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OBJECTIVE：To conduct the prescri ption comment of Chinese patent medicine based on self-developed rational drug use system and evaluate its effect ，and to promote rational use of Chinese patent medicine. METHODS ：The self-developed rational drug use system was used to evaluate the complete prescriptions and classified special prescriptions of Chinese patent medicines in our hospital from Jan. to Jun. 2019（before implementation ）and from Jan. to Jun. 2020（after implementation ）； combined with pharmacists ’manual comments ，the situation of irrational drug use in the two periods was compared ，and the effect of prescription comment by rational drug use system was evaluated. RESULTS ：Results of full prescription comment of Chinese patent medicine in our hospital showed that the unqualified rate of Chinese patent medicine prescriptions was 1.5％，which was significantly lower than 5.6％ before the implementation （P＜0.05）. Results of special prescription comment of Chinese patent medicine showed that the unqualified rates of TCM injection ，toxic Chinese patent medicines and emergency Chinese patent medicines were 11.8％，10.7％，11.0％ before implementation ；while after implementation ，they were 3.6％，4.2％ and 6.6％， which were significantly lower than before implementation （P＜0.05）. CONCLUSIONS ：Self-developed rational drug use system of Chinese patent medicine shows remarkable effect on full prescription comment and special comment ，which greatly improves the level of rational drug use of Chinese patent medicines in our hospital.
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OBJECTIVE: To explore the application effect of quality control circle management in improving the qualified rate of anesthetic drugs prescription in hospital. METHODS: The quality control circle was established to explore the causes of the unqualified anesthetic drugs prescription in our hospital by using the 80/20 rule and fish-bone diagram. The measures to improve the prescription pass rate were determined, and the changes of the prescription pass rate before and after QCC management were compared through the implementation and review of the measures. RESULTS: Using the management of quality control circle, the prescription quality of inpatient anesthetic drugs was significantly improved in our hospital in 2018 and the qualified rate increased from 70.07% in 2017 to 2018 97.78% above target value of 6.69%. After continuous quality control circle management, the qualified rate of prescription increased to 99.33% in the first three quarters of 2019. CONCLUSION: The development of QCC can effectively improve the qualified rate of anesthetic drugs prescription in hospital, not only standardizing the use of anesthetic drugs, promoting drug safety of patients, but also improving the comprehensive quality of pharmacists and the quality of hospital pharmaceutical care.
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OBJECTIVE： To investigate pharmaceutical care of cancer pain therapy in medical institutions from Beijing area， and to provide reference for improving the quality of pharmaceutical care for cancer pain in medical institutions and formulating cancer pain therapy decision by public health administration departments at different levels. METHODS： Inspection results of standardized diagnosis and treatment for cancer pain were analyzed retrospectively in Beijing Pain Therapy Quality Control and Improvement Center during Feb.-Mar. 2018. Scoring results of pharmaceutical care （20 points） and its 5 sub-items （personnel participation， drug supply， drug management， outpatient prescription comment and inpatient prescription comment， 4 points each item） were analyzed statistically and classified according to hospital level and pharmaceutical care inspection results. RESULTS： A total of 64 hospitals in Beijing participated in the inspection， including 27 tertiary A hospitals （42.19％）， 21 tertiary B hospitals （32.81％）， 16 secondary hospitals or first-level hospitals （25.00％）. Pharmaceutical care in all hospitals met the inspection requirements with qualified rate of 100％. 52 hospitals performed excellently （81.25％）， and 12 hospitals were qualified for pharmaceutical care （18.75％）. Among 5 sub-items of personnel participation， drug supply， drug management， outpatient prescription comment and inpatient prescription comment， the average score of drug supply item was the highest （3.83±0.05）； the lowest was the personnel participation item （2.93±0.13）. The results of pharmaceutical care inspection in tertiary A hospitals （17.80±0.28） and tertiary B hospitals （17.78±0.30） were significantly better than those in secondary hospitals or first-level hospitals（16.16±0.50）（P＜0.01 or P＜0.05）； there was statistical significance only in the score of outpatient prescription comment among 5 sub-items（P＝0.026）. Total scores of the hospitals with excellent pharmaceutical care were significantly higher than those of the hospitals with qualified pharmaceutical care in terms of personnel participation， outpatient prescription comment and inpatient prescription comment （P＜0.01 or P＜0.05）. There was significant difference in the inspection results of pharmaceutical care among the excellent group， the qualified group and the unqualified group classified by the results of personnel participation item （P＜0.01 or P＜0.05）. CONCLUSIONS： The quality of pharmaceutical care for cancer pain therapy in medical institutions from Beijing area has reached the qualified level， but the participation of clinical pharmacists in cancer pain therapy and outpatient prescription comment still need improvement in further. The training of clinical pharmacists and information construction of narcotic drug management should be strengthened so as to improve the overall quality of pharmaceutical care for cancer pain.
