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Objective To analyze the use of carbapenems in a hospital in 2016, so as to provide evidence for rational use of antibiotics. Methods The medical records of all patients treated with carbapenems in 2016 were collected. The use of antimicrobial agents, types of infections and etiological examinations were investigated. The medication rationality of antibiotics was evaluated, and the inappropriate problems were classified. Results A total of 383 cases were extracted, including 137 (35.78%) females and 246 (64.22%) males, with an average age of (59±12) years and a median age of 61 years. The total inspection rate was 95.30% (365/383). A total of 258 cases (67.36%) received the medicine according to the drug sensitivity results. The drug utilization indexes of imipenem/cilastatin sodium and biapenem were 1.29 and 0.76, respectively. There were 60 cases (15.67%) of irrational use of carbapenems. Conclusion There is still unreasonable clinical use of carbapenems in the hospital in 2016. The rationality evaluation of carbapenems use is conducive to understanding the clinical use and finding the typical problems, so as to provide reference for rational drug intervention.
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Objective: To carry out the studies of pharmacological action for extracts of Aconiti Radix and Aconiti Radix Cocta, and evaluate the selection of raw materials in prescriptions, in order to promote the development and clinical application of preparations. Method: The mixed extracts of Aconiti Radix and Aconiti Radix Cocta were prepared respectively according to the technique of aconitum injection, and different dose groups of Aconiti Radix and Aconiti Radix Cocta were established based on the dose of Aconiti Radix 0.152 5 mg·g-1, and then applied in such pharmacodynamic tests as analgesia, heart rate reduction, antitumor effect and toxicology tests, such as acute toxicity and organ observation. The data were analyzed systematically on the basis of literatures. Result: Compared with blank group, the extracts of both Aconiti Radix and Aconiti Radix Cocta had a significantly analgesic effect. At the same dose, the pain inhibition rate of Aconiti Radix injection (60.91%) was higher than that of Aconiti Radix Cocta injection (53.42%), and the pain inhibition rate of Aconiti Radix extract for oral administration(73.94%) was also much higher than that of Aconiti Radix Cocta extract (29.97%), with significant differences (Pth min after administration, the heart rate of the Aconiti Radix group was decreased first, then stabilized, and finally increased with the rise of the dose, while for the Aconiti Radix Cocta group showed a different trend of first stability, then decrease and finally increase. The result indicated the Aconiti Radix group had the effect in reducing heart rate in rats at a low dose. The survival inhibition rate was evaluated by 3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT). The extracts of both Aconiti Radix and Aconiti Radix Cocta had a significantly inhibitory effect on the proliferation of AGS gastric cancer cells, in which Aconiti Radix was stronger than that of Aconiti Radix Cocta at the same dose. In the acute toxicity test of rats, lethal dose 50%(LD50) of Aconiti Radix and Aconiti Radix Cocta were 3.9 g·kg-1 and 21.0 g·kg-1 respectively, which were equivalent to 4 times and 20 times of the clinical dose. LD50 of the extract of Aconiti Radix Cocta was 5 times than that of Aconiti Radix. The liver and kidney of dead rats were dark with obvious symptoms of poisoning after dissection, while all the organs of rats at the clinical and lower dose were normal. Conclusion: The safety of Aconiti Radix is lower than that of Aconiti Radix Cocta, but with greater analgesic, bradycardic and anticancerous effect. Therefore, it is suggested that the preparations, such as aconitum injection, should be prepared with Aconiti Radix in the treatment of severe pain of patients with advanced gastric and liver cancer, and the preparations for general pain can be prepared with Aconiti Radix Cocta, so as to achieve a truly safe and effective dialectical treatment.
