门诊一患多方现象及相关不合理用药分析

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[摘要] 目的 通过分析本院门诊一患多方现象，分析临床上的不合理用药情况。方法 抽取本院2011年1～12月期间的1 000例于同一天内就诊于本院不同科室（两个及以上）并开取处方的患者，以卫生部《医院处方点评管理规范》为标准，对同一位患者所开取的处方的合理性进行分析。 结果 1 000份处方点评为不适宜处方的有106份，不适宜率为10.60%，中成药与西药联用的处方有653份，占抽取总数的65.30%，单科处方不适宜的有22份，不适宜率为2.20%，占全部不适宜处方的20.75%，多科处方综合评价为不适宜84份，不适宜率为8.40%，占全部不适宜处方的79.25%，其中为中医药不适宜联用的有62份，占全部不适宜处方的58.49%，占多科综合评价的73.81%。 结论 门诊一患多方的处方不适宜率较高，表现为单科处方合格，但多科综合评价不合格，尤其是中西药联用不适宜的发生率较高，已成为门诊不合理用药的新盲区。

[关键词] 门诊；一患多方；不合理用药；分析

[中图分类号] R969.3 [文献标识码] C [文章编号] 1674—4721（2012）09（c）—0165—02

The analysis of one patient geting multi—prescriptions in outpatient service and irrational use of drugs

FENG Jieying

Pharmacy of Hospital of Traditional Chinese Medicine of Zhongshan City in Guangdong Province， Zhongshan 528400， China

[Abstract] Objective To analyse the phenomenon of one patient geting multi—prescriptions， and to discusse the current situation of the irrational use of drugs. Methods One thousand patients who were diagnosed in different department and got multi—prescriptions were treated as the research object， evaluated with the Hospital Management Standard Prescription Comments， the rationality of the prescriptions were discussed. Results One hundred and six prescriptions were not suitable，the rate was 10.60%，the prescriptions were combined traditional Chinese and western medicine， the rate was 10.60%， the prescriptions of alone department was 22， the rate was 2.20%， and the rate in the all not suitable prescriptions was 20.75%， the prescriptions of multi—department was 84， the rate was 8.40%， the rate in the all not suitable prescriptions was 79.25%， the not suitable alliance of traditional Chinese and western medicine was 62 cases， the rate in the all not suitable prescriptions was 58.49%， and for multi—departments was 73.81%. Conclusion The rate of not suitable prescriptions what one patient geting multi—prescriptions in the outpatient service is high， the performance is that the prescriptions of alone department were qualified， but the prescriptions of multi—departments were not suitable， especially the rate of alliance with traditional Chinese and western medicine was high， it is the new blind area in not rational drug use of outpatient service.

[Key words] Outpatient service； One patient geting multi—prescriptions； Not rational drug use； Analyse

“处方管理办法”的实施，极大地规范了专科用药，使得专科不合理用药现象明显减少[1]，但是一所医院科室较多，还存在一些不能明确界定科别的药物，患者合并多种疾病或不能明确界定的疾病时，需要在同一天就诊于同一医院的多个科室，由此便出现了患者在单一科室开的处方合格，但是多个科室开的药一起使用时则出现了配伍禁忌或不适宜，而大部分医院或医师对多个处方的监督和关注不够，导致了一患多方成为门诊的普遍现象[2]，不利于处方的管理及患者的合理用药。为此，笔者通过HIS系统进行了考察，笔者抽取本院2011年1～12月期间的1 000例于同一天内就诊于本院不同科室（两个及以上）并开取处方的患者作为研究对象，对本院一患多方现象及相关不合理用药情况进行了分析，现报道如下：