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Objective: To establish the rational drug use standard for elderly hypertensive patients after comprehensive assessment, so as to provide evidence for rational drug use in clinics. Methods: Such standards as Beers, STOPP and START were summarized, key items were extracted,duplicate contents were deleted,and the initial standard was formed and used as the first round questionnaire. The Delphi method was used to conduct the second round expert consultation questionnaire,and the positive coefficients, authority and coordination degree of the experts were evaluated. Results: A total of 10 experts participated in the consultation, and the effective re-covery rate of the second round was 100% and the average authority coefficient was 0. 88. The coordination coefficient of the two rounds was 0. 57 and 0. 76, respectively. The standard of rational drug use for the elderly patients with hypertension after comprehensive as-sessment was finally completed. The standard contained 13 comprehensive assessment contents and 21 drug warning entries. Conclu-sion: After 2 rounds of expert consultation,the opinions tend to be uniform with high degree of coordination. The standard can provide reference for clinicians and clinical pharmacists to use drugs rationally. At the same time,it also provides ideas for the establishment of rational drug use standards for other diseases.
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Objective: To analyze the prescriptions of analgesic drugs for the patients with cancer pain, and promote the rational use of narcotic and analgesic prescriptions. Methods: Using the PCNE classification system, the list of all drug-related problems (DRPs) from 115 patients admitted to the standardized treatment of cancer pain from January to December 2017 was analyzed. Re-sults: In our hospital from January to December 2017, there were 52 cases of prescribed DRPs for narcotic and analgesic drugs in the standardized treatment of cancer pain with the incidence of 45. 22% . DRPs mainly focused on treatment safety with the incidence of 72. 31% . The drug choice caused the highest incidence of DRPs accounting for 63. 24% , followed by dose selection accounting for 20. 59% . Conclusion: There are still unreasonable prescriptions of narcotic analgesia in our hospital. According to the PCNE classifi-cation system, it is necessary to strengthen the communication with clinicians, carry out education for the patients with cancer pain, and further educate pharmacy staff on the knowledge of analgesic drugs. Through the above measures, the regulation of prescription medication for narcotic analgesics can be intensified.
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OBJECTIVE:To explore new method of prescription comment in medical institutions of Chongqing under the background of"New Medical Reform",and to provide reference for prescription comment innovation and promoting rational drug use in clinic. METHODS:Through analyzing policy background of prescription comment innovation and practice,referring to experience of other regions,the achievements and problems were analyzed by developing centralized prescription comment and prescription comment information construction in municipal and regional (county-level) medical institutions of Chongqing. The countermeasures suggestion was put forward. RESULTS&CONCLUSIONS:The prescriptions of 16 municipal medical institutions were commented centrally,involving more than 300 medical records and 1600 prescriptions or medical orders. The prescriptions of 135 regional (county-level) medical institutions were commented centrally,involving more than 3100 medical records and 12100 prescriptions or medical orders."Chongqing Medical Institution Prescription Comment Key Technology Monitoring System"was established. Above measures innovated centralized prescription comment mode,improved the quality of prescription comment and promoted prescription comment informatization. There were still problems as incomplete coverage of the system,inspection to become a mere formality. It is suggested to strengthen internal quality control of medical institutions by establishing rational drug use scoring management system,developing clinical pharmacist ward round and prescription checking in advance;establish and improve third-party external comment and supervision mechanism;improve the knowledge of prescriptions comment staff in all directions so as to further standardize prescriptions and promote rational drug use in medical institutions.
