2种医嘱审核模式的临床应用及存在问题的文献分析(1)
摘 要 目的：總结人工医嘱审核和信息化医嘱审核模式的临床应用情况及存在的问题，为提高合理用药水平提供参考。方法：采用文献检索的方法收集资料，以“处方审核”“医嘱审核”“处方前置审核”“医嘱前置审核”“用药错误”“药物相关问题”“用药安全”“警报疲劳”“Medication review”“Decision support medication review”“Real-time medication review”“Real-time prescription surveillance”“Clinical alarms decision support systems”“Clinical pharmacy information systems”“Medication errors”“Medication related problem”“Medication safety”“Alert fatigue”等为关键词，在中国知网、万方数据库、PubMed、Embase、Web of Science等数据库中组合查询2000年1月-2019年11月发表的相关文献，对2种医嘱审核模式的临床应用及存在的问题进行归纳总结。结果与结论：人工审核模式能减少药物相关问题(如药物治疗效果不佳、有未治疗的症状或适应证、可能发生药物不良事件、不必要的药物治疗等)，提升患者生活质量，但可能无法降低患者死亡率或住院时长;存在所需医嘱审核药师数量多、审核时间不足、审核标准不一、审核时间滞后等问题。信息化医嘱审核模式能够减少药物相关问题、节省医嘱审核时间、降低用药错误发生率、减少不合理医嘱、提高审核效率，相比于人工审核模式具有一定优势，但存在警报疲劳等问题。目前我国医嘱审核模式以人工审核模式为主，信息化医嘱审核模式仍处于起步阶段，且大多关注其对于处方合格率的影响，而对患者不良事件发生率等临床效果影响的研究较少。后续可对此2种医嘱模式进行完善，为医院药学人员医嘱审核提供参考。
关键词 医嘱审核模式;人工审核;信息化审核;用药安全;警报疲劳
ABSTRACT OBJECTIVE： To summarize clinical application and existing problems of artificial auditing and information-based medical order auditing modes so as to provide reference for improving rational medication. METHODS： Collecting data by literature search，using “Prescription auditing” “Medical order auditing” “Prescription pre-auditing” “Medication error” “Medication-related problems” “Medication safety” “Alert fatigue” “Medication review” “Decision support medication review” “Real-time medication review” “Real-time prescription surveillance” “Clinical alarms decision support systems” “Clinical pharmacy information systems” “Medication errors” “Medication related problem” as keywords， the related literatures from Jan. 2000 to Nov. 2019 were retrieved from CNKI， Wanfang database， PubMed， Embase， Web of Science and other databases. The clinical application and existing problems of 2 medical order auditing modes were analyzed and summarized. RESULTS & CONCLUSIONS： The artificial auditing mode can reduce medication-related problems (such as poor drug treatment effect， untreated symptoms or indications， potential adverse drug events， unnecessary drug treatment， etc.)， improve life quality of patients， but can not decrease the mortality and the length of hospitalization stay; there are some problems， such as many pharmacists needed for medical order auditing， insufficient auditing time， different auditing standards， auditing time lagging. The information-based medical order auditing mode can reduce medication-related problems， save auditing time， reduce the incidence of medication errors， reduce unreasonable medical orders， and improve audit efficiency. Compared with the artificial auditing mode， it has certain advantages， but there are problems such as alarm fatigue. At present， the domestic medical order auditing mode is dominated by artificial audit mode; the information-based medical order auditing mode is still in the initial stage， and the most attention is paid to its influence on the qualified rate of prescription， while the research on the incidence of adverse events and other clinical effects is less. Later， the 2 midical order can be improve to provide a reference for medical order auditing of hospital pharmacy personnel., 百拇医药(宗宇桐 闫素英 褚燕琦)
关键词 医嘱审核模式;人工审核;信息化审核;用药安全;警报疲劳
ABSTRACT OBJECTIVE： To summarize clinical application and existing problems of artificial auditing and information-based medical order auditing modes so as to provide reference for improving rational medication. METHODS： Collecting data by literature search，using “Prescription auditing” “Medical order auditing” “Prescription pre-auditing” “Medication error” “Medication-related problems” “Medication safety” “Alert fatigue” “Medication review” “Decision support medication review” “Real-time medication review” “Real-time prescription surveillance” “Clinical alarms decision support systems” “Clinical pharmacy information systems” “Medication errors” “Medication related problem” as keywords， the related literatures from Jan. 2000 to Nov. 2019 were retrieved from CNKI， Wanfang database， PubMed， Embase， Web of Science and other databases. The clinical application and existing problems of 2 medical order auditing modes were analyzed and summarized. RESULTS & CONCLUSIONS： The artificial auditing mode can reduce medication-related problems (such as poor drug treatment effect， untreated symptoms or indications， potential adverse drug events， unnecessary drug treatment， etc.)， improve life quality of patients， but can not decrease the mortality and the length of hospitalization stay; there are some problems， such as many pharmacists needed for medical order auditing， insufficient auditing time， different auditing standards， auditing time lagging. The information-based medical order auditing mode can reduce medication-related problems， save auditing time， reduce the incidence of medication errors， reduce unreasonable medical orders， and improve audit efficiency. Compared with the artificial auditing mode， it has certain advantages， but there are problems such as alarm fatigue. At present， the domestic medical order auditing mode is dominated by artificial audit mode; the information-based medical order auditing mode is still in the initial stage， and the most attention is paid to its influence on the qualified rate of prescription， while the research on the incidence of adverse events and other clinical effects is less. Later， the 2 midical order can be improve to provide a reference for medical order auditing of hospital pharmacy personnel., 百拇医药(宗宇桐 闫素英 褚燕琦)