Establishment And Implementation On The Model Of Prescription Evaluation

Prescription evaluation is a medicine regulatory model which is developing in hospital management system in recent years. It can take comprehensive statistical analysis to clinical prescription that the doctor prescribed. It can reflect the whole and segment condition of medical institutions’ prescription from different aspects and different angles, and provide scientific data for medical institutions in order to reach the goal of the rational drug-use, drug monitoring and management.ObjectiveTo establish systematic and sustaining evaluation in order to discover the irrationality in drug use that may exist in hospital in time by establishing the prescription evaluation pattern suitable for writer’s operative hospital. After the intervention, we should observe the continuous improvement, and realize to improve rational drug use level in our hospital to ensure drug-use safety to patients eventually.Methods一. establishing the model of prescription evaluation1、By establishing relevant system and organization, we established the specialist team that the dean acts as the leader and working team on prescription evaluation.2、We established different kinds of medication management system, formulated The Hospital Formulary, The Hospital Medication Supply Directory and The Hospital Antimicrobial Drug Management System, established the standards of hospital prescription evaluation and the system of clinical pharmacists, and established a three-level prescription evaluation system.3、The classification and contents of the prescription evaluation. Prescription evaluation can be divided into the evaluation for outpatient and emergency departments, for doctors’ advice and special for antibacterial drugs. We also made the evaluation forms standards.4、Intervention measures. The intervention time was from July to December in2012.(1) In the level of pharmaceutical departments,there were dispensing pharmacists’ current intervention, communication with clinical doctors on prescription and special evaluation on antimicrobial drugs, and clinical pharmacists’ current intervention in the clinical.(2) In the level of the clinical intervention in the hospital，we organized training, and gave some rewards and punishment measures as personal promotion and assessment indicators.(3) Computer system automatically gave intervention,and electronic prescription also gave intervention to some non-standard prescription.二、The research on the model of prescription evaluation1. Prescription evaluation for outpatient and emergency serviceWe extracted prescription of the outpatient and emergency departments from January to June in2012and from January to June in2013, using excel software to establish the database and conduct statistical analysis.Extraction method; To extract randomly the outpatient prescription on16th in each month, the total number signed for m,(m/500)=n, n-1was sampling interval, then made the draw. We used the same method to extract emergency prescription.Evaluation contents included the rate of qualified prescription, average amount of each prescription, the average number of drug varieties, injection usage rate, the national essential drug usage rate and unreasonable type, etc.2. Prescription evaluation for inpatient serviceWe extracted300inpatient records from January to June in2012and from January to June in2013. We used the same method to extract the outpatient records.Evaluation contents contained the rationality of drug usage, drug expenditure proportion of the total costs, the number of drug varieties, the number of traditional Chinese medicine injection varieties, the number of national essential drug varieties, the number of parenteral nutrition preparation varieties, and the number of anesthetics varieties, etc.3. Specific evaluation to antimicrobial drugs included evaluation to outpatient prescription, emergency prescription, and inpatient prescription. Using SPSS13.0software to do statistical analysis.Results:1. The results of prescription evaluation for outpatient and emergency prescription:in the first half year of2012, the rates of the national essential drug usage, injection usage and rational prescription were20.65%,23.94%,1.69%and95.3%,respectively,the same item of2013were26.05%,20.10%1.83%and96.3%, respectively. The average amount of each prescription for2012and2013were106.04RMB and99.44RMB, respectively. On the type of error in the first half year of2012and2013, the number of irrational prescription was28and20, respectively. The number of inappropriate medication prescription was11and8, respectively. The number of exaggerated prescription was5and4, respectively.2. The result of prescription evaluation for inpatient prescription:Compared the first half year of2012with the same term in2013, on the differences of drug income percentage in the whole hospital income, surgical cases were40.38%and38.46%, respectively, non-surgical cases were44.50%and44.08%, respectively. On the national essential drug application, surgical cases were12and13, non-surgical cases were4.1and4.2, Unreasonable types were64(20.3%) and33(11.0%)respectively.3. The result of special evaluation on antimicrobials:Compared the first half year of2012with the same term in2013, the average utilization rates of antimicrobial drugs on outpatient service were17.55%and16.20%, respectively. The same items on emergency service were16.21%and16.75%, respectively.In the first half year of2012and2013on various index management comparison results of antimicrobial drugs, the percentages of patients receiving antimicrobials were51.80%and46.97%, respectively. The antibiotics using density were48.60and36.56.The percentages of antimicrobial inspection were35.68%and47.29%, respectively. The percentages of special-grade antimicrobial inspection were64.00%and79.24%, respectively. The coincidence rates of drug delivery0.5—2h before operation were77.83%and90.09%.The coincidence rates of drug delivery that not exceeding24h after operation were64.02%and85.23%, respectively. The above indicators have statistical significant(P<0.05).Conclusion:1. The established evaluation patterns are suitable for our hospital;2. Under the established evaluation patterns and intervention, there is a significant enhance on normalization and rationality no matter the prescription on outpatient, inpatient and emergency service or the usage of antimicrobials in our hospital.3. There still exists the phenomenon of irrational drug utilize, and a few management indexes are still not reach standard to antimicrobials. We require take constant intervention, continuous improvement, and clinical rational drug use is the eternal theme.