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OBJECTIVE： To establish antibiotics use rationality evaluation model in type Ⅰ incision surgery patients， and to provide reference for prescription review of clinical pharmacists. METHODS： Totally 432 inpatients underwent type Ⅰ surgical incision in a hospital from Jan. 1st- Dec. 31st， 2017 were selected as the research objects. The information of diagnosis and treatment including age， nosocomial infection， the number of kinds of antibiotics used were extracted. Based on the results of clinical pharmacists’ comments on the antibiotics use rationality in patients’ prevention and treatment， non-conditional Logistic regression and support vector machine （SVM） in machine learning method were used to convert clinical pharmacists’ comments into objective index that can be recognized by the machine learning model， using categories of antibiotics （preventive or therapeutic use） as dependent variables and the patient’s diagnosis and treatment information as independent variables. Classification and identification model was established for antibiotics use rationality in type Ⅰ incision surgery patients. Using sensitivity， specificity and Youden index as indexes， established mode was validated on the other 61 samples of type Ⅰ incision surgery patients. The rationality of antibiotics prescriptions in type Ⅰ incision surgery patients before （by manual review， Jan.-Dec. 2017） and after （Jan.-Oct. 2018） using the model were collected， and the effects of the model were evaluated. RESULTS： The sensitivity， specificity and Youden index of non-conditional Logistic regression model were 65.63％， 75.00％ and 40.63％， respectively. Main parameters of the model established by SVM included gamma 0.01， cost 10， sensitivity 92.19％， specificity 87.50％， Youden index 79.69％. The model established by SVM was better than non-conditional Logistic regression. SVM was used to validate established mode， and sensitivity， specificity and Youden index were 100％， 88.57％ and 88.57％， respectively. Compared with before using the model， the evaluation ratio increased from 69.44％ to 100％， the rate of prophylactic use of antibiotics decreased from 23.84％ to 16.43％， the rate of rational drug type selection increased from 37.86％ to 54.39％， and treatment course shortened from 5.01 days to 3.26 days after using the model. CONCLUSIONS： Established antibiotics use rationality evaluation model in typeⅠincision surgery patients by SVM in machine learning method fully covers all the patients， promotes rational use of antibiotics in typeⅠincision surgery patients， and provides a new idea for pharmacist prescription comment.
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Objective To analyze the rationality of the combined application prescriptions of traditional Chinese and Western medicine; To discuss the problems in the evaluation of the combined application of traditional Chinese and Western Medicine. Methods A total of 12 issue monthly outpatient combination application prescriptions of traditional Chinese and Western medicine were randomly selected in Gansu Provincial Hospital of Traditional Chinese Medicine (Here in after referred to as "this hospital"). According to the relevant laws and regulations, evaluation rules of the combined application traditional Chinese and Western medicine was developed, reviewed and statistically summarized. Results Totally 1900 prescriptions were sampled in the study and accounted for 8.67% in all prescriptions (including prescription of traditional Chinese herbal medicine) and accounted for 20.87% of all prescription of pure Western medicine and pure traditional Chinese patent medicine in the same period, which meet the requirements of sampling rate. Prescriptions of department of orthopedics accounted for the majority. The average number of drugs and the average amount of each prescription of department of orthopedics were lower than the overall average. The sample consisted of 1852 patients, 796 males and 1056 females. Middle-aged patients (36-60 years old) of combined medication were up to 49.46% of the total number of patients. 3990 terms of diagnosis were involved, including 1908 terms of traditional Chinese medicine diagnosis and 2082 terms of Western medicine diagnosis. Orthopedics disease diagnosis accounted for more than 50%. The main problems of the combined application of traditional Chinese and Western medicine were the non syndrome differeentiationg use of medicine, inappropriate usage and dosage, and the lack of attention to medicine interactions. Conclusion The combined application prescriptions of traditional Chinese and Western medicine of this hospital account for a small proportion. Prescription structure adapts with the size of the department, patient age and disease diagnosis. In the future, the prescription evaluation and intervention of syndrome differeentiationg application and dosage and medicine interaction should be strengthened.
