Problems and Countermeasures of Promoting the Operation of the Pre-prescription Review System in Our Hospital / 中国药房

OBJECTIVE： To promote the implementation of the pre-prescription review work， and to ensure the rational drug use of patients. METHODS： With the idea of PDCA （Plan， Do， Check， Action） cycle management， the phased improvement of three PDCA cycles was gradually implemented in the operation of the pre-prescription review system， aiming at the establishment of the working mode of the prescription review work， the improvement of the rules of knowledge base in the review system and the improvement of the ability of pharmacists to review prescriptions. The operation results of the system were evaluated by comparing the irrational prescription rate of outpatient pharmacies before and after the operation of pre-prescription review system. RESULTS： Through adopting the prescription review mode of “rigid” and “flexible” interception， regular revision of knowledge base rules， regular training and examination of prescription pharmacists， pre-prescription review system operated smoothly， and the pre-prescription review work was carried out in the process of continuous improvement. In the three PDCA cycles， the irrational rate of prescriptions decreased significantly， such as after the first PDCA cycle， the irrational rate of TCM outpatient prescriptions decreased from 22.0％ （1 393/6 332） in Jan. 2017 to 7.4％ （416/5 627） in Jun. 2017； after the second PDCA cycle， the irrational rate of outpatient prescriptions in hospital decreased from 4.87％ （5 244/107 691） in Mar. 2018 to 2.21％ （2 219/100 412） in Aug. 2018. After the third PDCA cycle， the percentage of over-treatment course prescriptions in total prescriptions decreased from 16.97％ （15 728/92 684） in Jun. 2018 to 5.55％ （5 394/97 275） in Sept. 2018. CONCLUSIONS： The pre-prescription review system can effectively intercept and interfere with irrational prescriptions， and PDCA cycle management can effectively promote the operation of the pre-prescription review work.

Fine Setting of the Use Rules for Proton Pump Inhibitors in Outpatient Prescription Pre-review of Our Hospital / 中国药房

OBJECTIVE： To improve the proper use of proton pump inhibitors （PPIs） and develop prescription pre-review. METHODS： Among “Hospital Self-Maintenance Rule Base” of “Rational use of drug” in our hospital， according to the application of PPIs in our hospital， the dosage of PPIs under different indications， drug combination， age range and taboo level for children were refined to promote the prescription pre-review. After refinement， the qualified rate of PPIs prescription post-evaluation among outpatient prescriptions， successful rate of pharmacist intervention during pre-prescription review and unqualified prescription rate of each item for 8 PPIs （including “interaction” “clinical diagnosis does not conform to medication” “repeated administration” “inappropriate usage”） were analyzed statistically from Jan. to Aug. 2018. The effects of fined setting were evaluated. RESULTS： From Jan. 2018 to Aug. 2018， the qualified rate of PPIs prescription post-evaluation gradually increased from 81.94％ to 95.10％； successful rate of pharmacist intervention during pre-prescription review increased from 32.75％ to 91.01％； the rate of unqualified prescriptions for 4 items decreased significantly month by month. CONCLUSIONS： The fine setting of the rules for the use of proton pump inhibitors in our hospital has effectively carried out the pre-examination of outpatient prescriptions and promoted the rational use of PPIs.