PDCA 循环管理法在门诊处方质子泵抑制剂负面清单干预中的应用

目的探讨PDCA循环法在门诊质子泵抑制剂使用负面清单管理干预中的效果。方法以PPIs说明书为依据,参考相关指南、专家共识及文献,建立门诊质子泵抑制剂使用的负面清单标准,并按照PDCA循环管理法程序,选取进行PDCA循环干预前(2016年1~3月)及干预后(2017年1~3月)门诊PPIs处方,每月随机抽取500份含有使用PPIs门诊处方,即干预前及干预后各1500例PPIs进行调查,分析干预效果。结果建立的负面清单标准包括适应证负面清单,预防用药负面清单,遴选药品负面清单,药品剂型或给药途径负面清单,用法、用量负面清单,联合用药或有不良相互作用负面清单及重复给药负面清单,共8个项目。在PDCA循环管理法下门诊处方PPI总负面清单率从干预前的45.53%(683/1500)下降至干预后的7.93%(119/1500)。其中适应证负面清单率由21.26%下降至3.80%(P0.05),预防用药负面清单由5.20%下降至0.73%(P0.05),用法、用量负面清单由9.67%下降至1.53%(P0.05),联合用药或有不良相互作用负面清单由7.27%下降至1.53%(P0.05)。本次干预达到了预期的目标值。结论 PDCA循环管理法在门诊处方质子泵抑制剂负面清单干预中起到明显效果。

Application of PDCA management approach in the intervention of negative list of proton pump inhibitors in outpatient prescription

Objective To investigate the effect of PDCA management approach in the intervention of negative list of proton pump inhibitors in outpatient prescription.Methods We established thenegative liststandard for the use of proton pump inhibitors in outpatient departments according to the manual of PPIs and with the reference of relevant guidelines,expert consensus and literature.Outpatient PPIs prescriptions before(from January to March 2016)and after(from January to March 2017)PDCA intervention were selected according to PDCA management procedures.500 outpatient prescriptions containing PPIs were randomly selected every month.It means that 1,500 PPIs were investigated before and after the intervention to analyze the effect of intervention.Results Established standard of negative lists included a total of 8 projects:the negative list of indications,the negative list of preventive medications,the negative list of selecting medications,the negative list of dosage forms or routes,the negative list of usage and dosage,the negative list of drug combination,the negative list of adverse drug reactions and the negative list of repeated drug use.The total rate of negative lists of PPI in outpatient prescriptions under PDCA management decreased from 45.53%(683/1500)before intervention to 7.93%(119/1500)after intervention.The negative list rate of indications decreased from 21.26%to 3.80%(P<0.05),and the negative list rate of preventive medications decreased from 5.20%to 0.73%(P<0.05).The negative list of usage and dosage decreased from 9.67%to 1.53%(P<0.05).The negative list of drug combination and adverse drug interactions decreased from 7.27%to 1.53%(P<0.05).The intervention reached the target we expected.Conclusion PDCA management approach has a significant effect in the intervention of negative list of proton pump inhibitors in out-patient prescription.