Page 120 - 《中国药房》2023年13期

以绩效考核为导向的合理用药管控机制探索与实践

周 萍 ，闫晓萌（绍兴市妇幼保健院，浙江 绍兴 312000）
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中图分类号 R95 文献标志码 A 文章编号 1001-0408（2023）13-1646-05
DOI 10.6039/j.issn.1001-0408.2023.13.20

摘 要 目的 以绩效考核为导向进一步健全合理用药管控机制，探索药学服务新路径，推进临床合理用药管理向纵深发展。

方法 我院通过实施“处方行为管理十分制”，辅以“加强处方审核”“规范临床用药”等举措进行药事管理制度改革。通过实现人机
结合前置审方、提升药师审方能力、实时优化审方机制、规范医师超说明书用药行为、完善药物评价机制等多项辅助措施，完成事
前预控与事中干预。评价结果参考“处方行为管理十分制”纳入绩效考核，实现多维度全闭环的合理用药管理。比较管理前、后相
关指标的统计结果以评价管理成效。结果 与管理前比较，管理后我院2022年医嘱（处方）不合理率相较2020年同期呈明显下降
趋势，住院医嘱不合理率从2020年的5.00%下降至2022年的2.69%，门诊处方不合格率由4.59%下降至2.48%；临床药师与医师沟
通频率增加，受邀参加临床会诊的次数从16次上升至58次，不合理医嘱（处方）干预接受率从52％增加到87％，医师对临床药学
服务有了深入了解与认可，临床合理用药意识有了显著提升。结论 以绩效考核为导向的合理用药管控机制，进一步规范了处方
及医嘱的开具，医药协作更为突出，实现了“事前审核，事中监督，事后评估”的闭环式药事管理，促进了临床合理用药。
关键词 合理用药；绩效考核；管控机制

Exploration and practice of rational drug use control mechanism based on performance appraisal
ZHOU Ping，YAN Xiaomeng（Shaoxing Maternal and Child Health Hospital， Zhejiang Shaoxing 312000， China）

ABSTRACT OBJECTIVE To further improve the rational drug use control mechanism based on performance appraisal， explore
new paths of pharmaceutical care and promote the rational clinical drug use management to deepen development. METHODS The
reform of pharmaceutical management system in our hospital was performed through implementing the “ten-point system of
prescription behavior management”， supplemented by the two carriages of “strengthening prescription review” and “standardizing
clinical medication”. By implementing a number of auxiliary measures such as man-machine integration pre-prescription review，
improving pharmacists’ prescription review ability， optimizing prescription review mechanism in real time， regulating physicians’
off-label drug use behavior， and improving drug evaluation mechanism， pre-control and in-process intervention were completed.
The evaluation results were incorporated into performance assessment by referring to the “ten-point system of prescription behavior
management”， so as to realize multi-dimensional and fully closed-loop rational drug use management. The effects of management
were evaluated by comparing the statistical results of related indexes before and after the management. RESULTS Compared with
before management， irrational rate of prescriptions and medical orders in our hospital in 2022 decreased significantly， compared to
the same period in 2020； the irrational rate of inpatient medical orders decreased from 5.00% in 2020 to 2.69% in 2022， and that of
outpatient prescriptions decreased from 4.59% to 2.48%； the frequency of communication between clinical pharmacists and
physicians increased； the times of clinical consultations increased from 16 to 58， and doctors’ acceptance of intervention for
irrational drug use had improved from 52％ to 87％ ； physicians had a deeper understanding and recognition of clinical
pharmaceutical care， the awareness of clinical rational drug use had been significantly improved. CONCLUSIONS The rational
drug use control mechanism guided by performance appraisal further standardizes the issuance of prescriptions and medical orders，
and makes physician-pharmacist cooperation more prominent， so as to realize the closed-loop pharmaceutical management of “pre-
review， in-process supervision and post-evaluation”， and promote rational drug use in clinical practice.
KEYWORDS rational drug use； performance appraisal； control mechanism

以合理用药为核心的药事服务是医疗服务改革的
＊第一作者 主任药师。研究方向：医院药事管理、临床药学。电
[1]
话：0575-85206832。E-mail：1614384020@qq.com 重要内容之一 ，促进药物合理使用和保障患者用药安

· 1646 · China Pharmacy 2023 Vol. 34 No. 13 中国药房 2023年第34卷第13期