According to the state, the “First Batch of Lists of Key Drugs for Rational Use of Drugs under National Monitoring” formulated by the Shandong Health and Health Commission (National Health Office Medical Letter  No. 558) and the Zibo City ’s key surveillance identified by the Health and Health Commission on this basis The rational use of medicines and drugs list, further strengthen and standardize the rational use of drugs monitored by our hospital, promote the rational use of medicines, reasonably reduce the cost of medicines, formulate this management method, the "Zibo City Maternal and Child Health Hospital key monitoring and rational use of drugs list" listed "Key monitoring drugs" implement monitoring management, and please implement them carefully.
I. Basic principles for rational monitoring of rational drug use
Physicians follow the principle of "can not be used, can be used less, not used more, can be taken orally, can be injected intramuscularly, not intravenously, and basic drugs are preferentially selected." Considering the cost and efficacy of drugs, strictly follow the scope of use specified in the instructions , Treatment courses, dosages and indications are issued for use to ensure that clinical medication is safe, reasonable, effective and economical.
、临床医生在应用重点监控药品时不得随意扩大药品说明书规定的适应症、用法用量及疗程等，不允许出现超说明书用药情况，若临床医生有充分循证依据（指南）支持某一药品可超说明书用药，应根据医院相关要求，签订知情同意书，否则视为不合理使用。 临床. Clinicians should not arbitrarily expand the indications, dosages, and treatment periods specified in the drug instructions when applying key monitoring drugs, and the use of drugs beyond the instructions is not allowed. If the clinician has sufficient evidence-based evidence (guidelines) to support a drug, Medication beyond the instructions should be signed according to the relevant requirements of the hospital, otherwise it is considered unreasonable use.
、重点监控药品的不良反应（根据我院药品不良反应上报统计）发生比例较高，有时甚至会发生危及生命的严重不良反应，对患者机体功能产生不良的干扰和影响，在执行用药方案时要密切观察疗效，注意不良反应，根据病情和药物特点进行必要检验和影像学监测，并根据病情变化情况及时修订和完善原定的用药方案。 比例 A high proportion of adverse reactions to key monitored drugs (according to the report of adverse drug reactions reported by our hospital), and sometimes even serious life-threatening adverse reactions, which have adverse interference and impact on patients' body functions. It is necessary to closely observe the curative effect, pay attention to adverse reactions, carry out necessary tests and imaging monitoring according to the condition and characteristics of the drug, and timely revise and improve the original medication plan according to the change of the condition.
Second, the hospital's key monitoring drugs rational use drug catalogue
According to the Zibo City's key monitoring and rational use drug list determined by the Zibo City Health and Medical Commission, the medical institution's Pharmaceutical Affairs Management and Pharmacotherapy Committee has fully evaluated and demonstrated, established a dynamic management mechanism, combined with the institution's drug use amount and prescription review results To the closed-loop management of each step of the corresponding drug selection, procurement, prescription, transfer, clinical application, monitoring, evaluation, etc., formulate a rational drug use list for key monitored drugs in the hospital.
Third, the key monitoring drug management objectives and implementation measures
According to the requirements of the municipal health and health committee, the target list of the top 10 drugs sold by the hospitals does not contain the published target requirements for the key monitoring drugs. After research by the party committee, the following measures were taken to ensure the smooth implementation of this work:
(I) Doctor's advice
The key monitoring drugs are marked through the information system, and the "Key Monitoring Drugs" dialog box pops up when the doctor orders the prescription to remind them.
Through the pre-prescription review software, 100% of the key monitoring drug prescriptions are reviewed, and the rationality of their medication is confirmed by the pharmacist.
And (iii) Special prescription reviews
Strictly implement the "Administrative Regulations for the Evaluation of Hospital Prescriptions", conduct special reviews of the drugs in the catalogue, and do a good job of publicizing, responding to and using the results, establishing an extraordinary warning system, and handling violations.
(Iv) Public announcement
Monthly ranking of top 10 key monitoring drugs for drug physicians and public announcements throughout the hospital; public physicians with 2 or more drugs ranking in the top 10 at the same time for public interviews, after the interviews The top 10 people who still have two or more drugs ranked still have their prescription rights suspended for one month.
(V) Purchase management
The Pharmacy Department controls the consumption and procurement of key monitored medicines in the hospital every month, and quantifies the purchase of the top 50 monitored medicines that enter the hospital's monthly sales amount by 10% each month until the sales amount exits the top 50. After that, a fixed amount of procurement will be carried out; drugs that have not entered the top 50 will be purchased according to 1/12 of the total sales in 2018; over-purchasing is not allowed. Drugs that have been ranked in the top 10 units of consumption for three consecutive months and whose drug unsuitability rate exceeds 10% are temporarily suspended. If they are really needed after the suspension, they should be discussed and approved by the hospital pharmacy committee before being used.
