医院处方集应用中存在的问题及对策探讨

医院处方集是医院药学信息服务工作的一项重要内容,是提高医院药事管理水平、促进合理用药的重要工具和手段。处方集的编制和管理也成为医院药事管理中非常重要的一项工作内容,但依靠传统模式编制、管理的处方集,在应用中存在的不足或弊端已不能满足医院合理用药及药事管理发展的需要。本文分析了医院处方集目前的应用现状及存在问题,对医院处方集建设的发展思路进行探讨。     

解读《处方管理办法》条例

2007年5月1日，《处方管理办法》开始在我国全面实施。结合国家近年来颁布的有关药事管理的法规、规范性文件和药事工作实践，对《处方管理办法》逐条研究、解读，领会其指导精神。《处方管理办法》是关于处方管理的第一部部门法规，对规范处方管理，提高合理用药水平将起到重要作用，所有医疗机构必须认真贯彻执行.     

医院药品处方集的编写和应用

根据《医疗机构药事管理暂行规定》和卫生部2005年3月印发的《医院管理评价指南》(试行)规定,我院制定了药品处方集.……     

电子版《药品处方集》的设计与应用

目的：探讨医疗机构编制使用电子版《药品处方集》的可行性及实用性。方法：自主研发数据库模式电子版《药品处方集》，提供给医、药、护以及管理人员使用。结果：电子版《药品处方集》内容全面，信息可靠，功能强大，查询便捷，更新灵活，适用面广，优于印刷版及以文本格式、电子报表编制的《药品处方集》。结论：随着计算机的普及，编制电子版《药品处方集》已不失为是切实可行的时尚方式，它的广泛应用大大提升了医院药事管理以及信息数字化管理水平，为临床安全、有效、合理、经济地使用药品起到重大的辅助作用，并显示了广阔的发展前景。     

国外医院处方集新药的遴选过程与标准介绍

目的:调查国内外处方集新药的遴选过程及影响因素。方法:通过阅读国内外文献对所报道的药事管理与药物治疗学委员会的组成和职能以及处方集新药的遴选过程和影响因素等内容进行分析。结果:处方集新药的遴选主要由药事管理与药物治疗学委员会负责组织进行,药师负责对申请新药进行评估并交由药事会讨论。药品的有效性和安全性是首要考虑因素,经济学因素和操作性方面的因素次之。结论:新药上会前的药品评估过程是药品遴选的关键环节,药品的安全性和有效性是影响药品能否过会的关键因素。     

我国药事服务费收费水平研究

目的:科学测算药事成本,量化药事服务费收费水平。方法:通过问卷调查收集全国12省市部分公立医院的财务数据,采用描述性统计方法分析医院药事成本,分别测算门诊药事服务费和住院药事服务费的收费水平。结果:门诊药事服务费按每张处方平均收取5～10元可补偿门诊药事成本,住院药事服务费按每床日平均收取15～30元可补偿住院药事成本。调研结果表明不同级别、不同类型、不同地区医院之间药事服务费收费水平存在较大差异。结论:各地在制定具体收费水平时,应根据实际情况分地区、分医院类型和级别来具体制定,并及时根据处方量和住院床日变化进行调整。     

信息技术在我院处方集系统管理中的应用

目的:利用现代信息技术对我院处方集系统进行管理,以提高医院药事管理水平。方法:以我院的信息技术平台为基础,从药品采购、处方评价、药品信息等方面围绕处方集系统进行现代化管理。结果:信息技术的应用,使医院药品采购环节更加规范;使处方评价更加规范、准确、高效;使药品信息的获取更加方便、快捷、准确。结论:现代信息技术使药事管理变得更加快捷、高效,将在医院处方集系统管理中得到更为广泛的应用。     

药事干预在儿童生长激素使用管理中的作用

[摘要] 目的：探讨药事干预在儿童生长激素使用管理中发挥的作用，为构建专科药物管理新体系提供思路。方法：比较药事干预前后生长激素处方量、不合理处方数、患者投诉的情况，分析药事干预的效果。结果：药事干预前生长激素处方量剧增，医院控费压力巨大，患者投诉频繁，药事干预后生长激素处方量显著下降，不合理用药情况得到改善，针对生长激素的投诉降为零。结论：药事干预是规范药物相关医疗行为、控制药费增长的有效手段，可提高医院对专科药物的管理水平，增强患者的就医满意度。     

编制医院抗感染药物处方集的经验体会

［摘要］医院处方集是根据患者治疗需要而制定的基本处方汇编，是医疗机构制定的处方规范和指南。目前，国内医院药品处方集的编制还处于探索阶段，参考国外处方集制度发展，应用比较成熟国家的相关政策、经验和方法，编制了医院抗感染药物处方集并进行了初步应用。介绍编制过程中积累的一些经验和体会，希望对在推行处方集制度起到一定的积极作用。     

我国“药事服务费”内涵的界定探讨

目的:重新界定我国"药事服务费"的内涵。方法:对比分析国内、外"药事服务费"引入的背景及相关概念。结果与结论:药师的"药事服务费"不应等同于医师的"处方费"、"诊疗费"。我国"药事服务费"的内涵应界定为药师在调配处方、用药指导时所提供专业技能服务的价值补偿。     

Implementation of pharmacy computerization in long-term care.

