Principles for the rational use of national key monitoring drugs （the second batch） / 中国药房

In order to strengthen the supervision of the use of drugs in hospitals，the Sichuan Academy of Medical Sciences· Sichuan Provincial People’s Hospital took the lead in compiling the Principles for the Rational Use of National Key Monitoring Drugs （the Second Batch） with a number of experts from multiple medical units in accordance with the Second Batch of National Key Monitoring Rational Drug Use List （hereinafter referred to as “the List”） issued by the National Health Commission. According to the method of the WHO Guidelines Development Manual， the writing team used the Delphi method to unify expert opinions by reading and summarizing the domestic and foreign literature evidence of related drugs， and applied the evaluation， formulation and evaluation method of recommendation grading （GRADE） to evaluate the quality of evidence formed， focusing on more than 30 drugs in the List about the evaluation of off-label indications of drugs， key points of rational drug use and key points of pharmaceutical monitoring. It aims to promote the scientific standardization and effective management of clinical medication， further improve the quality of medical services， reduce the risk of adverse drug reactions and drug abuse， promote rational drug use， and improve public health.

Rational use management standards of national key monitoring drug / 中国药房

At present， there is a lack of unified and standardized management for the rational use of national key monitoring drugs. According to the relevant requirements of the state， based on the relevant literature published at home and abroad in recent years and combined with the management practice of many medical institutions across the country on the national key monitoring drugs， in order to make the national key monitoring drugs more reasonable use and standardized management in medical institutions at all levels， the Clinical Pharmacy Branch of the Chinese Medical Association， the Pharmaceutical Epidemiology Special Committee of the Chinese Pharmaceutical Association and the Pharmaceutical Epidemiology Special Committee of the Sichuan Pharmaceutical Association organized experts to fully discuss， and to form this management standard. This standard mainly provides relevant opinions and suggestions on the basic principles of rational use of key monitoring drugs and the regulatory measures for key monitoring drugs， especially on how to strengthen the pharmaceutical management and use management of key monitoring drugs， further promoting the standardized use of key monitoring drugs.

Review and comment rules of national key monitoring drug prescriptions （medical orders） / 中国药房

In order to standardize the review and comment of national key monitoring drug prescriptions （medical orders） by medical institutions at all levels， the Sichuan Academy of Medical Sciences·Sichuan Provincial People’s Hospital took the lead in compiling the Review and Comment Rules of National Key Monitoring Drugs prescriptions （Medical Orders） herein after referred to as the Rules in accordance with the Second Batch of National Key Monitoring Rational Drug Use List （hereinafter referred to as the List） issued by the National Health Commission confirmed in Jan. 13， 2023. According to the laws and drug instructions issued by the national drug regulatory department， clinical guidelines and expert consensus， combined with the actual situation of patients （including age， body weight， liver and kidney function）， the writing group classified the common and unreasonable drug use problems for 30 kinds of drugs included in the List and develop the review and comment details. After two rounds of Delphi method questionnaire research and experts’ online meetings， and reviewed by the steering committee， the final Rules was formed. The Rules aim to provide reference for the evaluation of the rational use of drugs included in the List by medical institutions， so as to realize the standardized management of key monitoring drugs， promote the rational drug use in medical institutions， and ensure the safety of drug use for patients.

Analysis on the effect of PDCA cycle method to promote the management of key monitoring drug / 药学实践杂志

Objective To observe the effect of applying PDCA cycle method to promote the management of key monitoring drug, and provide a basis for the management of key monitoring drug in medical institutions. Methods To compare the consumption of drugs and prescription reviews before and after the adoption of PDCA management in a hospital. The control group was the inpatients with traditional management method in 2019, and the observation group was the inpatients with PDCA method in 2020. Results After the implementation of PDCA cycle, the consumption amount of key monitoring drugs decreased significantly (P<0.001); The problems of irrational prescription such as drug use without indication, repeated drug use, inappropriate dosage and route of administration, and long course of treatment were effectively controlled (P<0.05). The qualified rate of prescription increased from 65.96% to 90.76% (χ2=27.010, P<0.001). The incidence of adverse reactions was significantly decreased (χ2 =37.044, P<0.001). Conclusion PDCA method aims at continuous closed-loop management of key monitoring drugs in medical institutions, which can control drug costs to the greatest extent, reduce the economic burden of patients, promote rational drug use, reduce the incidence of adverse reactions, and ensure the quality of medical care.

