Page 105 - 2021年18期

我院PASS系统前置审核规则优化探讨——以钙调磷酸酶抑制剂

为例 Δ

＊
马祝悦 ，顾 婕，袁红宇（南京医科大学第一附属医院药学部，南京 210029）
#
中图分类号 R95 文献标志码 A 文章编号 1001-0408（2021）18-2271-06
DOI 10.6039/j.issn.1001-0408.2021.18.16

摘 要 目的：为优化合理用药监测系统（PASS）审核规则、提高我院合理用药水平提供参考。方法：以钙调磷酸酶抑制剂（CNI）
的处方审核为例。我院审方药师在日常工作中收集PASS系统的不适宜规则，并进行修改和完善。随机抽取我院2019年第4季度
（规则修改前）和2020年第4季度（规则修改后）含CNI的门诊处方和住院医嘱各3 000份，对比规则修改前后PASS系统的审核警
示情况以及假阳性、假阴性情况。结果：我院PASS系统存在超说明书用药判断过于严苛、审核规则不严格、禁忌证审核存在假阳
性情况、药物相互作用未按严重程度分级警示、患者肝肾功能判断不准确、问题描述冗长、系统数据库信息不全面或存在错误、食
物和中药对CNI的影响信息缺失等问题。针对这些不适宜规则，我院药学部通过制定超说明书用药的规范化管理流程、合理启用
PASS系统拦截功能、修改药物禁忌证的假阳性规则、分级警示药物相互作用、结合实验室检查报告进行审核、完善问题描述内容、
及时更新维护系统数据库信息以及增加患者教育内容等措施来提高PASS系统审核规则的质量。经过1年的规则优化，PASS系
统审核的警示数量从规则修改前的182份减少至规则修改后105份，假阴性、假阳性审核结果占比从25.03％降至0.43％。结论：
对审核规则进行优化，可以提高PASS系统的适用性，有利于前置审核工作的顺利推进，促进临床的合理用药。
关键词 合理用药监测系统；前置审核；钙调磷酸酶抑制剂；审核规则；合理用药

Discussion on the Optimization of Pre-review Rules for PASS System in Our Hospital：Taking Calcineurin
Inhibitor as an Example
MA Zhuyue，GU Jie，YUAN Hongyu（Dept. of Pharmacy，the First Affiliated Hospital of Nanjing Medical
University，Nanjing 210029，China）

ABSTRACT OBJECTIVE：To provide reference for optimizing the review rules of PASS system and improving rational drug use
in our hospital. METHODS：The prescription review of Calcineurin inhibitor（CNI）was taken as an example. The pharmacists of
our hospital collected the inappropriate rules in PASS system in their daily work，and modified and improved them. Three
thousands outpatient prescriptions and inpatient orders containing CNI in the fourth quarter of 2019（before the rule modification）
and the fourth quarter of 2020（after the rule modification）were randomly selected for our hospital. The warnings，false positives
and false negatives of PASS system review were compared before and after rule modification. RESULTS：There were some
problems in the PASS system of our hospital，such as too strict judgement on off-label use，lax review rules，false positive in the
audit of contraindications，failure to grade warnings according to the severity of drug interactions，inaccurate judgment of patients’
liver and kidney function，lengthy problem description，incomplete or wrong information in the system database，lack of effects
information of food and traditional Chinese medicine on CNI，etc. In view of these inappropriate rules，the pharmacy department of
our hospital improved the quality of PASS system review rules through formulating the standardized management process of
off-label use， reasonably enabling the interception function of PASS system， modifying the false-positive rules of drug
contraindications， warning drug interaction by grade， reviewing in combination with laboratory test reports， and real-time
maintenance of system database information and adding patient education content. The number of warning had decreased from 182
to 105，and the proportion of false-negative and false-positive review results from 25.03％ to 0.43％ after a year of optimization.
CONCLUSIONS：The optimization of CNI review rules can enhance the applicability of the PASS system，facilitate the advance of
the prescription pre-review，and promote clinical rational drug use.
KEYWORDS PASS system；Pre-review；Calcineurin inhibitor；Review rules；Rational drug use

Δ 基金项目：江苏省药学会-奥赛康临床药学基金科研项目（No. 借助合理用药监测系统（PASS）对潜在的用药风险
A202001）
进行警示，可帮助医师选择安全、合理、有效的治疗方
＊主管药师，硕士。研究方向：临床药学。电话：025-68303737。
[1]
案，防控用药风险，避免临床不良结局 。我院根据《医
E-mail：mzy66602@163.com
[2]
# 通信作者：主任中药师，硕士。研究方向：临床药学、药事管 疗机构处方审核规范》的规定 ，于 2019 年 3 月引进
理。电话：025-68306822。E-mail：3066076382@qq.com PASS系统，采用“前置审核系统+审核药师”的模式对我
中国药房 2021年第32卷第18期 China Pharmacy 2021 Vol. 32 No. 18 ·2271 ·