PDCA循环在门急诊近似错误处方持续质量改进中的应用

Application of PDCA Cycle in Continuous Quality Improvement of Near Miss Prescriptions in Outpatient and Emergency Department

关键词:  门急诊  近似错误处方  PDCA循环法  改进措施  用药安全

Key words:  outpatient and emergency  near miss prescriptions  PDCA cycle  improvement measures  medication safety

摘要:

目的 探讨PDCA循环法在医院门急诊近似错误处方持续质量改进中的作用。方法 通过对浙江大学医学院附属邵逸夫医院2016年药房审方药师呈报的门急诊近似错误处方进行回顾分析，采用PDCA循环法进行持续改进，并对项目实施各阶段近似错误处方比例、用法用量错误发生率、近似错误处方修改成功率等指标进行对比分析。结果 开展PDCA循环管理后，自2017年第2季度开始门急诊近似错误处方比例逐步下降。相比于2016年，2017年门急诊近似错误处方的用法用量错误比例由84.5%下降至41.9%，近似错误处方修改成功率>90%，诊断不全处方上报比例从2.9%上升至44.0%。结论 通过运用PDCA循环法，降低了近似错误处方的用法用量错误发生率，提高了近似错误处方修改成功率，有效地暴露了诊断不全处方，加强了门急诊近似错误处方的干预强度，提高了门急诊患者的用药安全。

Abstract:

OBJECTIVE To investigate the effects of PDCA cycle on the continuous quality improvement of the outpatient and emergency department near miss prescriptions in hospital. METHODS A retrospective analysis was conducted on the near miss prescriptions which were reported by the pharmacists in the outpatient and emergency department of Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University in 2016. PDCA cycle method was adopted for the continuous improvement, then the ratio of near miss prescriptions, the incidence of errors in usage and dosage, the success rate of near miss prescription modification as well as other indicators in each stage of this project were compared and analyzed. RESULTS After implementing PDCA cycle, the proportion of near miss prescriptions had gradually decreased since the second quarter of 2017. Compared with the reported near miss prescriptions in the outpatient and emergency departments in 2016, the prescription proportion of errors in usage and dosage was decreased from 84.5% to 41.9%, the success rate of near miss prescription modification was >90%, while the ratio of prescriptions with incomplete diagnosis was increased from 2.9% to 44.0%. CONCLUSION By adopting PDCA cycle, the incidence of errors in usage and dosage of near miss prescription is decreased, the success rate of near miss prescription modification is increased, the incomplete diagnosis of near miss prescription is effectively exposed, while the intervention intensity of near miss prescriptions is strengthened, and then the medication safety of the outpatient and emergency patients is improved.