鱼骨图分析,开展有针对性的药学干预,对主次要类型加以控制提出改进方案,有效提高处方质量和用药合理性,保障患者临床用药安全。Objective To investigate and analyze the situation of irrational prescription in outpatient and emergency department of Women and Children's Hospital of Ningbo University in 2023,and put forward targeted measures and suggestions to promote rational drug use and improve drug safety.Methods A total of 312914 outpatient and emergency prescriptions in Women and Children's Hospital of Ningbo University in 2023 were randomly selected by retrospective analysis method.The prescriptions were reviewed by manual review method,and the types of irrational drug use were analyzed.The composition factors and possible causes of irrational prescriptions in the results were analyzed by Pareto diagram and fishbone diagram.Results The number of reasonable prescriptions was 307092,and the reasonable rate was 98.14%.There were 5822 irrational prescriptions,the irrational rate was 1.86%.Pareto diagram analysis showed that the main types of irrational prescriptions were irregular writing before prescription(n=3088,50.22%),irrational use of antibiotics(n=889,15.27%),inconsistent diagnosis with medication(n=747,12.83%),inappropriate usage and dosage(n=574,9.86%).The secondary irrational prescription types were subprescription(n=347,5.96%),overdosage(n=268,4.60%),general irrational prescription types were component repetition(n=28,0.48%),interaction(n=23,0.40%),psychiatric prescription(n=18,0.31%),off-label drug use(n=4,0.07%).Conclusion The Pareto diagram can directly show the main types of unreasonable prescriptions such as irrational prescriptions were irregular written before prescription,irrational use of antibiotics,et al.The fishbone diagram can be used to analyze the related causes,carry out targeted pharmaceutical intervention,and control the main and secondary types,so as to effectively improve the prescription quality and drug use rationality,and ensure the clinical drug use safety of patients.

关 键 词：门急诊处方 处方点评 帕累托图 鱼骨图 

分 类 号：R92[医药卫生—药学]