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OBJECTIVE: To evaluate the effects of special prescription comment model intervention on prophylactic application of antibiotics during perioperative period of clean operation in our hospital. METHODS: By founding specialist group and prescription comment group, formulating unified form for evaluating prophylactic application of antibiotics during perioperative period of clean operation, establishing comment criteria referring to Guidelines for Clinical Antibiotics Use (2015 edition), Notice on Further Strengthening the Management of Clinical Antibiotics Use, drug package inserts and so on; havivg the aid of administrative intervention and quality assessment, The special prescription comment model was established. Based on stratified sampling (according to the clinical departments, kind of procedure), Each 180 medical records were collected from our hospital during Jan. -Jun. 2015 (before intervention) and Jan. -Jun. 2016 (after intervention). The unified form for perioperative period of clean operation was formulated to comment each medical record in respects of prophylactic utilization rate of antibiotics, medication indication, medication timing, drug selection, usage and dosage, medication course, drug combination, etc. RESULTS: After the following intervention measures were adopted, such as The prophylactic utilization rate of antibiotics of our hospital during perioperative period of clean operation decreased from 96. 7％ before intervention to 25. 0％ after intervention (P< 0. 05). The rates of drug use without indication, irrational medication timing before surgery, irrational drug selection, irrational usage and dosage, irrational medication course and irrational drug combination were decreased from 71. 3％, 72. 4％, 65. 5％, 23. 0％, 97. 1％, 17. 8％ before intervention to 4. 4％, 0, 8. 9％, 11. 1％, 22. 2％, 0 after intervention (P<0. 05) respectively. Before intervention, 8 categories 20 kinds of antibiotics were used prophylactically in our hospital during perioperative period of clean operation; 86 patients used 2 kinds of or more antibiotics, among which there were 31 cases of drug combination and 55 cases of drug replacement. After intervention, 3 categories 4 kinds of antibiotics were used prophylactically in our hospital during perioperative period of clean operation; there was no drug combination and drug replacement. CONCLUSIONS: Special prescription comment model can obviously improve rational use of antibiotics during perioperative period of clean operation.
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With the growth of number of Chinese patent medicines and clinical use, the rational use of Chinese medicine is becoming more and more serious. Due to the complexity of Chinese medicine theory and the uncertainty of clinical application, the prescription review of Chinese patent medicine always relied on experience in their respective, leading to the uncontrolled of clinical rational use. According to the traditional Chinese medicine (TCM) theory and characteristics of the unique clinical therapeutics, based on the practice experience and expertise comments, our paper formed the expert consensus on the prescription review of Chinese traditional patent medicine for promoting the rational use of drugs in Beijing. The objective, methods and key points of prescription review of Chinese patent medicine, were included in this expert consensus, in order to regulate the behavior of prescription and promote rational drug use.
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Objective To analyze the irrational prescriptions, improvement measures and improvement effect in our hospital in 2016. Methods 7200 outpatient and emergency prescriptions of our hospital in 2016 were randomly selected to study. 3600 prescriptions from January 2016 to June were selected as pre intervention group, and 3600 prescriptions from July 2016 to December were selected as post intervention group,First of all, the prescription of the pre intervention group was reviewed, according to the results of the review and literature review to determine the intervention measures. The types of prescription drugs, average amount of prescription, rate of antibiotic use and unreasonable prescription rate of two groups were observed. Results Types of prescription drugs(2.27 kinds vs. 1.93 kinds), average amount of prescription(171.74 yuan vs. 152.86 yuan), rate of antibiotic use(34.39% vs. 25.47%) and unreasonable prescription rate (9.36% vs. 2.14%)of post intervention group were significantly lower than those of pre intervention group(P<0.05). Conclusion The prescription comment and targeted intervention can reduce the incidence of irrational drug use and promote rational drug use in clinic, which has important clinical value.
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OBJECTIVE:To investigate the current situation of unreasonable prescriptions in outpatient and emergency depart-ments of our hospital,and to provide reference for rational drug use in the clinic. METHODS:The evaluation of outpatient and emergency prescriptions in our hospital during 2013-2015 were summarized and analyzed. Irrational prescriptions were divided into 3 categories,involving 19 items. The main,secondary and general factors of irrational prescriptions were analyzed by Pareto chart. RESULTS:Among 19 types of irrational prescriptions,main factors included unsuitable drug selection,inappropriate usage and dosage,inappropriate drug combination,prescribing not in accordance with the antibiotics management regulations,incomplete di-agnosis. No indications of medication,drug dosage beyond the regulations ofthree urgent seven slowwere treated as the second-ary factors. Other 12 items were general factors. CONCLUSIONS:According to the main and secondary irrational drug use types, clinical pharmacists should carry out effective intervention and pharmaceutical care to improve the level of rational drug use and en-sure the safety of clinical drug use.