A computerized pharmacy service is ideal for long-term care and a fairly stable resident census at the 812-bed Jewish Home and Hospital for Aged (JHHA). The skilled nursing facility (SNF) now uses pharmacy-generated medication administration records (MARs), drug stop-order lists, and formulary listings. The health-related facility (HRF) self-medicated residents receive individual counseling during pharmacy computer-mediated medication refill appointments. Improvements in clinical services have involved antibiotic and drug use review through selected drug category, computerized drug profiles, and drug regimen review. Administrative and financial benefits have been realized through cost reports and budget reduction, and streamlined internal pharmacy operations. Although most software packages are designed for retail use, pharmacy personnel at JHHA have successfully implemented and tailor designed the AIMS system to the needs of long-term care pharmacy.     

Superior hospital formularies: a critical analysis

The drug monograph section of eight superior hospital formularies was examined to (1) determine the type of pharmaceuticals, including dosage forms, listed, (2) delineate patterns of concurrence and divergence in drug acceptance, and (3) ascertain quantitative benchmarks by therapeutic category that may suggest optimum formulary size. The survey also undertook a comparative analysis of marginal drugs and reviewed the role of pharmacy personnel in supporting formulary administration. The critique of pharmaceutical preparations revealed significant patterns of similarity, heterogeneity, perplexity, and redundancy. The investigation also documented problems in dosage form selection and formulary publication. The report concludes that there is a need for more comprehensive studies that incorporate alternative quality assurance methods and focus on the more intangible factors of professional leadership and integrity.     

Survey of formulary system policies and procedures.

A telephone survey was conducted to determine the policies and procedures of hospital formulary systems. Directors of pharmacy at a random sample of 150 community hospitals were interviewed, and letters were sent to each respondent requesting copies of the formulary and drug evaluation form. One hundred thirty hospitals completed the interview (gross response rate of 87%), and 35 evaluation forms and 49 printed formularies were received. Almost all hospitals had a formulary system and a printed formulary; the most frequently stated purposes were to decrease costs and to ensure appropriate therapy. Most formularies received were simple drug lists with no supporting information. The typical pharmacy and therapeutics committee consisted of 11 members, met every month, and reported to the executive committee. About 80% of the responding institutions had formal procedures for considering formulary additions. Less than half had standardized drug evaluation forms. Most hospitals have a formulary system and a printed version of the formulary; however, the formulary often serves primarily as a drug list, with no supporting information.     

静脉药物配置中心不合理用药分析

随机抽取本院静脉药物配置中心2008年长期医嘱12210份,对用药情况进行统计.其中376份医嘱存在用药与诊断不符、重复用药、配伍禁忌、溶媒不当、间隔时间不合理、用法用量不当等情况：提示药师需加强对临床用药的审核与监控.     

医院药房药品管理智能化与调剂自动化实施方案

目的:探讨医院药房药品管理智能化与调剂自动化实施方案的发展现状及应用前景。方法:收集国外先进的药品调剂与管理的相关设备信息,查阅文献了解其在国内医院药房中的应用情况,并结合我院在应用智能化药品管理与自动化调剂设备改进工作模式方面的实践体会,分析当前医院药房实施药品管理智能化与调剂自动化的重要性、可行性及实施中的问题。结果:医院药房实施药品管理智能化与调剂自动化可大大提高工作效率和调剂的准确性,有效解决传统调剂工作模式中所存在的工作强度大、差错率高等诸多问题。结论:药品管理智能化与调剂自动化实施方案是医院药房现代化管理模式的发展趋势。     

Controlling financial variables--changing prescribing patterns

Techniques of formulary management, pharmacy and therapeutics committee intervention, and the use of clinical pharmacy services to change prescribing patterns and contain costs in hospital pharmacy departments are reviewed. Methods of using the formulary to contain costs include deletion of generic and therapeutic equivalents, inclusion of therapeutic categories and cost codes, and regular reviews and updates of its contents. Drug monographs for formulary evaluation prepared for the P & T committee should include a comparative review of other drugs in the therapeutic category and a cost impact statement. The P & T committee can help contain costs by developing policies for automatic stop orders and restricted drug use. Clinical pharmacy activities that can result in cost savings include physician education (focused on prescribing), target drug programs, target disease programs, pharmacist participation on TPN and i.v. therapy teams, and patient training programs for home care. A matrix for evaluating cost-containment activities is presented. By tailoring the described methods to departmental personnel resources and hospital needs, the pharmacy can be effective in controlling costs.     

Determining drug dispensing costs for use in cost-accounting systems

Identification of pharmacy costs to be used in a university hospital's cost-accounting system (CAS) is described. At the University of Wisconsin Hospital and Clinics (UWHC), Madison, standard pharmacy labor times for seven categories of products were developed by determining the pharmacist and technician times for purchasing, ordering, transcribing orders, manufacturing, and distributing and administering medications; pharmacy technicians administer most of the medications to patients at UWHC. The labor cost per dose (standard time multiplied by average wage including fringe benefits) was added to drug acquisition cost, which was obtained from the hospital's computerized formulary. The direct costs associated with drug distribution were identified for use in the hospital CAS. These data can be used to compare the cost-effectiveness of various medication administration schedules; they may also be useful in productivity monitoring and flexible budgeting.