市级药事质控中心在重点监控药物合理使用中的作用

目的 通过市级药事质控中心启动"医嘱全市集中点评"模式,将质子泵抑制剂、中药注射剂、外科围手术期预防使用止血药作为3大类重点监控药物,目的是发现重点监控药物在使用中存在的问题,并借助卫生行政部门进行有效干预,促进临床合理用药。方法 制定3大类重点监控药物点评标准,对绍兴市16家三级医院和市直医院开展全市医嘱集中点评,卫生行政部门发文通报,用药检查结果纳入医改绩效考核内容。各医院根据反馈的问题制定一套医院切实有效的用药管理措施,中心召开医嘱点评总结会议等干预措施。结果 2015年医嘱点评总不合格率为27.29%,2016年不合格率20.63%,2017年不合格率12.97%,医嘱合格改善率达52.47%。表明此3类重点监控药物均存在滥用现象,此模式对于提高全市医疗机构合理用药有显著效果。结论 通过行政与药师的联合干预,使被干预的3大类重点监控药物的合理使用率显著提高。该种干预模式可为今后持续开展类似工作提供一种新的思路和方法,值得各地市推广。

Role of municipal pharmaceutical quality control center in the rational use of key surveillance drugs

OBJECTIVE The municipal pharmaceutical quality control center initiated the mode of "centralized evaluation of doctors'' orders throughout the city". Proton pump inhibitors, traditional Chinese medicine injections and preventive use of hemostatic drugs during perioperative period of surgery were regarded as three major types of monitoring drugs, with the aim of finding out the problems existing in the use of key monitoring drugs and carrying out the monitoring with the help of health administrative departments to promote rational drug use in clinic. METHODS Sixteen tertiary hospitals and municipal hospital in Shaoxing had formulated three kinds of key monitoring drug evaluation standards, carried out centralized evaluation of the cities'' medical advice, issued a circular by the health administration department, and incorporated the results of drug use inspection into the performance evaluation of the medical reform. Hospitals had formulated a set of effective drug use management measures based on feedback issues. Intervention measures such as doctor''s advice review and summary meeting were held in the center. RESULTS The total unqualified rate of doctors'' orders was 27.29% in 2015, 20.63% in 2016, 12.97% in 2017 respectively. Improvement rate of doctors'' orders was 52.47%. It showed that abuse exists in all the three kinds of key monitoring drugs, and this model had a significant effect on improving the rational use of drugs in medical institutions in the city. CONCLUSION Through the joint intervention of administration and pharmacists, the rational use rate of the three key types of controlled drugs has been significantly improved. This kind of intervention mode can provide a new way of thinking and method for continuing similar work in the future, and it is worth popularizing in various cities.