应用中断时间序列模型分析处方前置审核及六西格玛管理模式对门诊处方合理率的干预效果  

Effect of Prescription Pre-Review and Six Sigma Management Model on Rationality Rate of Outpatient Prescriptions Based on Interrupted Time-Series Analysis

作　　者：张田 赵飞 李婷[1] 王洋[1] 张亚同[1] 金鹏飞[1] ZHANG Tian;ZHAO Fei;LI Ting;WANG Yang;ZHANG Yatong;JIN Pengfei(National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Bejing Key Laboratory of Assessment of Clinical Drugs Rish and Individual Application,Department of Pharmacy,Beijing Hospital,Beijing 100730,China)

机构地区：[1]北京医院药学部,国家老年医学中心,中国医学科学院老年医学研究院,北京市药物临床风险与个体化应用评价重点实验室,北京100730

出　　处：《中国药学杂志》2024年第24期2390-2395,共6页Chinese Pharmaceutical Journal

摘　　要：目的分析前置审核系统及六西格玛管理模式对门诊用药医嘱合格率的干预效果,以期提高药学服务质量,保障患者用药安全、合理、有效。方法收集北京医院2020年4月至2024年3月门诊处方合格率信息,利用中断时间序列分析(interrupted time series analysis,ITSA)的多阶段模型对前置审核系统全科室开展前、开展后,以及在前置审核基础上实施六西格玛管理法3个阶段门诊处方合格率的变化情况进行分析。结果ITSA结果显示,在全科室开展前置审核之前,我院门诊处方合格率基本稳定,约为86.56%。开展前置审核之后,当月处方合格率较前提高了9.81%,且处方合格率以0.17%的增长率呈逐月上升的趋势。2021年11月,在处方前置审核的基础上结合定义-测量-分析-改进-控制(DMAIC)管理法实施后,当月处方合格率提升至98.07%,达到目标值,处方合格率以每月0.05%的趋势持续提升。结论开展处方前置审核,实施六西格玛管理有助于形成事前审核、事中干预、事后点评、结果公示、及时沟通反馈的闭环管理模式,显著提升了门诊合理用药水平,更好地规范了医生处方行为,促进药师与医师的沟通协作,保障患者用药安全。OBJECTIVE To analyze the intervention effect of prescription pre-review and Six Sigma management model on the qualified rate of outpatient prescriptions to improve the quality of pharmaceutical care and ensure the safety,rationality,and effectiveness of medication in patients.METHODS The qualified rates of outpatient prescriptions in Beijing Hospital from April 2020 to March 2024 were collected.The multi-stage model of interrupted time series analysis(ITSA)was used to analyze the changes in the qualified rate of outpatient prescriptions in three stages:before and after the pre-review system was implemented in the whole department,as well as the implementation of Six Sigma management method based on the pre-review.RESULTS The ITSA showed that the qualified rate of outpatient prescriptions in our hospital was stable around 86.56%before the pre-review was carried out in all departments.After the implementation of pre-review,the qualified rate of prescriptions in that month increased by 9.81%.In November 2021,after the implementation of define measure analyze improve control(DMAIC)management based on prescription pre-review,the qualified rate of prescriptions in the month increased to 98.07%,reaching the target value,and the qualified rate of prescriptions continued to increase with a monthly trend of 0.05%.CONCLUSION The implementation of prescription pre-review and Six Sigma management is conducive to the formation of a closed-loop management model of pre-review,in-process intervention,post-comment,result publicity,and timely communication and feedback,which significantly improves the level of rational drug use in the outpatient department,better standardizes the prescribing behavior of doctors,promotes the communication and cooperation between pharmacists and physicians,and ensures the medication safety of drug use for patients.

关 键 词：中断时间序列 前置审核 六西格玛 处方合格率 

分 类 号：R969[医药卫生—药理学]