Formulation of Criterion for Clinical Application of Shuxuetong Injection by Clinical Pharmacists in Our Hospital Based on Evidence Quality Evaluation Method / 中国药房

OBJECTIVE： To provide reference for strengthening clinical application of key monitoring drugs and promoting rational drug use in clinic. METHODS： Based on evidence-based medicine， taking key monitoring drugs Shuxuetong injection as example， clinical evidence of domestic and foreign clinical studies were collected. The included literatures were graded according to the quality of GRADE evidence and recommended strength system. Evidence-based medicine evidence for the indications of Shuxuetong injection were evaluated， and criterion for clinical use of Shuxuetong injection was formulated in Huaihua First People’s Hospital （our hospital）. RESULTS： The main content of criterion for clinical application of Shuxuetong injection formulated by our hospital was that there was A-level evidence support for acute ischemic cerebral infarction， but it was weakly recommended and only used for adjuvant therapy； there was B-level evidence support for anticoagulation （for preventing DVT）， diabetic peripheral nerve lesion， but it was weakly recommended； there was only C-level or D-level evidence support for other indications， it was strongly recommendation against use. CONCLUSIONS： Clinical pharmacists formulate the criterion for clinical application of Shuxuetong injection by evidence quality evaluation method， provide reference for clinical application management of key monitoring drug and play an important effect on rational drug use in clinic.

Influence of key monitoring drugs policy on the change of adjuvant drugs in sample area / 中国药学杂志

OBJECTIVE:To examine the influence of key monitoring drugs policy in Anhui province and Sichuan province on the change of adjuvant drugs for promoting its rational use and providing a basis for policy formulation. METHODS: Based on the key monitoring drug libraries formed in the monitoring catalogs of all the provinces, combining with the key monitoring drug catalogs in Anhui province and Sichuan province, this study selected the characteristics of drug-typicality and data availability through the selection of adjuvant drug selection criteria. Eight drugs of Anhui province and 10 drug of Sichuan province were selected as research objects. The study extracted monthly data from 3 hospitals in Anhui province from November 2014 to September 2017 and quarterly data from 9 hospitals in Chengdu, Sichuan province in the first quarter of 2014 to the first quarter of 2017. Interrupted Time Series (ITS) model was used to analyze the changes of dosage and amount of sample drugs and reference drugs. RESULTS: ①After the implementation of the key monitoring drugs policy in Anhui province in November 2015, the usage trend of adjuvant drugs changed from rising to declining, with a significant decrease in the dosage (β3=-0.035, P0.1) and the amount of money (β3=-0.001, P>0.1). ③After the implementation of the key monitoring drugs policy in the first quarter of 2016 in Sichuan Province, the declining trend of the use of adjuvant drugs was widened with a decrease of the dosage (β3=-0.045, P<0.001) and the amount (β3=-0.037,P<0.001). CONCLUSION: The implementation of key monitoring drugs policy in Anhui province and Sichuan province can effectively control the use of most adjuvant drugs, with a significantly decrease of the dosage and amount.

Supervision and Consideration on Key Monitoring Drugs in Medical Institutions / 中国药师

Objective:To enhance the pharmaceutical administration of the key monitoring drugs, promote the rational drug use and reduce the drug consumption of patients. Methods:The key monitoring drugs directory was complied, and prescription comment was standardized,and the supervision management system was established. Through the comparison the indicators before and after the management intervention,a series of effective management methods were explored. Results and Conclusion: From the emphasized monitoring for the introduction of new key monitoring drugs,the drug categories in medical institutions were controlled from the source. Information means were used to perform the real-time monitoring for the key monitoring drugs. Drug prescription reviews and office feedbacks were carried out to supervise the complementary drugs afterwards. After the management intervention, the indicators of key monitoring drugs were improved significantly,suggesting the effectiveness of monitoring methods.

