JCI理念指导下改善综合性医院ST医嘱执行情况的研究

Research on Improving the Execution of ST Orders in Comprehensive Hospital under the Guidance of JCI Concept

关键词:  ST医嘱  执行情况  持续改进  JCI

Key words:  ST orders  execution  continuous improvement  JCI

摘要:

目的 探讨在JCI理念指导下改善综合性医院ST医嘱执行情况的有效干预措施。方法 在JCI理念指导下，先后采取提高药师对ST医嘱重视程度、干预临床医师的ST医嘱开具、调整紧急药品目录、调整临床科室备药等措施，研究多项举措依次通过的4个阶段对改善综合性医院ST医嘱比例、不规范ST医嘱比例、物流平均配送时间以及ST医嘱平均执行时间4项指标的影响，并比较4个阶段ST医嘱在30 min内执行给药的符合率。结果 在原有举措的基础上，通过提高药师对ST医嘱重视程度，改善了ST医嘱在住院药房的执行效率与物流平均配送时间，进而使ST医嘱开具比例、物流平均配送时间、ST医嘱平均执行时间得以明显改善（P均<0.01）；通过干预临床医师ST医嘱开具，主要改善了ST医嘱开具比例与不规范ST医嘱比例，进而使4项指标得以明显改善（P均<0.01）；通过调整紧急药品目录，主要改善了ST医嘱开具比例与不规范ST医嘱比例，进而使4项指标得以更为明显的改善（P均<0.01）；通过调整临床科室备药，缩短了ST医嘱平均执行时间，进而使物流平均配送时间、ST医嘱平均执行时间得以明显改善（P均<0.01）；上述4项措施依次通过的4个阶段，ST医嘱在30 min内执行给药的符合率均得以显著改善（P均<0.01）。结论 在JCI理念指导下，提高药师对ST医嘱重视程度、干预临床医师的ST医嘱开具、调整紧急药品目录、调整临床科室备药等多项措施均可有效改善综合性医院ST医嘱的执行情况，其中调整紧急药品目录是最为有效的措施。

Abstract:

OBJECTIVE To explore effective interventions of improving the implementation of ST orders in comprehensive hospitals under the guidance of the JCI concept.METHODS Under the guidance of JCI concept, to improve the implementation of ST orders, the following methods were adopted sucessively:improving the pharmacist' attention on ST orders, interventing the prescription of clinical ST orders, adjusting the list of emergency medicines and adjusting the drug preparation of clinical department. The four stages gradually added in were studied to assess the affection to the proportion of clinical ST orders, the proportion of irregular clinical ST orders, the average delivery time and the average execution time of ST orders, then compared the coincidence rate of ST orders executed in 30 min of the four stages.RESULTS Basis on the the original mode, improving the pharmacist' attention on ST orders improved the execution efficiency and average delivery time of ST orders in the hospital pharmacy, and made the three indexes, the proportion of clinical ST orders, the average delivery time and the average execution time of ST orders, significantly improved(P<0.01). Then added the measure of interventing the prescription of clinical ST orders, mainly ameliorated the proportion of clinical ST orders and the proportion of irregular clinical ST orders, then made the follow four indexes significantly improved(P<0.01). Then added the measure of adjusting the list of emergency medicines, mainly ameliorated the proportion of clinical ST orders and the proportion of irregular clinical ST orders, the four indexes were significantly improved(P<0.01). Then added the measure of adjusting the drug preparation of clinical department, this would reduce some implementation of these ST orders, further ameliorated the average delivery time and the average execution time of ST orders(P<0.01). After the four steps, the coincidence rates of ST orders executed in 30 min were significantly improved(P<0.01).CONCLUSION Under the guidance of JCI concept, the four measures, improving the pharmacist'attention on ST orders, interventing the prescription of clinical ST orders, adjusting the list of emergency medicines and adjusting the drug preparation of clinical department, can effectively improve the implementation of ST orders in comprehensive hospital. The measure of adjusting the list of emergency medicines showes the best effect among them.