【摘要】 目的 构建事前预防、事中管控、事后点评三位一体的医嘱审核三位一体循环体系，改善审方工作流程。方法 分析搭建医嘱审核三位一体循环体系的原因及搭建过程中存在的问题，由点评药师+临床药师+审方药师+信息药师+临床专家组成专业团队，结合临床实际情况，行政管理与专业相结合，建立医嘱审核的循环路径。在此基础上，开展医嘱专项审核工作，对止吐药、质子泵抑制剂(PPIs)、抗菌药物的专项审核工作前后的医嘱不合理率进行分析比较，分析2022年1月至10月医院审方系统更新后，住院医嘱系统审核和药师人工审核不通过占比。评价医嘱审核三位一体循环体系的搭建效果。结果 随着医嘱审核工作的开展，止吐药、PPIs、抗菌药物的不合理使用现象均有改善：外科围术期止吐药物的合理使用率由66.41%上升到97.35%;2021年第一季度与2020年第一季度PPIs的使用情况相比，使用费用、使用天数、医嘱干预情况及使用剂型均有所改善且差异有统计学意义(P<0.05);抗菌药物的医嘱不合理率从0.72%降至了0.28%。结论 医嘱审核三位一体循环体系的建立，对于促进临床合理用药具有很好的现实效用。但医嘱审核三位一体循环体系仍处于磨合阶段，后续仍需不断完善和改进。更多还原

【Abstract】 Objective To construct a three-in-one circulation system of medical order review including pre-prevention, in-process management and control, and post-comment. Methods The reasons for establishing the medical order review cycle system and the problems existing in the process of building were analyzed. The professional team was consisted of review pharmacists, clinical pharmacists, prescription checking pharmacists and information pharmacists, combining administration with profession, establish the circulation path of medical order review. On the basis of the establishment of audit path, special audit of medical advice was carried out, and the irrational rate of medical orders before and after the special review of antiemetic drugs, PPIs and antibiotics were analyzed and compared. After the prescription examination system was updated from January to October 2022, the proportion of inpatient medical order system audit and pharmacist manual audit failed was analyzed. Evaluate the establishment effect of the circular system of medical order review. Results With the development of medical advice review, the reasonable utilization rate of antiemetic drugs, PPIs and antibiotics had been improved. The reasonable use rate of antiemetic drugs in doctors′ orders increased from 66.41% before the intervention to 97.35% after the intervention. Comparing the use of PPIs in the first quarter of 2021 with that in the first quarter of 2020, the use cost, use days, intervention of medical orders and dosage forms were improved(P<0.05). The unreasonable rate of medical orders of antibiotics was decreased from 0.72% to 0.28%. Conclusion The establishment of the circulation system of medical order review has a good practical effect on promoting clinical rational drug use, however, the circulation system of medical order review in our hospital is still in the running-in stage and needs to be continuously improved in the follow-up process.更多还原