基于前置处方审核系统的儿童专科医院心内科门急诊超说明书用药合理性分析

Rationality Analysis of Off-lable Use in Outpatient and Emergency Department of Cardiology in Children's Specialized Hospital Based on Pre-prescription Review System

关键词:  前置处方审核  门急诊  心内科  儿童  超说明书用药  合理用药

Key words:  pre-prescription review  outpatient and emergency department  cardiology  children  off-lable drug use  rational drug use

摘要:

目的 对儿童专科医院心内科的全年度门急诊处方进行点评，分析超说明书的合理用药现状。方法 采用回顾性分析方法，汇总2021年度心内科门急诊处方在每日经前置处方审核系统审核后的所有阳性不合理处方，经药师、医师联合复审判定出假阳性不合理用药处方，再根据循证医学证据进一步判定超说明书用药情况，并用Excel软件进行统计分析。结果 抽取2021年度心内科门急诊所有处方共计84 821张，经合理用药软件点评得到不合理阳性处方335张，包含360条药品信息条目。经儿童心血管专科临床药师、医师联合复审前置审核系统筛出的阳性不合理处方后，判定假阳性不合理处方169张，涉及医嘱条目189条，其主要原因为儿科超说明书用药情况未在系统中完善以及系统无法审核处方医嘱的临床特殊事宜备注而导致的系统误判。排除系统误判，累积超说明书用药条目144条，其中超说明书适应证用药81条(56.25%)、超说明书用法用量45条(31.25%)、超说明书重复用药8条(5.56%)、超说明书药物相互作用用药8条(5.56%)和超说明书给药途径用药2条(1.39%)。结论 儿童心内科门急诊存在一定的超说明书用药情况，主要表现为超适应证用药和超用法用量。医院可通过不断完善超说明书用药规范化管理和系统规则进一步规范儿童心内科门急诊的合理用药，以期全方位提升临床的合理、规范用药。

Abstract:

OBJECTIVE To evaluate the annual outpatient and emergency prescriptions in cardiology department of children's specialized hospital and to analyze the status of off-lable rational drug use. METHODS Retrospective analysis was used to summarize all the unreasonable positive prescriptions of outpatient and emergency prescriptions in cardiology department in 2021 after the daily review by the pre-prescription review system. The unreasonable false positive prescriptions were jointly reviewed by both pharmacists and physicians. Then, off-lable drug use was further determined based on evidence-based medical evidence and statistical analysis was conducted with Excel software. RESULTS A total of 84 821 prescriptions in outpatient and emergency department of cardiology in 2021 were collected, and 335 unreasonable positive prescriptions were obtained from the reviewed of rational drug use software, involving 360 drug information items. After the clinical pharmacist and physicians in pediatric cardiovascular specialty jointly reviewed the positive unreasonable prescriptions screened out by the pre-review system, 169 false positive and unreasonable prescriptions were determined. The 189 items of medical orders were involved. The main reasons for false positives were that the pediatric off-label drug use had not been improved in the system, and the system was unable to review the clinical special notes of prescription orders, resulting in system misjudgment. Excluding systematic misjudgments, 144 items of off-label drug use were accumulated, Including 81(56.25%) off-lable indications, 45(31.25%) off-lable usage and dosage, 8(5.56%) off-lable repeated medication, 8(5.56%) off-lable drug interactions and 2(1.39%) off-lable routes of administration. CONCLUSION Off-label drug use exists in pediatric cardiology department, mainly manifested as off-label indication and off-lable usage and dosage. In order to further standardize the rational drug use, hospital can constantly improve the standardized management and system rules of off-label drug use, so as to comprehensively promote the rational and standardized drug use in clinic.