Design and preliminary application of pre-audit system for medical orders in hospitalized patients

Abstract

Objective To establish a pre-audit system for medical orders in hospitalized patients and increase the auditing rate in inpatients. Methods In the pre-audit system for medical orders, browser/server(B/S) and client/server(C/S) hybrid architecture was adopted and JAVA language was used for programming. The pre-audit system for medical orders was linked to the hospital information system and data integration platform, and audit module was improved on the basis of the pre-audit system for prescriptions which had been successfully operated in Xuanwu Hospital of Capital Medical University. More than 20 thousand related rules were added in the audit think tank for rational drug use of prescriptions and serious errors interception for indications, dosage and administration route, appropriate translation of Chinese patent medicine indications, refinement of compatibility taboos, audit of drug allergy risk, appropriate audit for pain medications, and audit for rational drug use related to height, body weight, body surface area, and test values were performed. The audit think tank for rational drug use was formed, which set up the foundation for intelligent examination of medical orders. The medical orders which were not passed by intelligent examination were transmitted to the pre-audit pharmacist to audit for the second time. By comparing the audit rate of medical orders in hospitalized patients before and after adopting the pre-audit system and the qualification rate at the first 4 months after adopting the system, the application effect was preliminarily evaluated. Results After launching pre-audit system for medical orders in June 2017, the examination rate of medical orders in inpatients increased from 42.53% (61 139/143 756) to 100% (at the first 4 months, the number of doctor′s orders was 69 183, 74 072, 99 816, and 184 184, respectively). At the first 4 months after the system was launched, the pass rate of audit for medication orders was 69.02% (47 753/69 183), 84.27% (62 416/74 072), 92.69% (92 516/99 816), and 97.21% (179 040/184 184), respectively. The difference in passing rate of audit for medication orders between the 4th month and the first month was statistically significant(χ2=42 548.86, P<0.001). Conclusions The pre-audit system for inpatients′ medication orders was successfully established. The intelligent audit for all inpatients realized using this pre-audit system and was of benefit to the rational drug use improvement in hospitals. Key words: Inpatients; Pre-audit system; Medical order