Primarily Exploration of Medical Orders Evaluation Mode According to Disease Classification / 中国药房

OBJECTIVE： To investigate the effects of new mode of medical orders evaluation according to disease classification. METHODS： Totally 16 kinds of common diseases were selected from each department of our hospital. Each 10 electronic medical records of each disease were randomly selected from 160 patients in the hospital information system from Jan. 1 to Dec. 31， 2016. The rationality of 10 720 medical orders were evaluated retrospectively during hospitalization. Statistical analysis was made on the relevant indicators such as unsuitable usage and dosage， the proportion of auxiliary drugs and unsuitable indications in medical orders of irrational drug use， and a new mode of prescription comment was established according to the classification of diseases. 9 862 medical orders of same disease types were collected after the implementation （from Apr.-May， 2017） of new mode and intervene to evaluate the irrational rate of them so as to evaluate the effects of new mode. RESULTS： In the samples in 2016， a total of 751 medical orders of irrational drug use were evaluated， the most of them were unsuitable usage and dosage （414 items， 55.12％）， especially in the intracerebral hemorrhage diseases （69 items， 16.67％）； under this kind of disease， most of irrational drug use was excessive dosage of single dosing （31 items， 44.92％）. The top three disease types in the list of the ratio of adjuvant drug cost in total drug cost were surgery for renal tumors （39.43％）， acute cerebral infarction （non-surgery） （37.03％） and intervertebral disc herniation surgery （35.26％）. 70 medical orders of irrational drug use were unsuitable indications （9.32％）. After the application of evaluation mode according to classification of disease types and intervene， the irrational rate of medical orders decreased from 7.00％ （751/10 720） before evaluation to 2.95％ （291/9 862）after evaluation， decreasing by 57.86％. CONCLUSIONS： The application of evaluation mode according to classification of disease types can achieve good results in controlling the irrational rate of medical orders and contribute to rational drug use in clinic.

Evaluation of the effects of comprehensive information feedback mode on auditing medical orders between PIVAS and clinical departments / 中华医院管理杂志

Objective To evaluate the effects of information feedback mode on auditing medical orders between pharmacy intravenous admixture services ( PIVAS ) and clinical departments. Methods Sorting and analyzing the work contents, satisfaction, and unreasonable medical order rates before and after auditing medical orders between PIVAS and clinical departments by using the information feedback mode. Results The information feedback mode of auditing medical orders has been well accepted. For example, the satisfaction between clinical departments and PIVAS was increased significantly (P < 0. 05), and unreasonable medical order rate was decreased significantly as well (P < 0. 05). There was a strong correlation between satisfaction and unreasonable medical order rate. Conclusions Establishment of comprehensive information feedback mode for auditing medical order between PIVAS and clinical departments has improved the PIVAS quality of clinical service, and strongly supported the introduction of PIVAS.

Analysis and review of medication order in the Maternal and Child Health Hospital of Yongkang from January 2016 to June 2016 by clinical pharmacists / 中国基层医药

Objective To investigate the situation of drug use in wards of the Maternal and Child Health Hospital of Yongkang,then analyzed the situation of irrational drug for facilitating the rational drug use.Methods 2 691 discharged inpatient medical records were randomly extracted in the Maternal and Child Health Hospital of Yongkang from January 2016 to June 2016,in which the irrational medication orders were analyzed statistically according to Hospital Prescription Review Management Regulations(Trial) and other relative provisions.Results Of the 2 691 medical records,2386(87.4％) records were rational and 305 (12.6％) records were non-rational.The irrational use of drugs manifested in the following aspects such as selection of the drug menstruum,usage,dosage,combination,antibacterial drug prevention and repeated drug use,etc.Conclusion Clinical pharmacists through the medical orders for clinical medication monitor,sequentially can reduce and avoid the happening of irrational drug use,and promote the clinical safety and rational drug use.