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Objective To analyze the application of antimicrobial agents before and after the improvement of prescription evaluation system in Green Town Cardiovascular Hospital.Methods One thousand outpatient prescriptions of antimicrobial agents were randomly selected from our hospital from January 2014 to January 2016,serving as the data before intervention.These prescriptions were analyzed according to the prescription evaluation system and effective interventions were proposed according to the existing problems in prescriptions.Another 1 000 effective prescriptions of antimicrobial agents during February 2015 to January 2016 in our hospital were taken as the data after intervention.Unreasonable use of antimicrobial agents and the satisfaction degree of physicians,nurses and patients towards the prescription were compared before and after intervention.Results After intervention,the percentage of unreasonable use of antimicrobial agents from May 2015 to May 2016 (2.10%) was significantly lower than that from April 2014 to April 2015 (30.00%),the difference was statistically significant (χ2=288.857,P<0.05).The satisfaction degree of physicians,nurses and patients towards the prescription from May 2015 to May 2016 [(93.23±5.93)points,(95.29±6.01)points,(68.99±4.27)points] was significantly higher than that from April 2014 to April 2015 [(75.34±5.32)points,(71.46±5.13)points,(68.99±4.27)points],the difference was statistically significant (t=110.706,95.368,123.711,all P<0.05).Conclusion The improvement of prescription evaluation system can obviously improve unreasonable use of antimicrobial agents,increase the satisfaction degree,avoid drug abuse,produce obvious effect and great significance.
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OBJECTIVE: To evaluate the effects of prescription evaluation system and the role of pharmacists through the analysis of the results of antibiotic prescription evaluation. METHODS: Random results evaluation analysis based on the results of prescription evaluation in paper during January 2013 to February 2015 and comments of software analysis during March to December 2015. RESULTS: The qualification rates of prescription are respectively 91.6%, 96.5% and 99.1% during 2013-2015 and the consistency of pharmacists and experts are respectively 88.6%, 89.3%, 97.9%, the types of unqualified prescription decrease. CONCLUSION: The evaluation system of antimicrobial agents prescription has accomplished transition from random evaluation of paper prescription evaluation to software ones, which fulfills the mode of prescription evaluation by information techniques.The improving consistency of pharmacists and experts indicates the professional standards of pharmacists.
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OBJECTIVE: To help the clinicians use multiple electrolytic and invert sugar injection properly and normatively, the specific prescription evaluation was developed. METHODS: The team of specific prescription evaluation was organized to develop the standards by evidence-based medical research method, then 327 cases of inpatients who were administrated the medicine in January 2016 and 327 cases of June 2016 in our hospital were randomized for the systematic analysis. RESULTS: The number of irrational medical records was 87 and the rate of irrational usage was 26.6% in January 2016. Unapproved indications(23.8%), over courses treatment(24.8%), contraindication(32.7%) and inappropriate drugs combination(17.8%) were the main situations of irrational usage of drugs. After the effective intervention, the irrational rate decreased significantly to 11.9%in June 2016 with the number of irrational medical records to 39. CONCLUSION: Though the irrational clinical usage of multiple electrolytic and invert sugar injection is prevalent, it could be effectively controlled by evidence-based specific prescription evaluation.
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OBJECTIVE:To provide reference for promoting rational use of vancomycin in the clinic. METHODS:Referring to vancomycin instruction,Guiding Principles for Clinical Use of Antibacterials (2015 edition) and Chinese Expert Consensus on Clinical Use of Vancomycin (2011 edition),720 inpatient medical records of vancomycin were collected from our hospital during Jan. 2013-Dec. 2014,and then drug use of those inpatients were analyzed retrospectively. RESULTS:Among 720 cases,male (428 cases)was more than female(292 cases),and most of them aged 41-65(45.83%). There were 50 cases of prophylactic drug use(6.94%)and 670 cases of therapeutic drug use(93.06%). The patients came from 36 departments. Among 720 cases,the dose of 19 cases were higher than 2 g/d,and there were 13 ADR cases(1.81%). Among 670 cases of therapeutic drug use,587 cases of microbiological samples (87.61%) were detected,and other antibacterials were used in 522 cases additionally (77.91%). DUI of vancomycin was equal to 0.96 in 549 cases no younger than 18 years old of herapeutic drug use. There were 240 cases of unsuit-able drug use (33.33%) in total,including 192 cases of unsuitable solvent (26.67%),28 cases of unsuitable usage and dosage (3.89%)and 20 cases of unsuitable drug combination(2.78%). CONCLUSIONS:The use of vancomycin in our hospital is basi-cally rational;vancomycin is widely used in departments;drug combination is a common phenomenon;the inspection rate of mi-crobiological samples is qualified;no drug abuse is found. However,there still is inappropriate use in the clinic. It is recommended to strengthen special evaluation and training about rational use of vancomycin,and further standardize monitoring for vancomycin use so as to guarantee the safety of drug use.
