42302张儿科门急诊处方点评及不合理处方的帕累托图分析
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摘要
目的:了解河南省省立医院(以下简称"我院")儿科门急诊不合理处方现状,分析不合理原因,提出管理对策。方法:汇总分析2017年我院儿科门急诊处方点评结果,使用帕累托图对不合理处方类型进行统计分析,找到造成处方不合理的主要、次要及一般因素。结果:共抽取儿科门急诊处方42 302张处方,不合理处方1 790张,处方不合理率为4.23%。1 790张不合理处方中不合理之处共1 816例次,未写临床诊断或临床诊断不全(775例次,占42.68%)、用法与用量不适宜(380例次,占20.93%)是处方不合理的主要因素;适应证不适宜(311例次,占17.13%)、药品剂型或给药途径不适宜(147例次,占8.09%)是处方不合理的次要因素;遴选药品不适宜(70例次,占3.85%)等其他因素是不合理处方的一般因素。结论:我院儿科处方合理率有待进一步提高。药师应根据不合理处方因素的类型制订针对性的解决办法,促进合理用药,保障患儿用药安全。
OBJECTIVE: To investigate the current situation of irrational prescriptions in pediatric outpatient and emergency department of Henan Provincial Hospital(hereinafter referred to as "our hospital"), to analyze the irrational reasons and put forward the management countermeasures. METHODS: The results of pediatric outpatient and emergency prescription comments in our hospital in 2017 were summarized and analyzed. Pareto chart was used to conduct statistical analysis on irrational prescription types, and the main, secondary and general factors causing irrational prescriptions were found. RESULTS: A total of 42 302 pediatric outpatient and emergency prescriptions were drawn, including 1 790 irrational prescriptions, with the irrational rate of 4.23%. Among the 1 790 irrational prescriptions, there were a total of 1 816 case-times of irrational problems, with no clinical diagnosis or incomplete clinical diagnosis(775 case-times, 42.68%) and inappropriate usage and dosage(380 case-times, 20.93%) were the main factors; inappropriate indications(311 case-times, 17.13%) and inappropriate dosage form or administration route(147 case-times, 8.09%) were the secondary factors; other factors such as inappropriate drug selection(70 case-times, 3.85%)were the general factors. CONCLUSIONS: The rational rate of pediatric prescriptions in our hospital needs to be further improved. Pharmacists should formulate targeted solutions according to the types of irrational prescription factors to promote the rational drug use and ensure the medication safety of children.
OBJECTIVE: To investigate the current situation of irrational prescriptions in pediatric outpatient and emergency department of Henan Provincial Hospital(hereinafter referred to as "our hospital"), to analyze the irrational reasons and put forward the management countermeasures. METHODS: The results of pediatric outpatient and emergency prescription comments in our hospital in 2017 were summarized and analyzed. Pareto chart was used to conduct statistical analysis on irrational prescription types, and the main, secondary and general factors causing irrational prescriptions were found. RESULTS: A total of 42 302 pediatric outpatient and emergency prescriptions were drawn, including 1 790 irrational prescriptions, with the irrational rate of 4.23%. Among the 1 790 irrational prescriptions, there were a total of 1 816 case-times of irrational problems, with no clinical diagnosis or incomplete clinical diagnosis(775 case-times, 42.68%) and inappropriate usage and dosage(380 case-times, 20.93%) were the main factors; inappropriate indications(311 case-times, 17.13%) and inappropriate dosage form or administration route(147 case-times, 8.09%) were the secondary factors; other factors such as inappropriate drug selection(70 case-times, 3.85%)were the general factors. CONCLUSIONS: The rational rate of pediatric prescriptions in our hospital needs to be further improved. Pharmacists should formulate targeted solutions according to the types of irrational prescription factors to promote the rational drug use and ensure the medication safety of children.
引文
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[11] 唐菲菲,范惠霞,赵宇燕.山西省儿童医院儿科门诊超说明书用药调查分析[J].中国药物与临床,2015,15(12):1717-1721.
