What Is a Prescription Error?

The prescription review mainly summarizes three management regulations based on the needs of the hospital based on the rational use of medications: Irregular prescriptions, unsuitable prescriptions for medications, and extraordinary prescriptions. Multi-level management is achieved through six evaluation indicators: the number of medicines prescribed in a single sheet, whether the use of medicines meets the indications, the proportion of national essential medicines, the proportion of antibacterial medicines, the proportion of injection formulations, and the proportion of unreasonable medications. This system includes three levels of review management in the hospital: self-examination when the doctor issues a prescription, review and evaluation by the pharmacy pharmacist, statistical supervision by the dean, and finally the health bureau supervises and manages the relevant data according to the hospital prescription review management standard (trial) Multi-level management urges doctors to rationally use medicine.

Prescription review is a drug supervision model developed in the Chinese hospital management system in recent years. It is a comprehensive statistical analysis of clinical prescriptions made by doctors in the process of prescription medication, reflecting the overall and subdivision of prescription work in medical institutions from different levels and perspectives. Situation, to provide scientific data support for the decision-making of the management of medical institutions, in order to achieve the purpose of rational drug use, drug monitoring and management.

Definition of prescription reviews

Purpose of the prescription review

The prescription review is a comprehensive evaluation of the normative and medication indications, drug choices, routes of administration, usage and dosage, drug interactions, compatibility contraindications, etc. in accordance with national laws, regulations and corresponding technical specifications on prescriptions to improve prescriptions Quality to promote rational use. The implementation of the prescription review system can understand the types and characteristics of prescriptions prescribed by doctors both inside and outside the clinic, so as to facilitate timely grasp of irrational medications and intervention measures, improve the quality of prescriptions, and ensure that patients' medication is safe, economical, and effective. The author's community service center has promoted the improvement of prescription quality through random spot checks and reviews of outpatient and surgical prescriptions, which is manifested in a significant decrease in the number of prescription drugs per prescription, the general name of the drug in the prescription drug and the percentage of the basic drug in the prescription drug. Increased, at the same time the types of unreasonable medication and the proportion of unreasonable medication prescriptions decreased significantly.

Prescription review questionsPrescription categories:

1 Drugs for hyperindications: Drugs for hyperindications are widely used in various treatment areas, among which antipsychotics, antiinfectives, and antitumor drugs are the most common. In the course of cancer treatment, if the existing conventional treatment fails, a new treatment method needs to be found, which is especially common for end-stage patients. At this time, physicians and patients are often willing to take greater risks and try new treatments. The treatment of tumors usually requires a wide variety of auxiliary drugs, which increases the possibility of drug use beyond the instructions of the drug.

2 Improper combination medication: In order to get rid of the disease of patients as soon as possible, clinicians often use several drugs with the same or similar efficacy, although it can alleviate the patient's condition, shorten the course of the disease, and improve the patient's recognition of the doctor. However, it is also possible that adverse drug reactions occur due to the addition or subtraction of any drug. Mainly include: repeated medication, the effect is too strong; repeated medication, the effect is weakened; inappropriate three forms of combined medication.

3 Unreasonable use of traditional Chinese medicine preparations: The composition of traditional Chinese medicine injections is complex, and improper choice of solvents will cause the pH value to change after compatibility, and the solubility of active ingredients will decrease and precipitate. The insoluble particles precipitated can cause granulomas and emphysema, resulting in insufficient oxygen supply. Causes phlebitis, local tissue thrombosis and necrosis, may also cause allergies and heat source reactions, which has greater harm. If it is not used reasonably, it will often cause great harm. ^[2] ^[3]

Improved strategies for problematic prescriptions: In view of the problems existing in the results of prescription reviews, our hospital puts forward the requirements of the actual cases according to the relevant provisions of the "Medicine and Therapeutics Committee" on rational drug use and personalized treatment, combined with previous clinical experience. Strategies to resolve the situation and develop regulations that can strengthen physicians' behavioral rules for medication.

