ABSTRACT
OBJECTIVE To improve the a pplicability of the prescription pre-review system to traditional Chinese medicine (TCM),and improve the quality of prescription review and rational drug use. METHODS The inappropriate pre-review rules of TCM prescription in prescription automatic screening system of our hospital were summarizd ,review rules were revised and the review process was standardized purposefully. The data of prescription review of Chinese patent medicine and TCM decoction pieces were collected from outpatient and emergency department of our hospital in the second quarter of 2020 (before the optimization of review rules )and the fourth quarter of 2021(after the optimization of review rules ). The reasonable rate of prescription and effective rate of intervention before and after the optimization of review rules were compared,and unreasonable problems were counted. RESULTS In our hospital ,the pre-review system had poor applicability in reviewing TCM prescriptions. There were some problems ,such as inconsistent or nonstandard names of TCM decoction pieces ,unreasonable dosage range settings,mechanical review of repeated drug use ,excessively strict review of “eighteen incompatible medicaments ”and“nineteen medicaments of mutual restraint ”and lack of safety warnings for special populations. In view of the above problems ,our hospital standardized the name of TCM decoction pieces ,and optimized the review rules such as dose range of TCM decoction pieces , usage and dosage of Chinese patent medicine ,repeated medication ,drug interaction ,drug taboos for special people ,etc. After the revision of the rules ,the qualification rate of Chinese patent medicine prescriptions increased from 97.38% to 98.17%(P>0.05), and the rate of effective intervention increased from 42.86% to 79.71%(P<0.05);the qualification rate of TCM decoction pieces prescriptions increased from 47.98% to 79.29%(P<0.05),and the rate of effective intervention increased from 11.17% to 29.13%(P<0.05). The number of unreasonable problems such as excessive daily dosage of TCM ,excessive dosage range ,drug interaction and drug contraindications for special groups decreased significantly in our hospital (P<0.05). There was no statistical significance in the number of unreasonable problems of repeated medication between 2 groups (P>0.05),but there was a downward trend. T he total number of unreasonable problems had also decreased significantly (P<0.05). CONCLUSIONS The optimization measures of review rules in our hospital canimprove the applicability of the review system for TCM prescriptions,and improve the quality of prescription review and the level of rational drug use. However ,review rules of indications and the effectiveness of prescription intervention still needs to be further improved.
ABSTRACT
OBJECTIVE:To provide r eference for optimizing the review rules of PASS system and improving rational drug use in our hospital. METHODS :The prescription review of Calcineurin inhibitor (CNI)was taken as an example. The pharmacists of our hospital collected the inappropriate rules in PASS system in their daily work ,and modified and improved them. Three thousands outpatient prescriptions and inpatient orders containing CNI in the fourth quarter of 2019(before the rule modification ) and the fourth quarter of 2020(after the rule modification )were randomly selected for our hospital. The warnings ,false positives and false negatives of PASS system review were compared before and after rule modification. RESULTS :There were some problems in the PASS system of our hospital ,such as too strict judgement on off-label use ,lax review rules ,false positive in the audit of contraindications ,failure to grade warnings according to the severity of drug interactions ,inaccurate judgment of patients ’ liver and kidney function ,lengthy problem description ,incomplete or wrong information in the system database ,lack of effects information of food and traditional Chinese medicine on CNI ,etc. In view of these inappropriate rules ,the pharmacy department of our hospital improved the quality of PASS system review rules through formulating the standardized management process of off-label use , reasonably enabling the interception function of PASS system , modifying the false-positive rules of drug contraindications,warning drug interaction by grade ,reviewing in combination with laboratory test reports ,and real-time maintenance of system database information and adding patient education content. The number of warning had decreased from 182 to 105,and the proportion of false-negative and false-positive review results from 25.03% to 0.43% after a year of optimization. CONCLUSIONS:The optimization of CNI review rules can enhance the applicability of the PASS system ,facilitate the advance of the prescription pre-review ,and promote clinical rational drug use.