Effects of Provincial Pharmaceutical Quality Control Center in Key Monitoring Drugs Supervision / 中国药房

OBJECTIVE:To promote effective supervision of key monitoring drugs by provincial pharmaceutical quality control center,and to improve rational drug use. METHODS:The effects of No.2 district of Sichuan province pharmaceutical quality con-trol center on 3 categories of key monitoring drugs guidance and supervision,through urging medical institution in the area to estab-lish key monitoring drugs supervision system,formulating prescription review guideline for 3 categories of key monitoring drugs [TCM injection,adjunctive drug,proton pump inhibitors (PPIs)],developing baseline data survey,inspecting the application of key monitoring drug in medical instaurations on the spot and other measures,were introduced. Through collecting the reports of re-gional quality control center to the provincial quality control center,supervision system of medical institutions were analyzed statisti-cally. Key monitoring drugs of medical institutions in the area were analyzed statistically in respects of rational utilization ratio,uti-lization quantity,utilization amount,etc.,so as to evaluate supervision effects. RESULTS:Up to Apr. 2016,92.26%medical insti-tutions had been aware of the relevant requirements of the documents;84.25% had established the hospital supervision system. 3 categories of key monitoring drugs prescription(orders)comment guideline had been developed in Mar. 2016. 18 third-grade class-A general medical institutions were randomly selected;among 3 categories,irrational utilization ratio of TCM injection decreased by 12.35%(35.41% vs. 47.76%);that of adjunctive drugs decreased by 9.64%(20.95% vs. 30.59%);that of PPIs decreased by 7.44%(40.49% vs. 47.93%) in May 2016,compare to Jan. 2016. Average consumption sum of them decreased by 12.07%, 13.30%,9.49%,respectively in Apr. 2016,compared to Jan. 2016. 55.02% medical institutions had started to collect the baseline data. CONCLUSIONS:The provincial pharmaceutical quality control center has played an important role on establishing a supervi-sion system,it can promote the effective supervision by guiding and supervising the medical institutions evaluating the supervision of medical institutions and pointing out the problems.

Pharmaceutical Administration Practice of Adjunctive Drugs in Medical Institutions of Sichuan Province / 中国药房

OBJECTIVE:To explore effective pharmaceutical administration measures for the rational adjunctive drugs. METH-ODS:The effective pharmaceutical administration of adjunctive drugs in medical institutions of Sichuan province was introduced, including establishing key monitoring management system of adjunctive drugs (establishing and implementing prescription review system,rational drug use training,strict supervision and examination) and playing promotion effect of provincial pharmaceutical quality management control center on medical institutions,etc. The effects of pharmaceutical administration in 18 third-grade class-A medical institutions were evaluated through statistically analyzing rational utilization ratio,drug ratio,consumption sum of ad-junctive drugs. RESULTS:Up to May 2016,key monitoring management system of hospital adjunctive drugs had been established and improved in medical institutions over Sichuan province. The rational utilization ratio of adjunctive drugs in 18 medical institu-tions increased from 69.41% in Jan. 2016 to 79.05% in May 2016;drug ratio decreased from 29.22% to 27.93%. The monthly consumption sum of adjunctive drugs decreased from 22 970 000 yuan in Apr. 2015 to 17 380 000 yuan in Apr. 2016(decreasing by 20.49%). CONCLUSIONS:Medical institutions of Sichuan province conduct effective pharmaceutical administration of adjunc-tive drugs through establishing the key monitoring management system for medical institutions and playing the role of the provincial pharmaceutical quality management control center for the supervision.

The application status of adjuvant drugs in our country and the management countermeasures study / 中国药学杂志

OBJECTIVE: To know the current application status of the adjuvant drugs in our country, and preliminary explore the management measures of adjuvant drugs. METHODS: Through searching, reading, and summarizing the relevant content and literature, the application status of adjuvant drugs in China and the global demand for rationalization of drug use were reviewed. A few questionnaires that associated with adjuvant drugs were designed by Delphi method to investigate the medicine experts nationwide and to explore the management countermeasures of adjuvant drugs. RESULTS: The survey showed that 98% of medical institutions existing adjuvant drugs use of unreasonable/no specification. The medicine experts believe that there are unreasonable usages such as traditional Chinese medicine injections, cancer drugs except for chemotherapy drugs, etc. The unified management of adjuvant drugs application should determined by the state. CONCLUSION: The excessive use of adjuvant drugs ubiquitous in our country. Key monitoring varieties directory of adjuvant drugs and the limit to the drugs' use indicators to evaluate the rationality of drug use should be set. And there can be a special review team to review the use of adjuvant at regular intervals in order to standardize the clinical application of adjuvant drugs.