Page 108 - 《中国药房》2022年12期

医疗机构中药处方前置审核规则的优化与实践 Δ

张 婷 ，顾 婕，丁兰萍，马祝悦，张杜枭，袁红宇（南京医科大学第一附属医院药学部，南京 210029）
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中图分类号 R969.3；R95；R288 文献标志码 A 文章编号 1001-0408（2022）12-1506-07
DOI 10.6039/j.issn.1001-0408.2022.12.16

摘 要 目的 改善医疗机构处方前置审核系统对中药处方的审核适用性，提高中药处方审核质量和合理用药水平。方法 总结我
院合理用药监测系统在中药处方前置审核中存在的审核规则不适宜问题，并针对性地修订审核规则、规范审方流程。抽取2020
年第2季度（审核规则优化前）和2021年第4季度（审核规则优化后）我院门急诊的全部中成药和中药饮片处方的审核数据，比较
审核规则优化前后的处方合理率和干预有效率并统计不合理问题。结果 我院审方系统对中药处方的审核适用性较差，存在审方
系统与医院信息系统中的中药饮片名称不统一或不规范、剂量范围设置不合理、重复用药的审核逻辑过于机械化、“十八反”“十九
畏”审核过于严格、特殊人群用药安全警示缺乏的问题。针对上述问题，我院规范了中药饮片名称，优化了中药饮片的剂量范围、
中成药用法用量、重复用药、药物相互作用、特殊人群用药禁忌等审核规则。审核规则优化后，我院中成药处方合理率从97.38％
上升至 98.17％（P＞0.05），干预有效率从 42.86％提高至 79.71％（P＜0.05）；中药饮片处方合理率从 47.98％上升至 79.29％（P＜
0.05），干预有效率从11.17％提高至29.13％（P＜0.05）。我院平均每月中药超多日用量、超剂量范围、药物相互作用、特殊人群药
物禁忌不合理问题数均显著下降（P＜0.05）；重复用药不合理问题数组间比较差异虽无统计学意义（P＞0.05），但有下降趋势。不
合理问题总数也大幅减少（P＜0.05）。结论 我院的审核规则优化措施能改善审方系统对中药处方的审核适用性，提高处方审核质
量和合理用药水平。但用药适应证的相关审核规则和中药处方干预有效率有待进一步完善和提高。
关键词 处方前置审核；中药；中药饮片；中成药；审核规则；合理用药

Optimization and practice in pre-review rules of traditional Chinese medicine prescription in medical
institutions
ZHANG Ting，GU Jie，DING Lanping，MA Zhuyue，ZHANG Duxiao，YUAN Hongyu（Dept. of Pharmacy，the
First Affiliated Hospital of Nanjing Medical University，Nanjing 210029，China）

ABSTRACT OBJECTIVE To improve the applicability of the prescription pre-review system to traditional Chinese medicine
（TCM），and improve the quality of prescription review and rational drug use. METHODS The inappropriate pre-review rules of
TCM prescription in prescription automatic screening system of our hospital were summarizd，review rules were revised and the
review process was standardized purposefully. The data of prescription review of Chinese patent medicine and TCM decoction
pieces were collected from outpatient and emergency department of our hospital in the second quarter of 2020 （before the
optimization of review rules） and the fourth quarter of 2021 （after the optimization of review rules）. The reasonable rate of
prescription and effective rate of intervention before and after the optimization of review rules were compared，and unreasonable
problems were counted. RESULTS In our hospital，the pre-review system had poor applicability in reviewing TCM prescriptions.
There were some problems，such as inconsistent or nonstandard names of TCM decoction pieces，unreasonable dosage range
settings，mechanical review of repeated drug use，excessively strict review of“eighteen incompatible medicaments”and“nineteen
medicaments of mutual restraint”and lack of safety warnings for special populations. In view of the above problems，our hospital
standardized the name of TCM decoction pieces，and optimized the review rules such as dose range of TCM decoction pieces，
usage and dosage of Chinese patent medicine，repeated medication，drug interaction，drug taboos for special people，etc. After the
revision of the rules，the qualification rate of Chinese patent medicine prescriptions increased from 97.38％ to 98.17％（P＞0.05），
and the rate of effective intervention increased from 42.86％ to 79.71％（P＜0.05）；the qualification rate of TCM decoction pieces
prescriptions increased from 47.98％ to 79.29％ （P＜0.05），and the rate of effective intervention increased from 11.17％ to
29.13％（P＜0.05）. The number of unreasonable problems such as excessive daily dosage of TCM，excessive dosage range，drug
interaction and drug contraindications for special groups decreased significantly in our hospital（P＜0.05）. There was no statistical
significance in the number of unreasonable problems of repeated medication between 2 groups （P＞0.05），but there was a
downward trend. The total number of unreasonable problems
Δ 基金项目：江苏省药学会-天晴医院药学基金科研项目（No.
had also decreased significantly（P＜0.05）. CONCLUSIONS
Q202007）
＊药师，硕士。研究方向：中药合理用药、药动学。电话：025- The optimization measures of review rules in our hospital can
68303737。E-mail：540812773@qq.com improve the applicability of the review system for TCM
# 通信作者：主任中药师，硕士。研究方向：临床药学、药事管 prescriptions，and improve the quality of prescription review
理。电话：025-68306822。E-mail：3066076382@qq.com and the level of rational drug use. However，review rules of

·1506 · China Pharmacy 2022 Vol. 33 No. 12 中国药房 2022年第33卷第12期