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recorded by medical department of the management department，finally were embedded into the outpatient HIS and were docked
with prescription pre-audit and comment system. Total number of reviewed Chinese patent medicine prescriptions，the number of
repeated prescriptions，the number of repeated prescriptions intercepted by HIS system，the number of prescriptions actively
modified by the prescribing physician，the ratio of repeated prescriptions，the frequency of active modification by the prescribing
physician and average cost of each prescription were compared between the third quarter of 2017（initial stage of sub-category
management of Chinese patent medicine）and the forth quarter of 2019. RESULTS：Chinese patent medicines in our hospital could
be divided into eight categories as internal medicine，surgery medicine，oncology medicine，gynecology medicine，ophthalmology
medicine，otorhinolaryngology medicine，orthopedics medicine and dermatology medicine；they contained 14，1，2，4，2，2，3，
1 sub-categories，respectively；some sub-categories were subdivided again. In the third quarter of 2017，159 610 prescriptions of
Chinese patent medicines were reviewed，and 421 prescriptions were unreasonable. Among which，there were 200 prescription of
repeated prescriptions，accounting for 47.15％；676 repeated prescriptions were actively intercepted by HIS and 476 intercepted
prescriptions were actively modified by prescribing physicians，with active modification rate of 70.14％. In the forth quarter of
2019，138 869 prescriptions of Chinese patent medicines were reviewed，and 381 prescriptions were unreasonable. Among which，
there were 47 prescription of repeated prescriptions，accounting for 12.43％；266 repeated prescriptions were actively intercepted
by HIS and 259 intercepted prescriptions were actively modified by prescribing physicians，with active modification rate of
97.37％. There were statistical significances in the ratio of repeated prescription and the rate of active modification by physicians
between initial stage and the forth quarter of 2019（P＜0.01）. The average cost of each prescription were 278.78 yuan in the third
quarter of 2017 and 220.85 yuan in the forth quarter of 2019，decreasing by 20.78％ . CONCLUSIONS：The sub-category
management of Chinese patent medicine is adopted in the pharmacy department of our hospital，which realize the pre-audit of all
prescriptions of Chinese patent medicines，and increased the pass rate of outpatient chinese patent medicine prescriptions . It is
helpful for doctors to dialectically use drugs，memorize the varieties of Chinese patent medicines and improve their professional
level；it is helpful for prescription reviewers to rapidly identify repeated prescriptions，improve the information audit and
management level of prescriptions. It is convenient for facilitate prescription reviewers to check the amount of prescriptions used
and found out the deficiency of the medicine list in our hospital. However，there are also some problems such as the conflict
between individualized medication and part of management system，and doctors and pharmacists have different opinions on
medicine classification.
KEYWORDS Outpatient；Chinese patent medicine；Sub-eategory management；Prescription review；Qualified rate；Rational
drug use

中成药是在中医药理论的指导下，以中药饮片为原 同审方药师的执行标准均不统一。2017年3月，北京市
料，按规定的处方和标准制成的一定规格、可直接用于 中医管理局、北京市卫生和计划生育委员会《关于加强
[1]
防治疾病的制剂 。随着我国医药卫生事业的迅速发 中成药合理使用管理的通知》明确提出，同一张处方中
[4]
展，以及国家对中医药支持力度的不断加大，中成药目 “同一亚类中成药只能开具 1 种”。但是，该文件中关
前已被广泛应用于临床，在防病治病中起到不可或缺的 于中成药分类及亚类的定义并不明确，造成各医疗机构
作用。然而随着药品使用量以及医疗支出的不断增加， 中成药分类管理难以实施。我院药学部为促进中成药
我国对药物使用的有效性、安全性和经济性的重视程度 的合理使用及有效监管，将我院现有中成药品种按照功
也日益加深，各级医院也纷纷制定了相关管理措施以提 能主治分亚类管理并嵌入至医院信息系统（HIS）中，借
[2]
高临床合理用药水平 。根据国际合理用药网络（Inter- 助信息化系统对同一亚类中成药联用处方进行拦截，以
national Network for the Rational Use of Drugs，INRUD） 降低我院中成药不合理处方数、提高合理用药水平，旨
中国中心组临床安全用药组的报告，2016年我国上报的 在为提高门诊中成药处方合格率、保障患者合理用药提
[3]
发生在处方环节的用药错误占56.5％ 。由于处方环节 供参考。
的错误相较于其他环节更易被拦截，因此药师审方时拦 1 资料与方法
截不合理处方就成为避免处方环节用药错误的重要手 1.1 我院中成药亚类分类原则
段之一。笔者发现，我院在审方环节拦截的不合理中成 收集我院全部中成药品种的药品说明书，参考《北
药处方中，重复用药占到了总不合理处方的 40％～ 京市基本医疗保险药品目录》（以下简称“医保目录”）、
50％，主要包括成分相同的中成药重复处方或功效相近 《临床用药须知》和美康合理用药信息支持系统中的相
的中成药重复处方。由于中成药多为复方制剂，目前尚 关信息，按照药品功能主治对我院所有中成药进行分
未明确规定多大比例的同类成分以及同种功效重复属 类：首先，按照医保目录中的分类方法划分大类，将我院
于重复用药范畴，故在药师审方环节，不同医疗机构、不 中成药分为内科用药、外科用药、肿瘤用药、妇科用药、

·2024 · China Pharmacy 2020 Vol. 31 No. 16 中国药房 2020年第31卷第16期