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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 better carries out the review of the interaction between triazole antifungal drugs and statins, ensure drug safety for patients and improve the efficiency of the manual review of pharmacists. Methods The advantageous combination with less interaction between the two kinds of drug was obtained by summarizing the interaction information of triazole antifungal drugs and statins. At the same time, optimizing the process of full manual reviews for drug interaction, and the advantageous combination of the two kinds of drug will be set up in advance on the doctor side of the review system. Doctors can adjust the drug in time according to the prompts of the information system when there is a significant interaction of the two kinds of drug in the prescription or medical order, which is issued by the doctors. Results After optimization, most doctors choose the drug combination of less interaction between the two kinds of drug according to the system prompts. The number of drug combinations of significant interaction which is manually reviewed by pharmacists is significantly reduced (P<0.05), and the review efficiency is improved, the drug safety risks brought by drug interactions to patients are reduced. Conclusion Refinement review of drug interactions between triazole antifungal agents and statins based on the optimization of the pre-audit system plays a positive role in improving the safety of patients’ medication and the efficiency of pharmacists' manual auditing.
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OBJECTIVE：To k now about t he current situation of pre-prescription review in medical institutions in China ，and provide reference for quality improvement of pre-prescription review in medical institutions. METHODS ：Retrieved from PubMed ， the Cochrane library ，EMbase（Ovid platform ），CNKI，CBM，VIP and Wanfang databases ，the studies about pre-prescription review in medical institutions in China were collected during the inception to Mar. 2020. After data extraction of the literatures met the inclusion and exclusion criteria ，descriptive analysis was used. RESULTS ：A total of 38 literatures were included ，involving 29 medical institutions ，of which 25 were third-grade class-A medical institutions （86.21％），22 comprehensive medical institutions （75.86％）；pre-prescription review was carried out from 2007 to 2019. Totally 84.62％ of medical institutions adopted the mode of “systematic review+manual review ”，and the main audited prescriptions were outpatient （emergency）prescriptions（76.00％）. Medical institutions adopting this mode mainly adopted the mode that auditing pharmacists rechecked the problem prescriptions intercepted by the system. The average manual review time of problem prescriptions in 8 medical institutions was within 60 s；the number of auditing pharmacists in 16 reported medical institutions ranged from 1 to 8，and educational degree of auditing pharmacists in 1 reported medical institution were bachelor degree or above. Their professional titles of 6 reported medical institutions were junior or above （83.33％）. Eleven medical institutions had full-time auditing posts （90.91％）. Success rate of problem prescription intervention was 93.99％ ；pre-prescription review could increase the qualification rate of prescription. CONCLUSION：The pre-prescription review in medical institutions in China has achieved certain results ，but still faces some problems，such as imperfect information system ，insufficient ability of auditing pharmacists and poor communication between doctors and pharmacists ，which will be the aspects that should be paid attention to in the future.
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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.
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OBJECTIVE:To improve the level of rational drug use,and to reduce the workload of clinical pharmacists. METH-ODS:Established“Intelligent Management and Solution for Clinical Rational Drug Use”of our hospital was introduced,including post-prescription review(all prescriptions review)system, self-maintenance system for rational drug use knowledge base,pre-pre-scription review (rational drug use real-time review) early warning system. The effects of intelligent system were evaluated. RE-SULTS & CONCLUSIONS:After the application of the system,the following aspects could be achieved,including“all prescrip-tions review”,“multi-prescriptions/longitudinal review”,system knowledge base real-time update and autonomous definition of re-view rules,effective communication and intervention between physicians and pharmacists before printing prescription by Yaozhidao instant messaging system. Through related trial evaluation,the proportion of false positive prescriptions decreased by 17.65% after 4 months of the application of the system;drug consultation prescriptions review average score of outpatient pharmacists increased from 81 to 94.85;the time of prescription review decreased by 4.72-5.46 times. Through mandatory interception of unqualified pre-scriptions,severe warning,timely prompt and pharmacists’intervention,the rate of unqualified prescriptions pre-reviewed by the system in respiration department decreased from 32% in Jan. 2015 and 21% in May to 4.62% in Dec. So,the application of the system promotes rational drug use in outpatient department,reduces the workload of pharmacists and ensures the safety of drug use comprehensively.