[12] 刘晓玲,裴保方,陈海燕,等.郑州市儿童医院2013年门诊处方超说明书用药情况调查[J].中国药师,2015,18(1):116-118.
[13] 张伶俐,李幼平,曾力楠,等.15国超说明书用药政策的循证评价[J].中国循证医学杂志,2012,12(4):426-435.
[14] 广东省药学会.关于印发《药品未注册用法专家共识》的通知[J].今日药学,2010,20(4):1-3.
[15] 中华医学会儿科学分会临床药理学组,《中华儿科杂志》编辑委员会.中国儿科超说明书用药专家共识[J].中华儿科杂志,2016,54(2):101-103.
[16] 梅枚,王立波,刘恩梅,等.中国儿童超说明书用药管理现状及认知度的横断面调查[J].中国循证儿科杂志,2017,12(4):289-294.
[17] 季宏建,岳峰,朱宏亮,等.我院门/急诊电子处方事前审核模式的建立及完善[J].中国药房,2017,28(1):80-83.
[2] 卫生部.关于印发《医院处方点评管理规范(试行)》的通知[S].卫医管发[2010]28号.2010-02-10.
[3] 肖永红.利用抗菌药物PK/PD优化感染治疗[J].中国抗生素杂志,2017,42(12):1033-1039.
[4] Hersh AL,Jackson MA,Hicks LA.Principles of judicious antibiotic prescribing for upper respiratory tract infections in pediatrics[J].Pediatrics,2013,132(6):1146-1154.
[5] 中华医学会儿科学分会消化学组,中华医学会儿科学分会感染学组,《中华儿科杂志》编辑委员会.儿童腹泻病诊断治疗原则的专家共识[J].中华儿科杂志,2009,47(8):634-636.
[6] 曾英彤,林璐,赖莎,等.盐酸氨溴索注射剂超说明书用药的多中心调查研究[J].中国药房,2017,28(29):4060-4065.
[7] 王小川,王晓玲,谢晓慧,等.15家医院儿科常用药品说明书儿童用药信息调查分析[J].中国药学杂志,2015,50(16):1446-1450.
[8] 张伶俐,李幼平,梁毅,等.全球门诊儿童超说明书用药现状的系统评价[J].中国循证医学杂志,2012,12(3):305-313.
[9] 张伶俐,李幼平,黄亮,等.四川大学华西第二医院2010年儿科门诊患儿超说明书用药情况调查[J].中国循证医学杂志,2012,12(3):267-273.
[10] 郭春彦,王晓玲.大型综合儿童医院门诊患儿超说明书用药情况调查[J].临床药物治疗杂志,2014,12(2):50-55.
[11] 唐菲菲,范惠霞,赵宇燕.山西省儿童医院儿科门诊超说明书用药调查分析[J].中国药物与临床,2015,15(12):1717-1721.
[12] 刘晓玲,裴保方,陈海燕,等.郑州市儿童医院2013年门诊处方超说明书用药情况调查[J].中国药师,2015,18(1):116-118.
[13] 张伶俐,李幼平,曾力楠,等.15国超说明书用药政策的循证评价[J].中国循证医学杂志,2012,12(4):426-435.
[14] 广东省药学会.关于印发《药品未注册用法专家共识》的通知[J].今日药学,2010,20(4):1-3.
[15] 中华医学会儿科学分会临床药理学组,《中华儿科杂志》编辑委员会.中国儿科超说明书用药专家共识[J].中华儿科杂志,2016,54(2):101-103.
[16] 梅枚,王立波,刘恩梅,等.中国儿童超说明书用药管理现状及认知度的横断面调查[J].中国循证儿科杂志,2017,12(4):289-294.
[17] 季宏建,岳峰,朱宏亮,等.我院门/急诊电子处方事前审核模式的建立及完善[J].中国药房,2017,28(1):80-83.