目的：结合上海市松江区中心医院前置审方系统运行实践，探讨前置审方系统在医院处方质量管理中的作用，为完善医院自定义处方审核规则提供理论依据及数据支持，进一步规范医师处方行为， 促进临床合理用药。方法：通过上海市松江区中心医院HIS系统及前置审方系统分别调取2019年3月-8 月(前置审方前)、2020年3月-8月(前置审方后)所有门诊处方，比较系统运行前后处方合格率、不合理类型及处方占比、药师干预成功率，评价前置审方系统在规范医师处方行为、提高处方质量中的作用，并对系统实施过程中存在的问题进行总结分析。结果：前置审方系统运行后，处方合格率由83.28% 上升至95.33%，药师干预成功率为60%左右，不合理处方占比以适应症不适宜比例最高(约63.01%)， 用法用量占比10.87%、相互作用占比5.11%、禁忌症占比0.44%。结论：前置审方系统可明显提高处方合格率、提升药师干预成功率，减少审方时间，对规范医师处方行为、提高处方质量有积极作用。但在系统运行期间也显现了人工智能的一些缺陷，有待于后续进一步改进。
Objective: Combining the operation practice of the Pre-review system in Shanghai Songjiang District Central hospital, to explore the role of the pre-review system in hospital prescription quality management, to provide theoretical basis and data support for improving the hospital’s custom prescription review rules, to further standardize physicians' prescription-making, and to promote the clinical rational use of drugs. Methods: Through the HIS system and pre-review system of Shanghai Songjiang District Central hospital, all outpatient prescriptions from March to August 2019 (before pre-review) and from March to August 2020 (after pre-review) were retrieved, respectively, to compare the pre- and post-prescription qualification rate, unreasonable types and proportion of prescriptions and the pharmacist intervention success rate, to evaluate the role of the pre-review system in standardizing physicians’ prescription behavior and improving prescription quality, and to summarize and analyze the problems existing in the implementation of the system. Results: After the pre-review system was put into operation, the prescription qualification rate has increased from 83.28% to 95.33%, and the success rate of pharmacist intervention has increased by about 60%. The proportion of unreasonable prescriptions has reached ahistorical high for indications (about 63.01%), usage and dosage (accounting for 10.87%), interaction (accounting for 5.11%), contraindications (accounting for 0.44%). Conclusion: The pre-review system could significantly increase the qualification rate of prescriptions, enhance the success rate of pharmacist intervention, reduce the time for examination of prescriptions, and have a positive effect on standardizing physicians’ prescription behavior and improving the quality of prescriptions. However, some defects of artificial intelligence also appeared during the operation of the system, which needed to be further improved.
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