Unreasonable Prescriptions Research Articles

Enhancing Drug Management, Cost Savings, and Staff Satisfaction in Anesthesiology: A Quality Improvement Project in a Chinese Tertiary Hospital.

In alignment with China's national directive for improved drug management in anesthesiology, the Affiliated Hospital of Qingdao University initiated a quality improvement project, aiming to tackle the prevailing challenges of inefficiencies in drug administration, escalating drug costs, and the notable communication gap between pharmacists and anesthesiologists. We employed a Plan-Do-Study-Act methodology to establish a pharmacy team and execute a multidimensional pharmaceutical intervention. The interventions included the formulation of standard procedures, guidelines and regulations, assistance from an information system (including automatic dispensing cabinets and prospective prescription review system), communication feedback (via WeChat groups), and education for anesthesiology staff. The intervention spanned from April to September 2023, focusing on optimizing medication management, achieving cost savings, and enhancing the satisfaction of anesthesia team members, with an additional observation from October to December 2023. Following the interventions, improvements were observed in drug management practices. These enhancements included increased compliance with accounting procedures, more rigorous registration of controlled substances, and more effective disposal of liquid residues. There was no adverse events related to high-alert medications or look-alike drug usage errors. The introduction of automatic dispensing cabinets and a prospective prescription review system markedly improved work efficiency. The utilization of a WeChat group facilitated effective communication about unreasonable prescriptions and drug-related issues. Among the 29,061 patients who underwent surgery both before and after the interventions, significant reductions were observed both in the drug proportion and the per capita drug costs (P = 0.03, P = 0.014, respectively). The per capita drug cost decreased by 20.82%, from ¥723.43 to ¥572.78, consistently remaining below ¥600 throughout the 9-month observation period. The per capita cost of monitoring drugs including dezocine, butorphanol, haemocoagulase agkistrodon, penehyclidine, and ulinastatin experienced a significant reduction (P < 0.05). Additionally, in the satisfaction questionnaires returned, a remarkable 94.44% of anesthesiology staff expressed high satisfaction with the comprehensive pharmaceutical interventions. The quality improvement project has yielded remarkable positive outcomes, serving as a model worthy of reference and replication in similar healthcare settings.

Analysis and measurements of irrational prescriptions for diabetes' patients in the outpatient and emergency

Objective: Analyze the unreasonable prescriptions of diabetic patients in the outpatient and emergency department of our hospital, and provide references for the rational use of drugs by diabetic patients. Methods: The prescriptions (total 12704) for diabetic patients were collected in Outpatient and Emergency Pharmacy from January to December 2020, and several parameters were counted, such as the basic conditions of diabetic patients, the number, types and proportion of unreasonable prescriptions, and the distribution of different departments. Results: The average age of patients was (63.75±12.02) years old. There were 7692 patients between 60 and 79 years old, accounting for 60.55%, and there were more male patients than female patients; 1,291 unreasonable prescriptions, accounting for 10.16%; The top three in the distribution of irrational prescription departments were 913 in internal medicine of Traditional Chinese Medicine, accounting for 70.72%, 125 in respiratory medicine, accounting for 9.68%, and 98 in neurology, accounting for 7.59%. The prescription failure rates of general internal medicine was the lowest 7.44%, and the prescription failure rate of the dialysis center was the highest 43.75%; Among the unreasonable prescription types, there were 1106 prescriptions with inappropriate drug usage and dosage, accounting for 85.67%, followed by 160 prescriptions with inappropriate dosage form or route of administration, accounting for 12.39%. Conclusion: The prescriptions for diabetic patients in the Outpatient and Emergency Department of our hospital are basically reasonable, but some non-endocrine departments have a high rate of prescription failure. It is necessary to improve the problems of irrational prescriptions to improve the quality of prescriptions and the level of reasonably clinical use of drugs.

