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基于循证证据的麻醉科处方前置审核规则精细化设置及效果

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邢晓敏 ，李祥鹏，王心怡，魏丽娜，李文静，李 静（青岛大学附属医院药学部，山东 青岛 266000）
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中图分类号 R971；R969.3 文献标志码 A 文章编号 1001-0408（2024）14-1690-06
DOI 10.6039/j.issn.1001-0408.2024.14.03

摘 要 目的 优化麻醉科处方前置审核规则，提高审方质量和合理用药水平。方法 统计并分析2023年4月1日至30日青岛大
学附属医院（以下简称“我院”）处方前置审核系统中麻醉科的住院医嘱，对不合理用药问题进行分类统计与循证查询，结合我院现
执行的《麻醉科临床路径用药规范》，对审核规则进行精细化设置，并建立审核管理与沟通反馈流程。对规则精细化设置后（2023
年5－12月）与设置前（2023年4月）的每月审核医嘱总数、预审弹窗医嘱数、系统拦截率、系统审核后医师修改率、药师审核率、医
嘱合理率进行比较，对设置后与设置前（2022年5－12月）的麻醉科次均药费进行环比比较。结果 麻醉科不合理用药问题主要包
括适应证不适宜、给药途径不适宜、用法用量不适宜、配伍不适宜、特殊人群用药问题、围手术期不合理用药问题。规则精细化设
置后，麻醉科预审弹窗医嘱数随时间延长明显减少，经过不断完善后逐步达到平稳状态。与设置前比较，规则精细化设置后系统
拦截率显著提高（P＜0.001），系统审核后医师修改率显著提高（P＜0.001），药师审核率显著下降（P＜0.001）；2023年5－12月医嘱
合理率与月份存在线性趋势（P＜0.001）。设置后与设置前相比，麻醉科次均药费由平均 720.72 元下降至平均 528.21 元，降幅为
26.71%。 结论 基于循证证据精细化设置麻醉科处方前置审核规则，可显著提高处方审核质量，促进合理用药，节约患者医疗费用。
关键词 处方前置审核；麻醉科；循证证据；审核规则；合理用药

Practice and effect evaluation of refined setting of evidence-based reference prescription pre-audit rules in
anesthesiology department
XING Xiaomin，LI Xiangpeng，WANG Xinyi，WEI Lina，LI Wenjing，LI Jing（Dept. of Pharmacy， the Affiliated
Hospital of Qingdao University， Shandong Qingdao 266000， China）

ABSTRACT OBJECTIVE To optimize the pre-audit rules for anesthesia prescriptions， improve the audit quality and rational
drug use. METHODS The inpatient medical orders of anesthesia department from prescription pre-audit system of the Affiliated
Hospital of Qingdao University （hereinafter referred to as “our hospital”） were analyzed from April 1 to 30， 2023. The
classification statistics and evidence-based inquiry were carried out for irrational drug use issues； combined with our hospital’s
current implementation of the Anesthesiology Clinical Pathway Medication Standards， the audit rules were set in details， and audit
management and communication feedback processes were established. The total number of monthly audited orders， the number of
pre-audit pop ups， system interception rate， physician modification rate after system audit， pharmacist audit rate， and reasonable
rate of medical orders after refined setting of rules （May-December in 2023） were compared with before setting （April in 2023）；
the average medication cost per anesthesia session after refined setting of rules was also compared with before setting （May-
December in 2022）. RESULTS Irrational drug use in the anesthesia department mainly included inappropriate indications，
inappropriate administration routes， inappropriate usage and dosage， inappropriate compatibility， medication problems in special
populations， and improper medication during the perioperative period. After the refinement of the rules， the number of pre-audit
pop ups in the anesthesia department significantly decreased over time， and gradually reached a stable state after continuous
improvement. Compared with before setting， the system interception rate after the refinement of rules （P＜0.001）， physician
modification rate after system audit （P＜0.001） both increased significantly， while the pharmacist audit rate significantly decreased
（P＜0.001）. There was a linear trend between the reasonable rate of medical orders and the month from May to December in 2023
（P＜0.05）. Compared with before the setting， the average medication cost of anesthesia per session decreased from 720.72 yuan to
528.21 yuan， with a decrease of 26.71%. CONCLUSIONS Based on evidence-based reference， refining pre-audit rules for anesthesia
prescriptions can significantly improve the quality of prescription examination， promote rational drug use， and save patient’s
medical expenses.
KEYWORDS prescription pre-audit； anesthesia department；
Δ 基金项目 国家卫生健康委医院管理研究所医院药学高质量发 evidence-based reference； audit rules； rational drug use
展研究项目（No.NIHAYS2308）
＊第一作者 主管药师，硕士。研究方向：疼痛药物治疗。E-mail：
麻醉科是医院极为重要的科室，其工作环境压力
xingxiaomin@qdu.edu.cn
大、时间把控严格，使用药品涉及多种麻醉药品和精神
# 通信作者 主任药师，硕士。研究方向：医院药学、药事管理。电
话：0532-82911566。E-mail：lijing7112@126.com 药品，且使用过程缺乏普通病房中护理人员的审核，一

· 1690 · China Pharmacy 2024 Vol. 35 No. 14 中国药房 2024年第35卷第14期