【摘要】 目的 探讨计划-执行-检查-处理（plan-do-checkact,PDCA）循环对医共体病区用药医嘱合格率的改善效果，验证阶梯式干预（行政到技术）策略的有效性。方法 2023年1月—2024年12月，随机抽取基线期（2023年1—3月）、首轮干预后（2023年10—12月）、次轮干预后（2024年10—12月）用药医嘱单各510份，比较3个时期的处方合格率及不同类型不合理处方的分布情况。结果 3个时期处方合格率分别为69.61%、90.98%、96.86%，首轮后处方合格率高于基线期，次轮后处方合格率高于基线期，次轮后处方合格率高于首轮后，差异均有统计学意义（均P<0.05）。3个时期出现的不合理处方问题数分别为203、46、16，其中书写不规范处方的占比呈下降趋势，用药不适宜处方的占比呈上升趋势，差异有统计学意义（P<0.05），超常处方的占比变化不大，差异无统计学意义（P > 0.05）。结论 PDCA循环可阶梯式提升医嘱质量，行政干预对基础问题（书写规范）效果显著，技术干预可进一步解决专业性问题（用药适宜性）。两轮干预后，初步建立了医共体三级处方点评模式。更多还原

【Abstract】 Objective To explore the improvement effect of the Plan-Do-Check-Act(PDCA) cycle on the qualification rate of medication orders in the ward of a medical consortium, and to verify the effectiveness of the stepped intervention(administrative to technical) strategy. Methods A three-phase independent sample design was adopted, with 510 medication order sheets randomly selected from each of the following periods: baseline(from January to March 2023), after the first round of intervention(from October to December 2023), and after the second round of intervention(from October to December 2024). The qualified rate of prescriptions and the distribution of different types of unreasonable prescriptions in the three periods were compared. Results The qualification rates for the three periods were 69.61%, 90.98%, and 96.86%, the qualified rate of prescriptions after the first round was higher than that in the baseline period, the qualified rate of prescriptions after the second round was higher than that in the baseline period, and the qualified rate of prescriptions after the second round was higher than that after the first round, the differences were statistically significant( all P < 0.05). The number of unreasonable prescription problems in the three periods was 203,46 and 16, respectively. The proportion of non-standard prescriptions decreased, and the proportion of inappropriate prescriptions increased, the difference was statistically significant(P < 0.05). The proportion of abnormal prescriptions did not change much, and the difference was not statistically significant( P > 0.05). Conclusion The PDCA cycle can improve the quality of medication orders in a stepwise manner. Administrative intervention is highly effective for basic issues(writing standardization), while technical intervention can further address professional issues(medication appropriateness). After two rounds of intervention, a three-level review model within the medical consortium was preliminarily established.更多还原