Clinical and immunological efficiency of bacteriophage in technique of delayed prescribing of antibiotics in patients with acute post-viral rhinosinusitis

Topicality: Acute Rhinosinusitis can be characterised as acute bacterial rhinosinusitis just in about 0,5 - 2% of the number of viral one and only such patients need prescription of antibiotics. At the same time, antibacterial therapy is prescribed in from 54% to 77% cases of Acute Rhinosinusitis. To reduce the number of unreasonable prescriptions, the strategy of delayed prescribing of antibioticsis the forward-looking one. Aim: to evaluate the level of IgА and sIgA in patients with post-viral RS and estimate the clinical and immunological efficiency of polyvalent bacteriophage in technique of delayed prescribing of antibiotics in comparison with the patients receiving standard APVRS therapy. Material and methods: 155 adult patients with acute post-viral RS participated in the trial who were given either standard therapy or polyvalent bacteriophage in addition to the standard therapy. In conjunction with the treatment, the IgА and sIgA levels were evaluated and their comparison with clinical dynamics was undertaken. Evaluation criteria: decrease in intensity of disease symptoms evaluated in accordance with MSS scale system during each visit in comparison with the 1st visit, antibiotic prescribing frequency, dynamics of changes of serum and secretory IgА levels. Results and discussion: The use of polyvalent bacteriophagein addition to the standard therapy of acute post-viral rhinosinusitisas a part of technique of delayed prescribing of antibiotics ensures clinically significant, faster dynamics of regression of typical clinical symptoms of post-viral rhinosinusitis: rhinorrhea, nasal congestion and post-nasal drip in comparison with the control group (p&lt;0.05). Positive dynamics of clinical symptomatology is followed by the fair increase of IgА and sIgA levels (p&lt;0.005), in comparison with the level before treatment and the control group. The statistically significant difference between the control group and the intervention one in IgА and sIgA indicators is associated with fairly higher (by 20%) rate of prescribing of antibiotics in the control group. Conclusion: polyvalent bacteriophage is a safe and effective medication for additional treatment of acute post-viral rhinosinusitis intended to improve indicators of systemic and local immunity and reduce the rate of use of antibiotics. The inclusion of the medication into the treatment regimen could be recommended to the patients as a part of technique of delayed prescribing of antibiotics.

Anemia and the use of antihypertensive medications in hemodialysis patients: multicenter retrospective observational study

Abstract. We hypothesized that the use of antihypertensive medications in patients treated by hemodialysis (HD) may interfere with the activity of erythropoietin and leads to an increase in the dose of erythropoiesis stimulating agents (ESAs). The aim of our study was to analyze the impact of antihypertensive medications on the effectiveness of anemia treatment. Methods. We conducted a multicenter retrospective observational study. The archival medical data from 379 patients treated by HD or hemodiafiltration (HDF) were used. The medical records of 142 patients were excluded from the study. The study group consisted of 237 patients: 108 (45.6%) women and 129 (54.4%) men, with an average age of 54 [41-62.5] years. Results. The analysis of the mean hemoglobin (Hb) stratified by the administration of antihypertensive medications in the dynamics of dialysis treatment demonstrated a significant impact of angiotensin-converting enzyme (ACE) inhibitors (F = 3.97; p = 0.048) and amlodipine (F = 6.9; p = 0.01) on the effectiveness of anemia correction. The significant effect of amlodipine on the need to increase the dosage of iron-containing medications (OR = 3.9; 95% CI (1.27-12.06), p = 0.002; RR = 1.9 95% CI (1.27-2.9) and continuous erythropoietin receptor activator (CERA) (OR = 5.2, 95% CI (1.2-24.4), p = 0.03; RR = 1.3 95% CI (1, 08-1.6), p = 0.006) weas showed by logistic regression analysis. The increased risk of failure to achieve of the target Hb level in HD patients received amlodipine was confirmed by Cox regression model (HR = 2.7 (95% CI 1.5-4.7)). Conclusions: The results of our study demonstrated a significant increase in the frequency of appointment and amount of anti-anemia therapy in HD patients when amlodipine is co-administered. Follow-up studies to determine the effect of amlodipine mechanism for anemia will avoid unreasonable prescriptions for the treatment of НD patients. Conflict of interest statement: the authors declared no competing interests.

