Discussion On Clinical Rational Application Management And Continuous Improvement Of Traditional Chinese Medicine Injection Based On Doctor’s Advice Work

Objective:Based on the usage of traditional Chinese medicine(TCM)injections in our hospital from 2015 to 2016,to analyze the problems in the clinical use of TCM injections in our hospital.PDCA cycle medical quality management measures was adopted to improve the clinical rational use of TCM injections.Select five kinds of TCM injections commonly used in our hospital,and bring the clinical use of this five key monitoring TCM injections into the PDCA cycle.Establishing guidelines for clinical application of TCM injections in hospital,targeted pharmaceutical intervention,administrative intervention and other methods were proposed.Meanwhile verify the effect of intervention.To summarize the methods of promoting rational clinical use of TCM injections,and provides a reference for the management of clinical use of key monitored drugs in medical institutions.Methods:1.Status survey: Use databases such as CNKI,Wanfang and VIP to consult literature,and learn the current situation of clinical application of TCM injections in China,the problems in clinical application and the current research progress.(2)Use the hospital prescription review system to extract the cases using TCM injectionss,comment on the rationality of medication prescribed by doctors,to learn the problems existing in the clinical use of TCM injections in our hospital and analyze the problems by classification.2.Key interventions:(1)Establish evaluation standards for comments on doctor’s orders for TCM injections,combined with the problems in the clinical use of TCM injections in our hospital,to unify the review standards of TCM injections doctor’s orders.Ten varieties of TCM injections with consistently high clinical application intensity in our hospital were selected.(3)Take pharmaceutical intervention and administrative intervention measures to solve the problems in the clinical use of key monitored drug varieties.3.Effect analysis:Use the hospital prescription review system,select one hundred and fifty cases of using the above ten TCM injections per month.Comment on the rationality of medicine prescribed by doctors according to the evaluation standards for TCM injections,and input the classified project data into Microsoft Office Excel.Calculate reasonable rate of medical advice and unreasonable medical advice problems.To analyze the medication problems in the medication order of the intervention group,and take timely intervention measures.(3)Summarize the results of special comments on doctors’ orders of TCM injections in monthly sample cases from 2017 to 2018,and verify the intervention effect.Results:1.Status survey results:(1)Based on the literature research and the actual situation of the use of TCM injections in our hospital,the problems in the clinical use of TCM injections in our hospital were learned,including: Off-label medication,Inappropriate selection drugs,Inappropriate solvent selection,The solvent dose is not suitable,Inappropriate dosage and frequency of administration,The course of medication is unreasonable,The combination medicine failed to flush the tube,Compatibility taboo,Repeated use and other clinical unreasonable use of drugs.(2)Unified medical order review standards: The rationality of indications,drug selection,usage and dosage,solvent selection,drug interaction and repeated use of TCM injections were reviewed.2.Through the key monitoring of the five varieties of TCM injections such as Aidi injection,the intervention of rational clinical use of TCM injections was standardized,and the continuous feedback of the effect and the correction of intervention measures were carried out by making use of the comments on medical history and doctor’s advice,so as to realize the continuous improvement of rational clinical use of TCM injections.3.The average rational utilization rate of TCM injections in our hospital has increased from 60.5% in2015 and 58% in 2016 to 82% in 2018.Advice has been effectively improved,the unreasonable issues in selecting drug suitability rationality,usage,dosage,solvent selection rationality from several aspects were improved significantly.4.Combination have made a big progress in the wash pipe operation,as far as possible to reduce the combination of medical damage.Due to the combination of complex,however,for the combination of potential risks still cannot fully evaluate,still need to be in the subsequent clinical applications,strengthen the drug monitoring and adverse drug reaction monitoring work,to focus on for a long time.Indications suitability has improved a lot,but is still the main problems of unreasonable medical advice,because is limited by the ability of Chinese medicine dialectical,disease and clinical evidence-based according to the deficiency of TCM injections condition limit,is still need continuous improvement to solve the problem.Conclusion:Based on the date of Comments on inpatients medical orders for TCM injections,and using PDCA cycle management style,to monitor the clinical rational use of TCM injections.After 2 years of continuous improvement measures intervention,the clinical rational utilization rate of the key monitored varieties increased obviously.At the same time the review standards of TCM injections were improved and intervention measures were revised.