医院结构化药学决策知识库建设实践与应用成效分析

Construction of Structured Pharmaceutical Knowledge Database for the Improvement of Drug Decision Support System

关键词:  药学服务  结构化  药学决策  知识库  信息化

Key words:  pharmacy service  structure  pharmaceutical decision  knowledge database  informatization

摘要:

目的 介绍上海交通大学附属第六人民医院构建结构化药学决策知识库的方法及实践。方法 首先进行药学信息结构化梳理，然后构建结构化药学决策知识库，并进行设置测试和运行，最后建立药学决策知识规则库的5步循环更新机制，用于实现用药决策支持功能。在此基础上，比较2016-2018年上半年不合理医嘱比例和构成。结果 按用法用量、禁忌症、适应证、相互作用、配伍、特殊人群用药等特征，对药品应用信息进行结构化梳理，并进行设置测试和试运行，经过药事管理与药物治疗学委员会讨论备案后上线，笔者所在医院结构化药学决策知识库共计包含用药规则10 000余条，涉及药品1 500余种。该系统自2017年初上线，将不合理医嘱比例从6.02%下降到2.07%，同时显著改变不合理医嘱构成，促进药学服务质量提升。结论 笔者所在医院结构化药学决策知识库不仅能提高医疗服务效率和质量，而且能提升医院用药安全的管理水平。

Abstract:

OBJECTIVE To introduce the methods and practices of constructing a structured pharmacy decision-making knowledge database of the Shanghai Jiao Tong University Affiliated Sixth People's Hospital. METHODS First, structured pharmaceutical decision knowledge database was constructed based on multi-faceted clinical medication information, including drug instructions, record information, dispensatory and clinical guideline. Then the database was constructed and tested. Third, the medication rules were revised by 5-step circular update mechanism. At last, the proportion and composition of unreasonable medical advice in the first half from 2016 to 2018 were compared. RESULTS After screening and listing the structured drug application information according to the characteristics of usage, contraindications, idication, interaction, compatibility, special population medication and so on, tested the database through trial operation. Then, after passing the discussion by the Pharmaceutical Management and Drug Treatment Committee, the knowledge database of structured pharmacy decision-making was set up online to run, that including more than 10 000 drug rules, involving about 1 500 kinds of drugs. The system had been launched since the beginning of 2017. Since then, it reduced the proportion of unreasonable medical orders from 6.02% to 2.07%, while significantly changed the composition of unreasonable of medical and promoted the improvement of the quality of pharmaceutical services. CONCLUSION The structured decision-making knowledge can not only improves the efficiency and quality of medical services, but also improve the management level of drug safety usage.