我院开展病区用药医嘱点评模式探讨

目的：探索适合我院病区用药医嘱点评的模式，促进临床合理用药。方法：根据我院用药与临床药师水平实际情况，初步制定医嘱点评模式及干预措施，并对我院2012年3月-2013年10月月使用金额排序前十位且异常增长的药品选两种随机抽取一时间段架上病历进行点评。结果：共点评病区用药医嘱单487份，涉及药品30种，39品次，平均不合理医嘱率为30.0%，其中，不合理医嘱主要为超说明书适应证用药（54.1%），不良反应预防及监测不当（20.6%），品种选择不当（11.6%），用法用量不适宜（11.0%），超禁忌证使用（2.7%），医务科每月将不合理结果纳入医疗质量整改通知书发至各科室，要求各科室进行整改回复，各个科室将整改情况于规定时间内反馈至内网专栏。结论：该模式可有效评价不合理医嘱，丰富临床药师用药经验，借以引起临床医生警惕，减少不合理医嘱的产生。

Exploration of Evaluation Mode on Medication Orders in Hospital Wards

Objective：To explore the review mode of medication orders in hospital wards and to promote the rational drug use in clinical practice.Methods：According to the actual situation of medication and the level of clinical pharmacist in our hospital,a review mode of medical orders and intervention measures were worked out, and two medication orders were reviewed which were randomly selected from the drugs of top ten in both usage and dosage and with abnormal increase of use in our hospital from March 2012 to October 2013.Results：About 487 ward medication orders were reviewed,including 30 kinds of medicines and 39 variety/times,about 30.0% or-ders was unreasonable averagely, the main problems of unreasonable orders including medication beyond drug indi-cations（54.1%）,improper prevention and monitoring of adverse reactions（20.6%）,inappropriate selection of medicines（11.6%）,unsuitable usage and dosage（11.0%）,and medication beyond contraindications（2.7%）. The medical department issued monthly the rectification notices of medical quality reporting the unreasonable results to each department. Rectification and responses were asked for each department and the feedback should be presented in intranet column within the specified time.Conclusion：The review mode can effectively evaluate the irrational medical orders and enrich the medication experience of clinical pharmacist, so as to give an alert to clinician and reduce the unreasonable medical advice.