基于医院信息系统的海军总医院中药处方评价体系构建

发布时间：2018-05-05 15:53

本文选题：海军总医院 + 中药处方　；参考：《北京中医药大学》2012年硕士论文

【摘要】：近年中药电子处方的普及为中医临床工作带来极大的便利,由其带来的审方模式改变、软件设计缺陷等问题,导致中药电子处方评价出现诸多问题,因此如何构建中药电子处方评价体系日益受到关注。论文包括文献综述和临床药学研究两部分。综述部分系统总结了传统中药处方评价和中药电子处方评价的内容与方法,阐述了中药电子处方的利弊及发展方向。中药电子处方取药流程发生改变先交费后审方,因此存在修改处方繁琐、错误输入增多、软件设计不够“中医化”等弊病,其未来发展动向有：开发合理用药自动提示系统、开发中药电子处方自动监测系统以及中药电子处方标准化建设等。临床药学研究包括两章内容。第一章“海军总医院中药处方管理现状及分析”,该章节首先对海军总医院信息系统的利弊进行了分析。其次随机抽取海军总医院2010年度门诊中药电子处方3600张,以《中华人民共和国药典》《处方管理办法》为标准,从药物剂量、特殊用法、配伍禁忌、药味数量及用药方法等5方面对其进行统计分析。结果：中药处方用药剂量不合格率为90.61%,特殊用法不合格率为29.33%,配伍禁忌不合格率为0.75%,用药方法不合格率为6.17%。处方中10味以下处方占总处方比例为19.33%,10-17味药处方占总处方比例为57.08%,18-21味处方占总处方比例为14.67%,22味以上处方占总处方比例为8.92%。超剂量用药前20味药物有清半夏、当归、柴胡、醋五味子、麦冬、首乌藤、丹参、酒萸肉、白术、郁金、蜜桑白皮、法半夏、黄连等。特殊用法中未脚注的前10味药物分别是薄荷、蜜枇杷叶、石斛、牡蛎、龙骨、砂仁、降香、檀香、石膏、钩藤。配伍禁忌中违反“十八反”、“十九畏”的处方有27张。结果显示,海军总医院存在中药处方不规范现象,而通过构建中药处方评价体系,可以推动海军总医院中药处方向规范化、标准化方向发展。第二章“海军总医院中药处方评价体系构建”。目前绝大部分中药电子处方评价方法仍为手工评价,有些医院甚至尚未建立处方点评制度,且绝大多数的处方评价是回顾性检验,在处方的调剂与发放流程,无法修正不合理用药,因此亟需构建中药电子处方分析和评价体系。该章节以《中华人民共和国药典》(2010年版一部)、《北京中药饮片炮制规范》(2008年版)、《《中药大辞典》为标准,结合海军总医院中药电子处方分析结果,以Microsoft Viaual Studio2010为开发环境,以Access为后台数据库,以C#语言为开发语言。校正中药处方用名,构建中药基本标准信息体系,其中包括中药标准用量信息、配伍及妊娠禁忌标准信息、特殊用法标准信息,并在现有的中药饮片代码基础上增加中药功效码,构建新的中药饮片代码。在以上工作基础上构建医生工作站中的处方提醒信息系统、评价体系用法帮助系统和药房工作站中的电子处方评价系统。初步临床应用显示本评价体系可提高医生开具处方的一次性合格率、提高药房审方的工作效率和准确度,处方评分还可为医生处方质量评价提供客观参考。本课题首次构建了中药电子处方评价体系,部分解决了海军总医院中医电子处方评价中存在的问题,提高了工作效率、提升了用药安全和中医信息化水平。该研究结果可为全国范围内的中药电子处方评价体系构建、中药电子处方标准化建设提供有益的参考。
[Abstract]:The popularization of electronic prescription of Chinese medicine in recent years has brought great convenience to the clinical work of traditional Chinese medicine . It has caused many problems in the evaluation of electronic prescription of traditional Chinese medicine due to the change of the mode of trial prescription and the defect of software design , so how to build the electronic prescription evaluation system of traditional Chinese medicine is becoming more and more attention .

The article includes literature review and clinical pharmaceutical research .

This paper summarizes the contents and methods of traditional Chinese medicine prescription evaluation and electronic prescription evaluation of traditional Chinese medicine , and expounds the advantages and disadvantages of traditional Chinese medicine electronic prescription and the developing direction of traditional Chinese medicine electronic prescription .

This paper analyzes the advantages and disadvantages of the traditional Chinese medicine prescription in the general hospital of the Navy . The results show that the prescription of the traditional Chinese medicine prescription is 90 . 61 % , the proportion of the special usage is 29.33 % , the prescription proportion of the prescription is 14.67 % , the prescription of the medicine is 6.17 % .

In chapter 2 , the traditional Chinese medicine prescription evaluation system is established . Most of the traditional Chinese medicine electronic prescription evaluation methods still have manual evaluation , some hospitals have not even established the prescription evaluation system , and most of the prescription evaluation is the development environment of the traditional Chinese medicine prescription .

The paper constructs the electronic prescription evaluation system for Chinese medicine for the first time , partially solves the problems existing in the traditional Chinese medicine electronic prescription evaluation of the navy general hospital , improves the working efficiency , improves the medicine safety and the traditional Chinese medicine informatization level , and can provide beneficial reference for the construction of the traditional Chinese medicine electronic prescription evaluation system in the whole country , and the standardized construction of the electronic prescription of the traditional Chinese medicine .

【学位授予单位】：北京中医药大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R82

【参考文献】