目的：探讨和实践基于医疗信息与管理系统(HIMSS)的药品闭环管理工作模式，评价其工作成效，为医院药学信息化建设提供经验与参考。方法：利用信息条码技术及临床合理用药决策支持系统，在药品入出库、调剂、使用等环节，建立一系列的信息流与物流网格化管理，形成药品闭环工作流程，实现药品管理与使用全过程可追溯。回顾性抽取该管理模式实施前(2018年1-6月)及实施后 (2019年1-6月)门(急)诊处方各18000张，进行处方合理性评估，同时收集清华大学附属垂杨柳医院同期院内OA办公系统上报的全部用药错误记录，对比分析管理模式实施前、后处方不合理问题及用药错误例数的变化情况。结果：与实施前相比，闭环管理模式实施后所有类型的不合理处方数均显著下降 (P＜0.05)，处方开具与转抄错误，调剂、给药时间与药品摆放错误的例数均显著下降(P＜0.05)。 结论：基于HIMSS的药品闭环管理模式可有效促进临床合理用药，保障患者用药安全。

Objective: To explore the closed-loop medication management mode based on the healthcare information and management system (HIMSS) and evaluate the effectiveness of the work in order to provide experience and references for the construction of hospital pharmaceutical informatization. Methods: By utilizing information bar code technology and the system supported by clinical rational drug use decision, the work processes of closed-loop medication based on a series of management of information flow and logistics gridding were established in order to achieve the traceability of the whole process of medication management. A total of 18000 prescriptions before (from January to June, 2018) and after the implementation of the closed-loop medication management mode (from January to June, 2019) were collected retrospectively, and the rationality of prescriptions was evaluated. The records of all medication errors reported by the hospital Office Automation System in the same period were collected. The unreasonable prescription problems and cases of medication errors before and after the implementation of the management mode were compared and analyzed. Results: Compared with the pre-implementation, the number of irrational prescriptions for all types decreased significantly after the implementation of the closed-loop medication management mode (P＜0.05). Prescription issuing and transcribing errors, wrong time for dispensing and administration and the errors of drug placement have significantly decreased (P＜0.05). Conclusion: The closed-loop medication management mode based on HIMSS can effectively promote the rational use of drugs and ensure the medication safety for patients.