帕累托图+鱼骨图分析法在管理重点监控药品持续改进中的应用

目的：分析某院重点监控药品不合理用药医嘱的情况及原因，并通过持续整改提高合理用药质量。方法：收集某院2017年1月至2017年12月重点监控药品专项点评不合理医嘱1 131份，利用帕累托图对其进行统计、分类、分析，确定重点监控药品不合理使用存在的主要类型，再应用鱼骨图分析不合理使用的根本原因；制定改进措施，并进行整改。结果：重点监控药品不合理医嘱1 131例，其中整改前（1-6月）的不合理用药医嘱792例，整改后（7-12月）339例；帕累托图分析显示不合理用药类型中，主要问题类型排名前三位的分别是适应证不适宜（占36.52%）、用法用量不适宜（占28.38%）、遴选药品不适宜（占14.94%）。经整改后重点监控药品占药品总费用比例从第一季度的11.72%下降至四季度的7.10%；合理率从58.75%上升至82.34%。结论：临床药师通过应用帕累托图+鱼骨图分析法分析重点监控药品不合理用药具体情况，继而有针对性地进行干预和药学服务，有效促进了重点监控药品合理用药质量持续提升。

The application of the continuous improvement in the management of key monitoring drugs through Pareto diagram and Fishbone diagram analysis

OBJECTIVE To analyze the reasons of the irrational use of key monitoring drugs, and improve the quality of rational drug use through continuous rectification.METHODS A total of 1 131 irrational medical records of key monitoring drugs were collected from January 2017 to December 2017. These data were then analyzed and sorted by using Pareto-diagram to determine the dominant types of the irrational uses of certain drugs. Then the fundamental reasons of the irrational uses were analyzed through fishbone diagram to make improvement plans.RESULTS There were 1 131 irrational medical records of key monitoring drugs, 792 cases of unreasonable drug use were prescribed before the rectification (January to June) while 339 cases after rectification (July to December). According to the analysis of Pareto chart, the main types of unreasonable drug use in the top three were unsuited indication (36.52%), inappropriate administration and dosage (28.38%) and unsuited drug selection (14.94%). After the rectification, the proportion of the cost of key monitoring drugs in that of the total cost of prescribed drugs decreased from 11.72% in the first quarter to 7.10% in the fourth quarter, meanwhile the rate of rationality rose from 58.75% to 82.34%.CONCLUSION Through the analysis of the specific situation in irrational use of key monitoring drugs with Pareto diagram and fishbone diagram, clinical pharmacists can carry out targeted interventions and pharmaceutical services to effectively promote the quality of rational drug use.