(Vi) Interview with suppliers
Suppliers of the drugs in the key monitoring drug list were interviewed one by one, and a clean sales commitment was signed, and for the drugs that violated the clean sales, the hospital drug supply list was removed.
(Vii) Off-catalog drug management
For the abnormal increase in the sales of drugs outside the catalogue, strengthen early warning and find out the reasons, take targeted rectification measures, interview drug suppliers, and if necessary, include them in the hospital's key monitoring and rational use of drug catalogues.
Fourth, the hospital's key monitoring drug management working mechanism
、落实责任追究制度。 落实 Implement the accountability system. The dean is the first person in charge of the hospital's key monitoring drug management, and the directors of each clinical department are the first person in charge of the key monitoring drug management in the undergraduate department, ensuring that the responsibility goes to the department and to others.
、医务科、药剂科为责任科室。 责任 The medical department and pharmacy department are responsible departments. Responsible for organizing special monthly supervision and inspection by clinicians and clinical pharmacists, and propose intervention and improvement measures based on relevant information.
、临床药学为药学专业技术支撑科室。 ㈢ Clinical pharmacy is the technical support department of pharmacy. Responsible for key monitoring drug prescriptions and medication orders, organize clinical pharmacists to conduct monthly special reviews, analysis, evaluation and reporting of monitoring data.
、信息科为全程监测数据提取技术保障科室。 信息 The Information Section is the technical guarantee section for the whole process of monitoring data extraction. Responsible for the implementation of dynamic monitoring and extraordinary early warning on the procurement, sequencing, and use of key monitored drugs.
、监察室为落实点评通报科室，负责落实对临床科室和医师应用重点监控药品及不合理用药情况进行通报和公示。 ㈤ In order to implement the review and notification department, the supervision office is responsible for implementing the notification and publicity of the application of key monitoring drugs and unreasonable drug use by clinical departments and physicians. The contents include the names of medicines, the names of the top 10 physicians and their departments, and the conditions of unreasonable use.
、医务科、药剂科负有培训职能职责，进一步强化临床合理用药意识和自觉遵守用药规范。 ㈥ The medical department and pharmacy department have the responsibility of training functions to further strengthen the awareness of clinical rational drug use and consciously abide by the drug use specifications. Responsible for organizing medical staff in clinical and medical technology departments to conduct training and education on relevant regulations, rules and regulations on key monitoring drug management and knowledge on rational drug use of key monitoring drugs, and continuously improve the ability of clinical rational drug use.
Fifth, hospital detailed monitoring drug review details
The medical department, the pharmacy department and the clinical department shall jointly formulate the review details of the key monitoring drugs according to the actual drug use situation in the hospital. Reviews are performed by the pharmacy department, and the results of the reviews are publicized and feedbacked.
6. Evaluation and rewards and punishment measures for key monitored drugs in hospitals
考核办法： ㈠Assessment method:
1. The Pharmacy Department makes special comments on the use of key monitoring drugs based on data provided by the rational medication system each month, and strengthens the control of the top ten key monitoring drugs entering the hospital each month. The top ten billing physicians for this drug are in the hospital. Public announcement.
2. The Pharmacy Department conducts statistical analysis of clinical applications of the key monitoring drugs in the department every month, and focuses on the following inspections based on the drug instructions: (1) medication without indication or beyond the indication range of the instructions; (2) overdose medication; (3) whether the frequency of administration is reasonable; (4) whether the choice of vehicle is reasonable; (5) whether the infusion concentration is reasonable; (6) whether the treatment course is reasonable; (7) whether there are contraindications to use of drugs; (8) the combination of three key monitoring Drugs.
奖惩办法： ㈡Reward and punishment methods:
Departments and individuals who use the "Key Monitoring Drugs" in violation of regulations shall be handled as follows:
1. For the first time to use "key monitoring drugs" in violation of regulations, the supervisory office will notify the public and interview the responsible person, and the fine will be 100 yuan.
2. For the second illegal use of “Key Monitoring Drugs”, the director and the parties will be fined 200 yuan each, which will be publicized by the hospital.
3. For the third illegal use of "Key Monitoring Drugs", the party's performance bonus for the month will be deducted, practice will be suspended, special learning and training will be conducted, and the job will be resumed after passing the assessment.
4. Use of " "Key monitoring drugs" that lead to punishment by our health and health committee, medical insurance and other departments, the party committee of the hospital shall hold the relevant departments and individuals responsible according to the severity of the circumstances.
5. Departments and individuals who have not used the “Key Monitoring Drugs” illegally throughout the year shall be used as one of the priority considerations for annual assessment, bonus distribution, evaluation of superiors, promotion of titles, etc.
This management measure has been implemented for one year since its promulgation.
Zibo Maternal and Child Health Hospital
September 19, 2019
Attachment 2: Zibo Maternal and Child Health Hospital's List of Key Monitoring Drugs.docx
Attachment 1: Zibo Maternal and Child Health Hospital's key monitoring drug management organizations and responsibilities.docx