Establishment and application effect of prescription pre-audit system based on structure-process-outcome (SPO) model
10.3760/cma.j.cn114015-20240110-00020
- VernacularTitle:基于结构-过程-结果（SPO）模型的处方前置审核系统的建立及其应用效果
- Author:
Xiaomin XING
1
;
Xiangpeng LI
1
;
Xianghua QUAN
1
;
Xinyi WANG
1
;
Wenxiao WANG
1
;
Jing LI
1
Author Information
1. 青岛大学附属医院药学部，青岛 266000
- Publication Type:Journal Article
- Keywords:
Prescription drug monitoring programs;
Pre-audit system;
Quality management;
Pharmaceutical services;
Structure-process-outcome quality model
- From:
Adverse Drug Reactions Journal
2024;26(9):551-556
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To establish a prescription pre-audit system based on the structure-process-outcome (SPO) model in the the Affiliated Hospital of Qingdao University and explore its application effect.Methods:Based on the structural dimension of SPO model, the organizational structure, pharmaceutical team, management system of pharmaceutical prescription audit, and audit environment of the prescription pre-audit system were established. Based on the process dimension of SPO model, the pre-audit process, medication knowledge base, and audit rule base were established, quality monitoring and control were implemented, and relevant personnel training were conducted. Based on the outcome dimension of SPO model, the review rate, manual review rate, clinician acceptance rate of prescription review, reasonable rate of outpatient and emergency prescription comments, and intervention rate of inpatient medical order were verified after the prescription pre-audit system application.Results:The prescription pre-audit system was first launched in the main hospital area of the Affiliated Hospital of Qingdao University in March 2021, and achieved full coverage in all five hospital areas by May 2023. The review rates of outpatient and emergency prescriptions and inpatient medical orders had been increasing year by year from 2021 to 2023, and all reached more than 99% of the expected rates in 2023. Compared with 2021, the proportions of outpatient and emergency prescriptions and inpatient medical orders submitted to manual review decreased in 2023 [1.2% (112 206/9 509 430) vs. 2.9% (16 214/549 672), 2.9% (206 258/7 152 620) vs. 3.9% (147 679/3 814 929), the proportions of prescriptions that failed to be reviewed in time decreased [0.7% (62 382/9 509 430) vs. 1.4% (7 429/549 672), 0.3% (22 816/7 152 620) vs. 2.2% (83 303/3 814 929)], and the acceptance rates of outpatient and emergency prescription review and inpatient medical orders review by clinicians increased [76.1% (2 421/3 180) vs. 57.0% (339/595), 94.3% (1 000/1 060) vs. 70.7% (797/1 128)], with statistically significant differences (all P<0.001). But there were still some prescriptions and orders that needed manual review but were not reviewed in time and finally missed review. Compared with 2021, the reasonable rates of outpatient and emergency prescription comments increased in 2023 [96.7% (924 558/956 252) vs. 92.2% (983 827/1 067 357), 98.7% (518 307/525 227) vs. 98.0% (181 296/185 069)], and the intervention rate of inpatient medical orders decreased [0.7% (196 522/26 751 992) vs. 0.9% (195 660/22 631 289)], with statistically significant differences (all P<0.001). Conclusions:Applying the SPO model can improve the organization and management of the prescription pre-audit system, and ensure the smooth launch and safe operation of the system. After verification, the operating speed of the prescription pre-audit system and prescription review speed of pharmacists could basically meet the clinical needs, the indicators of rational drug use in the hospitals were improved, and the professional and technical ability of pharmacists were enhanced.