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OBJECTIVE:To explore the clinical utilization of carbapenems in a hospital,analyze and evaluate its medication rationality. METHODS:All the 508 medical records of inpatients treated with carbapenems from Jul. 2012 to Jun. 2015 were retro-spectively investigated,the utilization and pathogenic examination of carbapenems were evaluated;by setting the carbapenems eval-uating standard,the medication rationality of carbapenems was evaluated and inappropriate cases were classified and analyzed statis-tically. RESULTS:The drug utilization indexed (DUI) of Imipenem and cilastatin sodium for injection and Meropenem for injec-tion were 0.80 and 1.32,respectively;the total rate of microbial inspection was 95.9%;according to the drug sensitive test result, the rate of drug selection was 62.8%;there were 54 cases(10.6%)of irrational use records,in which,irrational dosage(42.6%) and improper drug selection (31.4%) were the major problems. CONCLUSIONS:There are some inappropriate medication prob-lems in carbapenems utilization in the hospital. Developing the carbapenems utilization evaluation is helpful to discover typical medi-cation problems,which can provide reference for intervention and continuous improvement of rational drug use.
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OBJECTIVE:To promote the working efficiency of hospital prescription evaluation and improve pharmacists profes-sional quality through developmenting electronic prescription evaluation system (EPES) for outpatient department used by taking full advantage of large amount of information of electronic prescription. METHODS:By using system structure of Client/Server, Web Service middleware,programming tool of PowerBuilder and database technique of Oracle and sharing Hospital information sys-tem data,EPES was designed and applied,which could collect prescription information and generate summary form automatically after artificial prescription evaluation. RESULTS & CONCLUSIONS:Integration of outpatient electronic medical records,historical prescriptions and medical test results query system make the EPES carry comprehensive information which could make up for disad-vantages of paper prescription form in the aspect of obtaining outpatient medical records,historical prescriptions or medical test re-sults. EPES can accomplish general and special prescription evaluation and also pledges the equity and justness of process by ran-dom sampling. The operation of the system could improve the efficiency from taking 24-36 h in paper prescription form to 4-6 h to complete general prescription evaluation,which also improves professional quality of pharmacists by intensive training.
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OBJECTIVE:To analyze the problems about the prescription review by the monitoring system for rational drug use (PASS 1.6.1.7) and discuss the countermeasures. METHODS:A retrospective method was adopted. A total of 4 942 prescriptions of our hospital in the first quarter of 2015 were selected at random,and reviewed by PASS and the pharmacist respectively. The re-view results were analyzed,and then countermeasures were put forward for the problems found to exist in the software review. RE-SULTS & CONCLUSIONS:The conformity rates of prescriptions which had been determined as acceptable through PASS review and pharmacist review were 81.20% and 97.40% respectively. PASS misjudged 929 (18.80%) rational prescriptions as irrational ones,mainly concerning administration and dosage,simultaneous existence of Western medicine and Chinese patent medicine on one prescription,repeated drug use and use with caution,etc. PASS misjudged 122(2.47%)irrational prescriptions as rational pre-scriptions,mainly concerning administration and dosage,inconformity between diagnosis and drug use,etc. The above-said prob-lem was attributed to imperfect hospital management and insufficient software intelligence. It is suggested that the hospital should strengthen the data maintenance and management of information system and PASS developer should improve software rules to in-crease the accuracy rate of prescription review.