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OBJECTIVE: To establish the criteria in repeated usage of traditional Chinese patent medicines. METHODS: Fifteen experts were invited to take a two-rounded questionnaire survey. Experts' positive coefficients, authority coefficient, reliability, concentration degree and coordination degree towards experts' opinions were calculated by SPSS23.0 after integrating the opinions. The criteria were modified based on the prespecified principles. RESULTS: In this two-rounded survey, experts' positive coefficients were 100.00% and 93.33%, averaging authority coefficient was 0.91, reliability of two rounds were 0.87 and 0.82. Coordination degree increased from 0.36 (P<0.01) to 0.46 (P<0.01). Three first level index and eighteen second level index were included in this cirteria. CONCLUSION: With well response, authority, reliability and coordination, this study could define preliminary evaluation criteria of repeated traditional Chinese patent medicines.
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Objective:To investigate the clinical application of fibrinogen (FIB) in a certain hospital to enhance the rational use in clinics.Methods:A retrospective investigation was adopted to analyze the clinical application of FIB in a certain hospital in 2016. Results:Totally 489 inpatients were treated with FIB in 2016,and among them,243 cases were surgery patients and another 246 ones were non-surgery patients. The main involved departments were cardiovascular surgery,cardiovascular medicine,emergency,intensive medicine,gynaecology and obstetrics, gastroenterology and neurosurgery. The rationality of indication was 80.0% (391/489), and the non-indication use mainly existed in cardiovascular surgery and cardiovascular medicine departments. Among the 391 cases with in-dication,3 cases were with improper compatibility,17 cases with low dosage, and the irrationality of usage and dosage was 17.9% (20/391). Conclusion:The clinical application of FIB is basically rational in the hospital,while non-indication use still exists during the perioperative period in cardiovascular and cerebrovascular surgery,and nonstandard usage and dosage appear in clinics from time to time. The prescription comment on blood products such as FIB should be enhanced in order to improve the rational use in clinics.
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OBJECTIVE:To provide scientific reference for prescription comment. METHODS:Network questionnaire was de-signed to investigate the development of hospital prescription comment taking hospital pharmacists from Shanghai as the object. The surveyed data were analyzed statistically. RESULTS:A total of 51 effective questionnaires were collected with effective recovery rate of 100%,involving 51 hospitals. Second-level prescription comment mode was adopted in 51 hospitals;the mode of"initial clinical pharmacist comment,expert group re-comment"was mostly adopted in second-level hospitals,accounting for 23.53%. The mode of"outpatient pharmacist initial comment,clinical pharmacist re-comment"was mostly adopted in third-level hospitals and general hospitals,accounting for 23.53% and 21.57%,respectively. The method of"all prescriptions randomly selected at one stage"was mostly adopted in third-level hospital(accounting 23.53%). 45.10% of them did not adopt information system for pre-scription comment. 86.27% of surveyed hospitals carried out the review once a month. The limitation on the amount of drugs which were"less than 2 weeks"and"less than 1 month"took up the high proportion(41.18%,45.10%). Among irrational used common drugs,antibiotics accounted for the highest proportion (43.14%). In supernormal prescriptions,the most common problem was drug use without indication(accounting for 64.71%). Surveyed pharmacists from different types of hospital had different comments on same prescription. The effects of prescription comment on hospital rational drug use and pharmacist's ability had been widely recognized,but its effects on physician prescribing behavior was not satisfactory(only 5.88% respondents believed the great effects of prescription comment). Main ideas and suggestions of surveyed pharmacists for improving the role of prescription comment were"to improve the comment ability of pharmacists","to pay more attention by hospital leaders"and"to increase the degree of infor-mation management". CONCLUSIONS:During the process of prescription comment,it is necessary to improve the authority of prescription comment and the scientific sampling method,optimize the frequency of prescription comment and the consistency of comment results,and also pay attention to combination with administrative intervention.
