| Objective:In order to strengthen the management of prescription quality, promote the clinical rational drug use, ensure medical security, the ministry of health in2007promulgated the "prescription management method", put forward the medical institutions should set up a prescription review system to intervene on irrational drug use; the ministry of health issued the methods for the administration of prescription comment on "Document number [2010]28". To further standardize hospital prescription comment work. This document pointed out:prescription review is a hospital for medical treatment quality improvement and drug application management important constituent, is an important means to improve the level of clinical medication. Prescription comment in this document is based on to the relevant laws and regulations, technical specifications and evaluate the standardization of the prescription writing and clinical drug use suitability (medical indication, drug choice, dosage, usage, dosage, drug interaction and incompatibility, etc.). The purpose of this methods is to discover or potential problems and formulate,implementation the improving measures of the rational drug use. The idea is important safeguards of implementing the pharmaceutical administration law,"the professional medical practitioners law", the "regulations on the administration of medical institutions of pharmaceutical affairs","prescription management method" and other relevant laws, regulations and rules. To Explore and improve the effective prescription review measures, methods, ways, prescription is the prerequisite and guarantee for the continuous improvement of prescription. In recent years, the PDCA cycle (Deming circle) is widely used in quality control, provides a new way of thinking for us. Application of the PDCA cycle on hospital pharmacy, satisfactory results have been achieved. We apply the PDCA cycle to outpatient prescription comment, Inpatient medical record review and drug special review, explore new ways of drug review work, promote the clinical rational drug use. Methods:1. We choose outpatient prescriptions for comments from January2013to June2014, this paper analyzes the factors which cause irrational drug use by using the fishbone diagram to qc circle. The most influential factors was found by using Plato and formulated improvement objectives.In the first round of PDCA cycle (January2013-December2013), will improve the electronic prescription system, will strengthen the physician drug knowledge training as the main target of improvement.In the second round of PDCA cycle (January2014-June2014), the prescription fraction defective is reduced to below5%as the goal. The qualified rates of outpatient prescription from January2013to June and July2013to June2013were comparatively analyzed.2. We selected inpatient hospital medical records for drug review from in October2012to May2013. Main factors of irrational drug use was analyzed. To estabolish the electronic medical record system was PDCA cycle improvement goals. The inpatient medical records from October2012to December and March2013-5months was comparatively analyzed.3.Dynamic monitoring the usage of antibiotics, usage amount from April2013to December2013, etc.was carried on.The Class "the use limited" antimicrobial agents "Sulbenicillin Sodium for Injection " abnormal use was warned and intervented for reducing its irrationalhe use. Application rationality of Sulbenicillin Sodium for Injection is analyzed and from the indications, usage and dosage, drug economics, coadministration and et al.4. We chose inpatient medical records of parenteral nutrition drugs fat milk amino acids (17) and glucose (11%) injection (Calvin) for special review in our hospital from January2013to September2013and compared (analyzed) to the special review result from January2013to march before implement PDCA cycle and from July to September in2013after implement PDCA cycle. In medicine, medical records, related indicators monitoring, drug compatibility, etc, all records are more complete, the use of fat milk amino acids (17) and glucose (11%) injection tend to be rational.Results:1.Currently our prescription comment after using PDCA cycle, prescription qualified rate increased significantly, irrational drug use is greatly improved. The recording of the basis of medicine, medical records, the relevant indicators of monitoring records and drug incompatibility were more complete. Application practice proved PDCA cycle is a suitable method for medical quality continuous improvement. The reason analysis and countermeasure of unqualified prescriptions is the premise of effective increasing qualified prescription rate. In PDCA cycle, using the experience of the fishbone diagram of the quality management circle unreasonable factors were analyzed, and the Plato was used to find the influential factors as a focal point of the next step of work and solved the problem in a planned way step by step. It can be targeted and avoided repeated labor and low efficiency. It can rapidly in a short time improve the efficiency of prescription comment. Outpatient prescription qualified rate is69.05%before PDCA cycle implementation, and increased to96.77%, up by27.72%after PDCA cycle implementation. Two groups of prescription qualified rate was statistically different (P<0.05).2. We reviewed inpatient medical records of478cases and found irrational medical records of131cases. Inpatient medical records qualified rate was60.93%before the implementation of PDCA, it was84.17%after the implementation of PDCA, increased by23.24%.3.Dynamic monitoring of antimicrobial agents was carried on by Using PDCA cycle fast accurate screening in April-June2013abnormal use of antimicrobial agents:" Sulbenicillin Sodium for Injection was screened fast and accurately in April-June2013as antimicrobial agents abnormaly used. Early warning and intervention On the use of Sulbenicillin Sodium for Injection were made. Its rationality was evaluated, the scope of its use was narrowed, the usage quantity was reduced. So the generation of drug-resistant strains for reducing the hospital infection was possibly avoided. To December2013, the application of the drug was rational. The research provides a new method for pharmacists comprehensive management of the rational use of antimicrobial drugs.4.Using of fat milk amino acids (17) glucose (11%) injection (Calvin,parenteral nutrition)in inpatients was reviewed specialy and more reasonable, specified after the implementation of the PDCA cycle. physicians is to pay more attention to drug review work and the use of drugs is rational. Pharmacist also is pay more attention to individualized medication review according to patients condition than a simple medicine theory. Prescription review work has greatly increased the pharmacist professional qualities and skills.Conclusions:1. This research provides a new way of thinking for the management of drug review work.PDCA cycle can be planned step by step to solve problems in drug evaluation, to achieve the target, to avoid the low efficiency of repeated labor. The method is simple in operation and a comprehensive, sustainable management tool to promote the prescription comment.2.PDCA cycle is rising cycle, each cycle has a new goal and content. A cycle is made once, the quality is improved. Unresolved issues is put in the next cycle for the achievement of continuous quality improvement. The cause analysis of problems and making countermeasures are the premise of effective PDCA cycle. We can pick out all the cause of the problem and find most influencial factors as the aim of improving by using the tools fishbone diagram and Plato, methods such as brainstorming, ideas and can quickly improve the work efficiency in a short time.3.Drug review is a long-term and important work, this research established a new method of drug review through practice of the outpatient prescription comment, inpatient medical records review, special drug review of inpatient medical records, as well as the dynamic monitoring and evaluation of antimicrobial agents. It was proved this method is effective and can promote the rational drug use significantly. |
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