Establishing and perfecting the drug administration system: Our hospital has formulated a series of regulations on prescription review and penalties with reference to the specific requirements of relevant departments, established a management system centered on clinical rational drug use regulations, and established a clinical drug supervision team and accident identification team. Developed rules for handling accidents involving medication. 2. Strengthen publicity and training: led by senior experts in clinical departments and pharmacy experts, and lead other medical personnel to carry out publicity and education activities. Specifically includes: (1) According to the "Prescription Management Measures", "Drug Management Measures" and other relevant regulations and the professional quality and level of our hospital medical staff, based on the principle of seeking truth from facts, the division of labor is clear and the focus is to rationally use medication and Systematic training for individualized treatment, and the personnel participating in the training cover the whole hospital. (2) While carrying out the necessary centralized training, we also provide local or individual training for all medical personnel in order to achieve full coverage of pharmaceutical knowledge. ^[4]

The traditional way of prescription reviews

Most traditional prescription management models use real-time reminders to urge doctors to use drugs rationally. They lack a comprehensive multi-level retrospective prescription monitoring management system. For a large number of doctors' prescriptions, only 100 or 1 prescriptions can be randomly selected each month for review. Checking the statistics, there is no unified standard to evaluate the unreasonable use of drugs, and it lacks persuasiveness and authority. There are many difficulties in the management of prescription reviews.

The modern model of prescription reviews

Through the modern technology level, an automated model of prescription reviews is established, which not only can review sample prescriptions in real time, but also contains all the details of the hospital's prescription reviews, not only statistics and reviews of prescription antibiotics, injections and other medications. A module for safe medication has also been added. The evaluation items for unreasonable prescriptions include: inappropriate combination medication, repeated administration, contraindications for compatibility, whether there will be adverse drug reactions (ADR) and potential clinically significant drug interactions. There are several major difficulties in realizing such a comprehensive functional module: 1. Establishment of a database: a core database of safety medication information analyzed by evidence-based medicine, and a database obtained by the expert committee as the core to establish a database. The World Health Organization (WHO) ) The ADR classification method is based on the summary of safe medication information according to different risk levels, providing medical workers with real-time safe medication tips during the prescription process. Formed the most complete database of safe medication information in line with international standards. 2. Compatible with various medical management systems: Since most of the prescription data comes from hospital management systems such as hospital HIS systems, how to achieve integration without harming the interests of other management software vendors in the hospital. 3. Establishing supporting hospital management system: related systems for self-inspection, supervision, and evaluation of rational drug use by medical workers, hospital administrators, medical institution supervision departments, and drug use supervision departments have been established to allocate responsibilities and make full use of pharmacist prescription Review function, multi-level supervision. ^[4] ^[3]

Establishment of prescription review database

The core database of safety medication information analyzed and established by evidence-based medicine method, and the database obtained by the expert committee as the core to establish the database, based on the World Health Organization (WHO) adverse drug reaction (ADR) classification method based on different risk levels Safe medication information provides medical workers with real-time safe medication tips during the prescription process. Formed the most complete database of safe medication information in line with international standards.

Prescription reviews compatible with a wide range of medical management systems

Since most of the prescription data comes from hospital management systems such as hospital HIS systems, how to achieve integration without harming the interests of other management software vendors in the hospital.

Establishment of hospital management system supporting prescription reviews

Relevant systems for self-examination, supervision, and evaluation of rational drug use by medical workers, hospital administrators, medical institution supervision departments, and drug use supervision departments have been set up to distribute responsibilities, make full use of the pharmacist's prescription review role, and provide multi-level supervision.

Basic principles of prescription reviews

The prescription review mainly refers to the relevant laws:

The Ministry of Health's Health Medical Administration issued [2010] No. 28 Document "Management Guidelines for Hospital Prescription Reviews (Trial)"

Drug Administration Law

Law of Practising Physicians

Regulations on the Administration of Medical Institutions

"Prescription Management Measures"

Key benefits of prescription reviews

Modern prescription review system: ^[2]

Timely (Real time and Repeatable)

A prescription review form can be generated at any time according to the prescription review requirements of the Ministry of Health

Accuracy and consistency

Accurately calculate six review indicators based on a professional database. Avoid a lot of manual operations and unify the criteria in reviews.

Traceability (Fully follow through)

It can automatically trace back to irrational prescriptions, detailed prescriptions of departments, doctors, incidents and other detailed information, and found a basis for future traceability.

The role of prescription review pharmacists in prescription reviews

The pharmacist is the main body of the prescription review. By randomly checking the outpatient prescriptions for review, you can understand the outpatient doctor's diagnosis and treatment habits and treatment characteristics, find out irregularities in time, promote standardized, scientific and reasonable medication, and improve service quality. ^[4]

Summary of prescription reviews

Prescription reviews play a very important role in the rational use of medicines and individualized treatments. They can improve the quality of medical treatment, improve the clinical application management and clinical drug treatment levels of medicines, promote the optimization of the hospital's medical management system, reduce the medical burden on patients, and generate more Good social and economic benefits.