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OBJECTIVE:To explore the ideas for the prescription comment of TCM injections,and provide reference for clini-cal rational use. METHODS:Totally 9 457 prescriptions in PIVAS and 400 hospitalized medical records in our hospital in 2015 were collected. The prescriptions and hospitalized medical records which contained TCM injections were retrospectively commented in aspects of indications,usage and dosage,drug combination,solvent selection and repeat medication,and analysis of typical case. RESULTS:In 2015,there were 2 544 prescriptions(26.90%)in PIVAS and 195 medical records(48.75%)that used TCM injections;the irrational use was mainly inappropriate solvent selection(50.70%),inappropriate usage and dosage(27.00%),inap-propriate indications (10.33%),inappropriate combination therapy (7.51%) and repeat medication (4.46%). CONCLUSIONS:Prescription of TCM injections should be commented with the medical records and individual analyzed;in terms of unreasonable prescriptions and medical records TCM clinical pharmacists should actively intervene unreasonable prescriptions by the bed.
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OBJECTIVE:To provide reference for rational use of antibacterial drugs in the clinic. METHODS:In retrospective study,outpatient and emergency antibacterial drugs prescriptions were randomly selected from a hospital during 2013-2014,and then analyzed statistically. DDDs of antibacterial drugs were analyzed by using DDD method. RESULTS:From 2013-2014,the ap-plication rate of antibacterial drugs in the hospital declined substantially from 13.8% to 11.9%,and the rate of irrational use dropped from 2.7% to 1.2%. The application rate of antibacterial drugs was higher in pediatric department,emergency department and urology department;drug cost per capita was higher in infectious department,nephrology department and emergency depart-ment. The application rate of antibacterial drugs in pediatric department decreased greatly in 2014,compared with 2013,maintain-ing about 40%. The application rate of antibacterial drugs in emergency department during Jan.-Sept. in 2014 was lower than corre-sponding period in 2013,and that of the hospital during Jan.-Sept. in 2014 was lower than corresponding period in 2013,but dur-ing Oct.-Dec. in 2014 was slightly higher than corresponding period in 2013. Single type of antibacterial drugs were mainly used in outpatient department,accounting for 91.50% and 90.77% of antibacterial drug prescriptions in 2013 and 2014;two-drug account-ed for 8.44% and 9.11%. The top 3 antibacterial drugs in the list of DDDs during 2013-2014 were roxithromycin,cefuroxime and cefminox. CONCLUSIONS:The use of antibacterial drugs is up to the requirements of Nation Special Rectification Actirity for Clin-ical Application of Antibacterial Drugs in 2013. The prescription comment improve the quality of antibacterial drug prescriptions and rational use index greatly in outpatient department,but the application rate of antibacterial drugs is too high in some depart-ment. There still is irrational use of antibacterial drugs.
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OBJECTIVE: To analyze the features of high-risk drugs prescriptions for elderly outpatients in our hospital, so as to provide references for establishing the prescription comment method of high-risk drugs used by elderly outpatients and promote the rational drug use. METHODS: The number and amount of money of high-risk drugs prescriptions for elderly outpatients were counted, and the amount of high-risk drugs were sorted, so as to find out the features of high-risk drugs use in elderly outpatients and determine the prescription comment catalogue. According to "The hospital prescription comment management specification (Trial)", and combined with the use of high-risk drugs and physical characteristics of elderly patients, the prescription comment technical manual of high-risk drugs used by elderly outpatients was established, and the key drugs were commented for demonstration purpose. RESULTS: Elderly patientsoccupied a high proportion in our hospital, and the amount of money of single prescription was also high, which indicated that the elderly patients had more complex drug use. Through analysis of high-risk drugs prescriptions, the comment catalogue was established. And through empirical review of the prescriptions of key drugs, it was found that the proportion of unreasonable prescriptions was high, with variousproblems among different prescriptions. CONCLUSION: This study established the prescription comment technical manual of high-risk drugs used by elderly outpatients, which should become an important measure to prevent and reduce drug-induced diseases in elderly patients, and improve the effectiveness and safety of clinical medication.
