PDCA循环在医院处方持续质量改进中的应用

Application of PDCA Cycle in Hospital Prescription Continuous Quality Improvement

关键词:  处方  持续质量改进  戴明循环

Key words:  prescription  continuous quality improvement(CQI)  PDCA

摘要:

目的 探讨PDCA循环理论在医院处方质量持续改进中的应用及可行性，促进临床合理用药。方法 用Epidata软件录入不合理处方并进行汇总分析评价，然后运用PDCA循环理论对不合理处方进行干预并观察效果。结果 PDCA循环后，我院不合理处方数和百分率显著下降(P<0.01)。①调剂药师组：不合理处方百分率从0.44%下降到0.31%(P<0.01)，下降幅度31.01%,其中不规范处方从0.23%下降到0.16%(P<0.01)，下降幅度32.98%；用药不适宜处方从0.17%下降到0.12%(P<0.01)，下降幅度31.75%；超常处方从0.04%下降到0.03%(P<0.05)，下降幅度17.42%。②临床药师组：不合理处方百分率从4.96%下降到3.16%(P<0.01)，下降幅度36.38%,其中不规范处方从2.63%下降到1.61%(P<0.01)，下降幅度38.23%；用药不适宜处方从1.94%下降到1.19%(P<0.01)，下降幅度37.66%；超常处方从2.63%下降到1.61%(P<0.01)，下降幅度23.40%。临床诊断不全、剂量和单位不一致处方数和百分率均显著下降(P<0.01)，中药注射剂、抗菌药物使用趋于合理。处方质量持续改进达到预期目标。结论 PDCA循环用于医院处方持续质量改进效果显著，可在医院处方质量管理中推广应用。

Abstract:

OBJECTIVE To investigate the application and feasibility of the PDCA cycle theory in the continuous improvement of prescriptions quality and to promote clinical rational use of drugs. METHODS The irrational prescriptions were collected, analyzed and evaluated with Epidata software. Irrational prescriptions were intervened based on the PDCA cycle theory and the results were observed. RESULTS After the application of PDCA, the number and the proportion of the irrational prescriptions in our hospital dropped down significantly(P<0.01). ① Dispensing Pharmacists group: The proportion of irrational prescriptions dropped by 31.01%, from 0.44% to 0.31%(P<0.01). Among them, the proportion of nonstandard prescriptions dropped by 32.98%, from 0.23% to 0.16%(P<0.01), the proportion of unsuitable drug use prescriptions dropped by 31.75%, from 0.17% to 0.12%(P<0.01), the proportion of paranormal prescriptions dropped by 17.42%, from 0.04% to 0.03%(P<0.05).②Clinical Pharmacists group: The proportion of irrational prescriptions dropped by 36.38%, from 4.96% to 3.16%(P<0.01).Among them, the proportion of nonstandard prescriptions dropped by 38.23%%, from 2.63% to 1.61%(P<0.01), the proportion of unsuitable drug use prescriptions dropped by 37.66%, from 1.94% to 1.19%(P<0.01), the proportion of paranormal prescriptions dropped by 23.40%, from 2.63% to 1.61%(P<0.01). The number and proportion of incomplete clinical diagnosises, prescriptions with discordant units and dosage decreased significantly (P<0.01). The use of traditional Chinese medicine injection and antibacterial drugs tended to be rational. The expected objective of continuous improvement of the quality of the prescriptions is achieved. CONCLUSION The application of PDCA cycle obviously improved the hospital prescription quality. It can be widely used in hospital prescription quality management.