多学科协作下门诊审方规则优化实践OA

Objective To promote the refined management of outpatient prescription review work.Methods The departments of obstetrics and gynecology,hematology,dermatology,nephrology,and neurology were selected as examples,the outpatient prescription data and corresponding prescription review records from January 1 to June 30,2023(before rule maintenance)and July 1 to December 31,2023(after rule maintenance)were collected from the hospital information system and Tianji Health Prescription Review System.The changes in the proportion of pre-review problem prescription in the system,the proportion of prescriptions returned by physicians for modification before submission,the proportion of pharmacist reviewed prescriptions and the proportion of pharmacist intervened prescriptions,modification of pharmacist intervention prescriptions and application for dual signature dispensing by physicians in five departments were compared before and after rule maintenance,as well as the distribution of warning types and warning levels in the 2023 outpatient prescription review rules were analyzed.Results Except for the proportion of pre-review problem prescription in the system in the department of obstetrics and gynecology and the proportion of prescriptions returned by physicians for modification before submission in the department of dermatolog and neurolog,the differences in other indicators before and after rule maintenance were statistically significant(P<0.05).After rule maintenance,the proportion of pharmacist reviewed prescriptions was significantly increased,while the proportion of pharmacist intervened prescriptions was significantly decreased(P<0.05).Except for the department of obstetrics and gynecology,the modification of pharmacist intervented prescriptions by physicians in other departments was significantly improved,and the application for dual signature dispensing by physicians in each department was decreased to varying degrees.In 2023,a total of 176 outpatient review rules were maintained by author of this paper.The top three warning types in the review rules by quantity were medication without indications(45.45%),inappropriate daily/single dose(17.61%),and inappropriate dosing frequency(12.50%).After the maintenance of the outpatient prescription review rules,the top three warning levels by number in terms of quantity were general warning(47.73%),interception(29.55%),and inactive(10.23%).Conclusion At present,the main problems in the maintenance of the hospital's prescription review work include the untimely import of the basic rules of the prescription review software,incomplete warning levels of the basic rules,inability to effectively intercept unreasonable prescriptions,and possible interference with the clinical diagnosis and treatment rhythm,increasing the distrust of physicians.It is recommended to carry out graded management of drug usage and dosage,adjust warning levels as appropriate,simplify warning information and provide medication advice,enhance pharmacists'evidence-based ability,and continuously optimize prescription review rules to further promote clinical safe and rational drug use.