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Objective To evaluate the rationality of antibiotic use in the outpatient and emergency departments in some class 3A hospitals in China through International Network for Rational Use of Drugs (INRUD).Methods The antibiotic prescriptions were collected from the outpatient and emergency departments in 78 class 3A hospitals of 25 provinces through INRUD during 2014-2015.The basic information of the antibiotic prescriptions and the prescriptions rationality were evaluated.Results A total of 447 894 prescriptions of antibiotics were analyzed.From 2014 to 2015,the qualified rate the prescriptions increased from 91.52％ to 93.08％,and the antibiotic use rate was similar (11.72％ and 12.04％).The major irrational prescription type was inappropriate prescription,including inappropriate indication (32.42％,34.02％) and inappropriate usage and dosage (24.22％,18.56％).Conclusions Totally,the antibiotic use in the outpatient and emergency department reached the standard in China.However,the use of antibiotics didn' t meet the national requirements in some area.It is necessary to promote the rational use of antibiotics.
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Objective To evaluate the rationality of antibiotic use in the outpatient and emergency departments in some class 3A hospitals in China through International Network for Rational Use of Drugs (INRUD).Methods The antibiotic prescriptions were collected from the outpatient and emergency departments in 78 class 3A hospitals of 25 provinces through INRUD during 2014-2015.The basic information of the antibiotic prescriptions and the prescriptions rationality were evaluated.Results A total of 447 894 prescriptions of antibiotics were analyzed.From 2014 to 2015,the qualified rate the prescriptions increased from 91.52％ to 93.08％,and the antibiotic use rate was similar (11.72％ and 12.04％).The major irrational prescription type was inappropriate prescription,including inappropriate indication (32.42％,34.02％) and inappropriate usage and dosage (24.22％,18.56％).Conclusions Totally,the antibiotic use in the outpatient and emergency department reached the standard in China.However,the use of antibiotics didn' t meet the national requirements in some area.It is necessary to promote the rational use of antibiotics.
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OBJECTIVE:To explore the construction effect of rational drug use monitoring system on the improvement of clini-cal drug use in the hospital. METHODS:The data about the construction of rational drug use monitoring system were collected from our hospital,including pharmacist workstation prescription check(check before prescription/medical order charging to realize warning in advance),clinical pharmacy management system prescription comment(realize prescription/medical order comment after-wards)and adverse drug reaction/adverse drug event(ADR)reporting information platform(realize online ADR reporting)during 2014-2015. The data was analyzed to evaluate the effectiveness of system construction. RESULTS & CONCLUSIONS:There were a total of 3 417 329 prescriptions audited by the pharmacist workstation within 2 years through improving system functions,includ-ing 7 315 prescriptions were returned to doctors to be modified,the percentage of which declined from 0.39% to 0.08%. The pass rate of prescription comment pre-judgment increased from 81.2% to 90.4% in 2015 by clinical pharmacy management system. The valid case number of ADR monitoring and reporting increased from 186 cases to 267 cases,involving all department of our hospi-tal. The construction of rational drug use monitoring system in our hospital can improve the standardization of prescription/medical orders,the level of rational drug use and the case number of ADR,which has achieved the expected results.
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Objective To investigate the clinical application of parenteral nutrition drugs and promote the rational use of drugs.Methods The data of parenteral nutrition drugs used in our hospital were analyzed,including the quantity,the amount of money,the scope and purpose,etc.The rationality of drug use was reviewed by prescription comment simultaneously.Results On similar medicines comparison,the fat emulsion,amino acids (17) and glucose (11％) injection (1440mL) and fat emulsion and amino acids (18) injection (1 000mL),which were designed according to the basal metabolic rate in patients were far greater than the fat emulsion,amino acids(17) and glucose (11％) injection (1 920mL) of the added value of design.And the balanced amino acid preparations in compound amino acid in 18 AA-Ⅳ usage,was far greater than 18 AA-Ⅱ and 18 AA.Fat emulsion preparation with concentration of 20％ dosage was bigger,because the price advantage,ordinary long-chain fat milk consumption was greater than the long chain fatty milk.In terms of drug use rationality,the usage,dosage,compatibility and adverse reactions of parenteral nutrition drugs were analyzed.The dosage,frequency and compatibility problems still needed to be improved.Conclusion The use of parenteral nutrition drugs were basic reasonable,but we should strictly control the indications for parenteral nutrition support,such as drug compatibility,using frequency to strengthen management and reasonable application of drugs to improve medication safety.