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AIM: The pre-prescription system of outpatient was established and implemented based on six sigma DMAIC model to ensure the safety of drug use and promote rational of drug use. METHODS: The rules database was made scientifically and precisely, according to DMAIC model of Six Sigma-define, measure, analyze, improve and control. The pre-prescription system of our hospital was established and improved, through adopting the prescription review mode of interception and Intervention. And the process management was continued to optimize. RESULTS: The rule-making of pre-trial system for outpatient prescription in our hospital was reasonable, and the rate of clinical approval and acceptance was high. After the system audit, the average rate of doctor's revision was 76.32%, and the average rate of Pharmacist's intervention was 63.23%, the effective rate and qualified rate of pharmacist intervention were 97.23% and 96.87%, respectively. CONCLUSION: Based on Six Sigma DMAIC model, the pre-trial system for outpatient prescription was established and implemented, which improved the level of rational drug use, effectively ensured the safety of drug use, and improved the satisfaction of patients.
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OBJECTIVE: To understand the current situation of off-indication drug use of folic acid in our hospital, to explore the rationality of the use of folic acid in combination with the latest guidelines, Meta-analysis and other data, to put forward suggestions for improvement and to provide reference for the rational use of folic acid in clinic. METHODSE: Retrospective study method was used to select all outpatient prescriptions of folic acid in our hospital from January 2019 to October 2019. According to the "drug instructions", relevant guidelines and consensus of experts, the data were processed and analyzed by Excel software. RESULTS: A total of 12 087 patients were included, including 11 226 patients using 5 mg folic acid and 861 patients using 0.4 mg folic acid. The results showed that there were 18 departments using 5 mg folic acid. The diagnosis of folic acid was found in nervous system, immune system and kidney system. Sixteen departments, including obstetrics, family planning, gynecology and respiratory medicine, used 0.4 mg folic acid, which were mainly diagnosed as pregnancy examination, infertility, menopause, postoperative lung cancer and so on. CONCLUSION: At present, there is a universal phenomenon of off-indication drug use of folic acid. In the current study, clinical pharmacists should strengthen the evaluation of rational use of folic acid in the aspects of over-indication.
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OBJECTIVE:To evaluate the application effects of PDCA cycle management in the outpatient prescription intervention.METHODS:A total of outpatient prescriptions (pre-intervention group) during Jan.-Dec.2014 and 918 659 (intervention group) were selected during Jan.-Dec.2015 were selected from a hospital.Irrational 9utpatient prescriptions were analyzed before and after the application of PDCA cycle management,and the improvement of main indexes were compared such as unsuitable usage and dosage,incomplete clinical diagnosis writing,no physicians' signature on the prescription or inconsistent with sample.RE SULTS:Before intervention,there were 2 347 irrational prescriptions,including 1 401 nonstandard prescriptions,849 unsuitable prescriptions and 97 abnormal prescriptions.After intervention,there were 1 161 irrational prescriptions,including 695 nonstandard prescriptions,425 unsuitable prescription and 41 abnormal prescriptions,decreasing 50.53％,50.39％ 49.94％ and 57.73％,respectively.The proportion of unsuitable usage and dosage,incomplete clinical diagnosis writing,no physicians' signature on the prescription or inconsistent with sample,nonstandard prescription paper,unsuitable indications,no signature and date for prescription revision or no reason and new signature for overdose use,outpatient prescriptions more than 7 d common dose or emergency prescriptions more than 3 d common dose without special situation in total amount of outpatient prescriptions decreased from 0.72‰,0.57‰,0.45‰,0.27‰,0.20‰,0.19‰ and 0.15‰ before intervention to 0.32‰,0.25‰,0.19‰,0.11‰,0.09‰,0.08‰ and 0.07‰ after intervention.CONCLUSIONS:PDCA cycle management significantly improves the quality of outpatient prescriptions.There still are irrational outpatient prescriptions in this hospital,and it is to be intervened continuously.
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OBJECTIVE:To provide reference for reducing and avoiding medication errors of high-alert drugs in outpatient de-partment. METHODS:The medication errors of high-alert drugs in outpatient prescriptions were collected from our hospital during 2013-2014,and then analyzed retrospectively in terms of the type and degree of medication error,caused factors of medication er-rors,etc. RESULTS:670 997 prescriptions were checked in two years,and 501 medication errors were found,including 26 medi-cation errors of high-alert medication. There were 7 incorrect route of administration of insulin,1 repeated medication and 1 incor-rect dose of oral hypoglycemic agents,6 repeated administration of opioid drugs and non steroidal anti-inflammatory drugs,2 indi-cation error of paracetamol and codeine phosphate,1 specification and 1 indication error of glucose injection,2 route of administra-tion error of lidocaine,2 administration frequency errors of methotrexate,2 dose error of digoxin and 1 dose error of warfarin;18 doctors'prescribing errors were found by pharmacists'prescription audit,accounting for 69.2%;8 doctors'prescribing errors were not found by pharmacists'prescription audit,accounting for 30.8%. CONCLUSIONS:Medication errors of high-alert drugs occur mainly in the prescription segment,and the main reason is that the electronic prescription system lack of compulsory strategy and policy constraints. Improvement of safety administration of high-alert drugs need to find the error link and adopt targeted medi-cation safety practices.
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Objective To investigate antimicrobial use in 33 township central hospitals,and improve the rational use of antimicrobial agents. Methods Thirty-three township central hospitals in 1 1 counties were randomly select-ed,7 920 outpatient prescriptions,medical records of 465 non-surgery patients and 213 surgery patients were inves-tigated and analyzed. Results Of 33 hospitals,antimicrobial usage rate in outpatients and inpatients was 56.60%and 89.68% respectively,combined antimicrobial usage rate was 24.16% and 43.58% respectively. Antimicrobial use density in inpatients was 147.25DDDs. Antimicrobial usage rate in surgery patients was 97.18% ,combined an-timicrobial usage rate was 59.90% ,the percentage of one drug,two-drug combination and three-drug combination was 40.10% ,47.82% ,and 12.08% respectively. The percentage of antimicrobial use in patients of type Ⅰ,Ⅱ, and Ⅲincision was 97.56% (40/41),96.93% (158/163)and 100.00% (9/9)respectively,combined antimicrobial us-age rate was 30.00% ,67.72% ,and 44.44% respectively.Conclusion The overuse of antimicrobial agents exists in 33 township central hospitals,antimicrobial usage rate,combined usage rate,antimicrobial use density and antimi-crobial prophylaxis in typeⅠincision operations are all high.
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OBJECTIVE:To standardize the writing of outpatient prescriptions and set up monitoring mechanism on rational use of antibiotics and drug costs.METHODS:A total of 400 prescriptions collected from 8 departments(50 from each department)of our hospital in the fourth quarter of 2005(before the examination)and from first to fourth quarter in 2006(after the examination)were examined statistically according to Inspection Items and Writing Requirements of Clinical Prescriptions,Guiding Principle of Rational Application of Antibiotics in Hospital,Principles of Classified Management of Antibiotics which were formulated by our hospital.RESULTS:Before prescription examination,the qualified rate of prescriptions was only 57.5%,but rose to an average of 85.6% after the examination.CONCLUSION:To include the standardized writing of prescriptions and reasonable application of antibiotics in the assessment of hospital comprehensive goals was proved to be an effective management method.