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To review the evaluation modes,implementation,workflow and effectiveness appraisal of antimicrobial prescriptions of PHMCH and to compare the effects of the evaluation data of such prescriptions during the period from January to June of 2012,and that from January to June of 2013 of the hospital.The results indicate that the 2013 period,compared with that in 2012,the variations such indexes as the proportion of rational prescriptions in outpatient and emergency departments,the proportion of outpatient antimicrobial prescriptions,AUD,the proportion of antimicrobials cost within total drug costs were 2.5％,-4.71％,-1.22 and-0.37％ respectively.Most notable change among which is the proportion of outpatient antimicrobial prescriptions.Such results prove the prescription evaluation mode of the hospital as institutionalized,standardized and effective.
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Objective To promote rational drug use by investigating quality of the outpatient and emergency prescriptions in the hospital .Methods We statistically summarized the evaluations of prescriptions and analyzed the drug use from January to Novem-ber ,2012 .Results The outpatient and emergency prescriptions were compliant to relevant writing standards ,without missing i-tems .The inaptitude of prescriptions were mainly in forms of inappropriate indication ,usage ,and dosage of drug and menstruum . The irrational prescriptions accounted for 5 .5% of those evaluated .Conclusion Rational drug use has been basically ensured through implementation of prescription evaluations and interventions .Irrational prescriptions exist in relatively small scale and are to be eliminated .
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Objective To learn and evaluate the present prescriptions from outpatient departments of 21 public hospitals in Songjiang district,and to promote rational drug use.Methods A total of 75,600 outpatient prescriptions from 21 public hospitals in Songjing district were collected monthly from January 2008 to October 2010 and analyzed statistically using indexes for prescription evaluation.Results of the 75,600 prescriptions,the types of drugs in each prescription averaged 2.35,the ratio of antibiotics use and injection agents use were 35.77％ and 17.40％,respectively.The percentage of essential drugs without added profit accounted for 41.91％ of the total drug use,and the average drug cost per prescription was RMB 85.99.Comparison of indexes for prescription evaluation showed that the ratio of antibiotics use and injection agents use as well as the average cost per prescription in secondary hospitals were significantly higher that those in community health centers (P＜0.01),while the percentage of essential drugs without added profit and the average number of drugs in each prescription were statistically smaller than those in community health centers (P＜0.01).Conclusion Drug use in outpatient departments of 21 public hospitals was rational in general,especially noteworthy is the significant improvement made at community health centers in recent three years.
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OBJECTIVE:To improve rational drug use level by monitoring prescription evaluation.METHODS:The management,technique,design of indexes and the computation of the indexes,etc.in the prescription evaluation were analyzed and standardized in accordance with Prescription Management Method.RESULTS & CONCLUSIONS:An effective method and standard of prescription evaluation has been put forward;it is advisable for medical institutions to conduct prescription evaluation based on the actual situation of their own so as to improve rational drug use level.
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OBJECTIVE: To discuss the way to evaluate outpatient prescription in medical institutions according to Prescription Administrative Policy so as to provide reference for the practice of prescription evaluation system. METHODS: 500 outpatient prescriptions from April 16 to April 20 in 2007 in our hospital were sampled randomly for an evaluation in respect of drug utilization, prescription behavior, pharmaceutical care level etc. RESULTS & CONCLUSIONS: To evalnation from The prescriptions involved use of injections and of antibacterials, prescribed drugs were covered in "national essential drugs" , prescriptions with general name, the knowledge of patients on the administration and dosage were drectively.It is supply reference for the prescription evaluation system.
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0.05). Minimum total probability are used to predict minimum sample volume which is close to overall level. Above method can be used as basic method for sample survey in regular prescription evaluation.