ІНТЕГРОВАНИЙ ABC/FMR/VED-АНАЛІЗ РЕАЛІЗАЦІЇ ПРОСТАТОПРОТЕКТОРІВ (НА ПРИКЛАДІ АПТЕЧНОЇ МЕРЕЖІ)

Мета роботи. Здійснити наглядний розподіл простатопротекторів (ПП) за обсягом товарообігу з одночасною ідентифікацією частоти їх роздрібної реалізації залежно від важливості ПП для фармакотерапії.Матеріали і методи. Матеріалами дослідження були ЛЗ із терапевтичної підгрупи G04C «Препарати для лікування доброякісної гіперплазії передміхурової залози». Місце дослідження – аптечна мережа ТзОВ «Іва-Фарм» (м. Івано-Франківськ), до складу якої входить 21 аптека і 10 аптечних пунктів. Період дослідження – 2017 р. Методологія дослідження ґрунтувалася на інтегрованому АВС/FMR/VED-аналізі.Результати й обговорення. За даними реалізації ПП аптечною мережею за 2017 р. виявлено, що глибина їх асортименту становила 26 позицій або 33,3 % від зареєстрованих ПП в Україні. Шляхом ABC-аналізу встановлено 10 найважливіших ПП за обсягом реалізації у вартісному показнику (серед них 4 формулярних ПП), а за даними FMR-аналізу – 8 найважливіших ПП за обсягом реалізації у натуральному показнику (серед них 5 формулярних ПП). За допомогою формального VED-аналізу визначено, що більшість ПП є життєво необхідними. При цьому частка реалізованих неформулярних (бажаних) ПП у вартісному показнику становить менше половини, а в натуральному показнику – третину. Унаслідок інтегрованого ABC/FMR/VED-аналізу визначено три найважливіші формулярних ПП за обсягом реалізації у вартісному і натуральному показниках, а саме: Омнік капс. № 30, Флосін 0,4 мг № 30, Аводарт 0,5 мг № 90.Висновки. Результати інтегрованого АВС/FMR/VED-аналізу роздрібної реалізації ПП можуть слугувати базою для прийняття рішень щодо збалансованості асортименту ПП в аптечній мережі. Висока частка реалізації неформулярних ПП у вартісному та натуральному показниках вказує на необхідність проведення моніторингу доцільності застосування таких ЛЗ та обмеження необґрунтованих призначень неформулярних ПП шляхом підвищення ефективності інформаційної роботи серед лікарів-урологів.

Звичне невиношування: що необхідно робити і чого робити не слід (Огляд)

The article presents an overview of domestic and foreign publications on pregravid preparation and early pregnancy in women with a history of habitual miscarriage (HM). Modern terminology is presented, questions about the causes of this pathology are considered and ways of its overcoming are determined. The views of specialists from leading institutions and obstetric and gynecological communities of the world on the issues of pregraved preparation and management of pregnancy in women with HM are presented. Among the main issues considered are the following: optimal timing for the next pregnancy; key recommendations on the management of women with HM (genetic examination, routine administration of progesterone preparations, correction of the «male factor», psychoemotional disorders, anatomical defects of female reproductive organs); the management of women with reproductive losses in the history on the background of antiphospholipid syndrome and congenital thrombophilia. It was noted the need to correct the infectious component of miscarriage. The role of vitamin and micronutrient supplementation in women with HM and their required quantity at the stage of pregravid preparation (folates, iron, iodine, vitamins D, B12) is defined. The evidence base on the use of sublingual and vaginal forms of micronized progesterone (luteina) for correction of the II phase of MC and early pregnancy in women with HM is presented. The emphasis is also on what should be avoided: unreasonable and unjustified prescriptions without special indications (additional examinations, medications, etc.). Key words: habitual miscarriage, pregravid preparation, key recommendations, micronutrient supplementation, micronized progesterone, gestalider, luteina.

