基于帕累托图及鱼骨图分析法探索医院中药配方颗粒调剂服务质量提升的应用与实践  

Exploring the application and practice of pareto chart and fishbone diagram analysis to improve the quality of traditional Chinese medicine granule dispensing service

作　　者：吴汉彪 洪燕萍[1] 仇志坤[1] 陈永[1] 赖莎 WU Hanbiao;HONG Yanping;QIU Zhikun(Key specialty of clinical pharmacy,The First Affiliated Hospital of Guangdong Pharmaceutical University,Guangzhou 510080,China)

机构地区：[1]广东药科大学附属第一医院临床药学重点专科,广州510080

出　　处：《中国处方药》2025年第7期100-105,共6页Journal of China Prescription Drug

摘　　要：目的探索帕累托图及鱼骨图分析法在提升医院中药配方颗粒调剂服务中的作用。方法制作医院中药配方颗粒调剂服务质量问题登记表,统计2022年7月~2022年12月(整改前)和2023年1月~2023年6月(整改后)的中药配方颗粒调剂服务过程中出现的质量问题及类型,同时统计整改前后的调剂时间,并随机抽取整改前后各一个月的盘点情况进行分析。通过帕累托图及鱼骨图分析法,确定中药配方颗粒调剂服务问题的主要类型,制定相关整改措施,持续改进质量,最后比较整改前后的调剂服务质量差异。结果整改前中药配方颗粒调剂服务处方3918张(22178剂),出现服务质量问题208例。整改后中药配方颗粒调剂服务处方7289张(39991剂),出现服务质量问题83例。帕累托图分析显示,中药配方颗粒调剂服务问题的主要类型(A类)为:装量差异(16.35%)、贴错标签(15.87%)、候药时间长(15.38%)、忘放药盒(12.98%)和封膜不紧漏药(10.58%);中药配方颗粒调剂服务问题次要因素(B类)为:机器故障(9.13%)、未对患者进行用药指导(6.25%);中药配方颗粒调剂服务问题一般因素(C类)为:内服与外用袋混淆(5.29%)、调剂差错(3.85%)、加药错误(2.88%)、发药错误(1.44%)。经整改后,中药配方颗粒调剂服务人次增加,服务质量问题发生率由管理前的5.31%下降为1.14%。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装量差异;中药配方颗粒调剂人员平均调配时间由整改前的(7.44±2.114)min降低为整改后的(4.78±1.103)min(P<0.05)。结论利用帕累托图及鱼骨图分析方法可以有效提高中药配方颗粒调剂人员工作技能及效率,保障中药配方颗粒服务质量。Objective To explore the implementation and application of improving the dispensing quality of traditional Chinese medicine(TCM)formula granules based on Pareto chart and fishbone diagram analysis method.Methods A registration was created for the quality of dispensing service of TCM formula granules in hospitals.The quality problems and types in the dispensing service of traditional Chinese medicine formula granules from July 2022 to December 2022(before rectification)and from January 2023 to June 2023(after rectification)were counted.At the same time,the dispensing time before and after rectification was counted,and the inventory of one month before and after rectification was randomly selected for analysis.Through Pareto chart and fishbone diagram analysis method,the major types of dispensing service problems of TCM formula granules were determined,relevant rectification measures were formulated,and continuous quality improvement was carried out.Compare the differences in the quality of dispensing services before and after the rectification.Results Before the rectification,there were 3918 prescriptions(22178 doses)for dispensing service of TCM formula granules,and 208 cases of service quality problems.After the rectification,there were 7289 prescriptions(399991 doses)of dispensing service of TCM formula granules,and 83 cases of service quality problems.Pareto diagram analysis showed that the main types(class A)of dispensing service problems of TCM formula granules were as follows:Loading difference(16.35%),mislabeling(15.87%),long waiting time(15.38%),forgot to put the medicine box(12.98%),and untight sealing and drug leakage(10.58%).The secondary factors(category B)of dispensing service problems of TCM dispensing granules were as follows:machine failure(9.13%),no medication guidance for patients(6.25%);The general factors(category C)of dispensing service problems of TCM formula granules are as follows:internal and external bag confusion(5.29%),dispensing error(3.85%),dosing error(2.88%),drug delivery error(1.4

关 键 词：药学服务 帕累托图 鱼骨图 中药配方颗粒 调剂质量 

分 类 号：R288[医药卫生—中药学]