Development and Application of Medical Order Management Module for Chemotherapeutic Drugs in Hos-pitalized Information System / 中国药房

OBJECTIVE:To promote the standardization and rationality of medical order for chemotherapeutic drugs,and im-prove its safety use in clinic. METHODS:Through developing the investigation of relevant status quo,the design factors and infor-mation that should be involved and considered of the medical order management module for chemotherapeutical drugs in hospital-ized information system(HIS)were determined. The reference standard chemotherapy regimen used in medical orders was put for-ward. The basic data was maintained and menu setting was conducted. Based on HIS,the function module of automatically import-ing patients'information,drug and program selection,warning were designed;the docking and effective application of medical or-der management module for chemotherapeutical drugs in hospital medical order management information system was achieved. Its application effects were evaluated by summarizing monthly irrational rate of medical orders within 2 years. RESULTS & CONCLU-SIONS:The medical order management module for chemotherapeutical drugs developed in our hospital can achieve physician autho-rized management,automatically importing patient-related information,preservative chemotherapy regimen for easy entry and selec-tion. The irrational numbers of chemotherapy orders were decreased from 28 orders (1.15%) in prime (Jun. 2014) to 4 orders (0.14%)2 years later(Jun. 2016). Procedures of medical orders for chemotherapeutical drugs are standardized,initially realize in-formation management,improve input efficiency and accuracy of medical orders,which have provided protection and support for standardizing physicians'diagnosis and treatment behavior and avoiding the hospital risk,and promote correct,safe and rational use of chemotherapeutic drugs.

Preliminary Study on the Thinking Mode of Nephrology Clinical Pharmacists Reviewing Medical Orders / 中国药房

OBJECTIVE:To investigate the thoughts and ways of clinical pharmacist in nephrology department to review medi-cal orders,and to provide reference for rational drug use in nephrology department. METHODS:Based on specific cases of nephrolo-gy department,the thoughts and ways of clinical pharmacist in nephrology department to review medical orders were investigated from several aspects,including whether the therapeutic drugs had covered all the problems,drug duplication,drug selection,usage and dosage and course of treatments,drug interaction and compatibility. RESULTS & CONCLUSIONS:By establishing rigorous and systematic review thinking mode,based on their professional specialty,clinical pharmacists of nephrology department can sort the reviewing thought,fill in the gaps of medical orders reviewing and enhance the ability of participating in the clinical practice.

Analysis of Antibiotics Medical Order Evaluation in Our Hospital from 2012 to 2014 / 中国药房

OBJECTIVE:To provide reference for rational use of antibiotics in the clinic. METHODS:From 2012 to 2014,5 medical records were selected randomly from 17 clinical departments each month,1 005 cases in 2012,1 020 cases each year in 2013 and 2014,a total of 3 045 cases. Rationality of antibiotics use was analyzed to summarize and analyze irrational drug use. RE-SULTS:The rate of antibiotics use from 2012 to 2014 were 39.90%,36.27% and 32.84%;the rational rate of antibiotics medical orders were 40.90%,68.11% and 82.67%. Irrational drug use manifested as irrational medication time,unreasonable drug selec-tion,inappropriate indications,inappropriate drug selection,inappropriate usage and dosage,inappropriate drug combination, off-label use etc. CONCLUSIONS:By clinical pharmacistsadvance interventionandadministrative intervention,the use of an-tibiotics in wards of our hospital tend to be more reasonable. But it still necds to strengthen awareness arnd management to effective-ly protect the rational drug use.

Investigation of Unreasonable Medical Orders at Pharmacy Intravenous Admixture Service of Our Hospital / 中国药师

Objective:To analyze the unreasonable medical orders at the pharmacy intravenous admixture service ( PIVAS) of our hospital to improve clinical medication. Methods: The medical orders from January to October in 2013 were collected and reviewed, the unreasonable medical orders were analyzed and the results were informed to the clinics. Results:Totally 323 unreasonable medical orders were found, which accounted for 0. 03%. The unreasonable aspects included unreasonable compatibility, input error, irregular medical orders, over dosage or concentration, unsuitability between dosage and age and the disproportion between dosage and diagno-sis. Conclusion:The irrationality in intravenous medical orders still exists in clinics, which shows drug use risks. The unreasonable medical orders can be avoided or reduced through the review of medical orders by pharmacists at PIVAS to improve the safety of clinical drug use.

Reasons for Quarantined Patients' Incomplete Obedience to Medical Order and Countermeasures / 中国医学伦理学

This paper analyzes the reasons for quarantined patients' incomplete obedience to medical orders and comes up with relevant countermeasures as follows.1.External compulsory medical treatment should be combined with patients' internal self-consciousness.2.It is necessary to strengthen the mutual communication between doctors and quarantined patients,and observation for patients' condition.3.It is necessary to strengthen mental care and respect for patients' legal rights.4.A positive role should be taken in improving treating environment and give mental support from family members.