Construction of a comprehensive quality management system for PIVAS by feed forward control theory

Objective The objective of this study was to explore the construction of a comprehen-sive and systematic quality management system for pharmacy intravenous admixture service (PIVAS) and form quality management method and model reflecting distinct gradations, specific responsibility and all staff participation, so that we can provide safe and effective intravenous solutions for the patients and guar-antee the quality and safety of intravenous infusion and improve management quality. Methods According to Quality Management Standards of PIVAS published by Ministry of Public Health and JCI Standard, with the theory and methods of feed forward control and delicacy management, by establishing and complet-ing three-grade-quality management organization, defining the quality control indicators, selecting and demonstrating with the application of expert meeting method and Delphi method, a scientific quality control system was formed. Statistics on unreasonable prescriptions, adverse drug reaction of intravenous infusion, defect of pharmacy intravenous admixture and satisfaction of medical staff and patients were compiled and evaluated throughout the implementation of the practice changes in 38 wards. Results Significant differences were observed in various indicators, comparing statistics collected during 6 months of the same season throughout the implementation of the practice changes. χ2 value was 160.54, 21.39 and 10.29 by comparison of unreasonable prescriptions, adverse drug reaction and number of drug preparation errors. The satisfaction degree of medical staff and patients improved evidently, χ2 value was 14.34 and 26.76. Conclusions The construction and implementation of three-grade-quality management system adapt to high-risk, high strength, high sense of responsibility, process-oriented and intensive management of PIVAS. The impact on the continuous improvement PIVAS quality and assurance in safety of intravenous infusion is remarkable. Key words: Pharmacy intravenous admixture service; Quality management system; Delicacy management; Feed forward control; Safety of intravenous infusion

An analysis of clinical irrational drug use in primary hospitals

Objective To analyze the situation and reasons of unreasonable medication use,and to promote and improve rational use in the grassroot hospitals to insure safe drug use in patients.Methods 960 pieces of Western prescriptions at clinic were chosen from January 2009 to January 20101.According to the theory of pharmacy, the irrational prescriptions were classified and statistically analyzed.Rusults Unreasonable prescriptions were totally 90 (9.38%). Irrational drug use was mainly in four areas,according to the proportion of the number of prescriptions. They were as follows: unreasonable combined use 29(32.22%), repeated drug use 25 (27.78%), improper drug selection 20 (22.22%), and unreasonable use 16 (17.78%). Conclusions Rational use of drugs has a long way to go, especially for antibiotics. Clinicians need preseribe medicines scientifically and supervision and regulation need to be strengthened. Key words: Clinical irrational drug use; Rational drug use; Analysis

Analysis to Unreasonable Prescription of Traditional Chinese Medicine

Objective By investigating the quality and unreasonable prescription of traditional Chinese medicine in our hospital, to analyze the reason and thus put forward the solution and elevate the whole rational administration level in our hospital. Methods 3000 prescriptions prescribed in our hospital from April 2008 to April 2009 were randomly investigated. Select the unreasonable prescriptions and unreasonable use of medicines in a prescription for statistical analysis. Results There were 258 unreasonable prescriptions among spot-check 3000 sheets of prescriptions, reaching 8.6%. There were 633 unreasonable medications, including oversized or excessively small dosage, improper compatibility, repeated medications, etc. Conclusion There is the phenomena of unreasonable prescription in our hospital. Therefore, we should reinforce the management of prescribing medicines and enhance the level of reasonable medication. Key words: Traditional Chinese medical prescription; Unreasonable prescription; Analysis

Analysis on the Quality of Outpatient Prescription before and after the Implementation of Comment on Prescription

Objective To compare and analyze the changes in quality of outpatient prescription before and after the implementation of comment on prescription,which includes the reasonableness of the use of medicine and the qualified rate of the writing of prescription.Methods The comment was made on the prescriptions of the patients who were diagnosed in the outpatient department of our hospital from 2006 to 2007.Results After the impIementation of comment on prescription,the rate of probiem prescription was 3.66%,which was absolutely lower than that before the implementation of comment on prescription(14.1%).Conclusions After the comment on unreasonable prescriptions and unreasonable use of medicine,the interference and warning for the reasonable prescription of medical practi-tioner would be strengthened,which would make the management of medicine,writing out and adjustment of prescription and control of medical cost more Scientific,reasonable and standard. Key words: Comment on prescription; Quality of prescription; Comparative analvsis