杨雪婷　郑鹏程　曹玮

[摘要] 目的 探討PDCA循环法在门诊质子泵抑制剂使用负面清单管理干预中的效果。 方法 以PPIs说明书为依据，参考相关指南、专家共识及文献，建立门诊质子泵抑制剂使用的“负面清单”标准，并按照PDCA循环管理法程序，选取进行PDCA循环干预前（2016年1～3月）及干预后（2017年1～3月）门诊PPIs处方，每月随机抽取500份含有使用PPIs门诊处方，即干预前及干预后各1500例PPIs进行调查，分析干预效果。 结果 建立的负面清单标准包括适应证负面清单，预防用药负面清单，遴选药品负面清单，药品剂型或给药途径负面清单，用法、用量负面清单，联合用药或有不良相互作用负面清单及重复给药负面清单，共8个项目。在PDCA循环管理法下门诊处方PPI总负面清单率从干预前的45.53%（683/1500）下降至干预后的7.93%（119/1500）。其中适应证负面清单率由21.26%下降至3.80%（P<0.05），预防用药负面清单由5.20%下降至0.73%（P<0.05），用法、用量负面清单由9.67%下降至1.53%（P<0.05），联合用药或有不良相互作用负面清单由7.27%下降至1.53%（P<0.05）。本次干预达到了预期的目标值。 结论 PDCA循环管理法在门诊处方质子泵抑制剂负面清单干预中起到明显效果。

[关键词] PDCA循环管理法；质子泵抑制；负面清单；干预

[中图分类号] R954 [文献标识码] C [文章编号] 1673-9701（2018）09-0145-05

Application of PDCA management approach in the intervention of negative list of proton pump inhibitors in outpatient prescription

YANG Xueting1，2 ZHENG Pengcheng1，2 CAO Wei1，2

1.The First People's Hospital of Yunnan Province， Kunming 650032； 2.The Affiliated Hospital of Kunming University of Science and Technology， Kunming 650032

[Abstract] Objective To investigate the effect of PDCA management approach in the intervention of negative list of proton pump inhibitors in outpatient prescription. Methods We established the "negative list" standard for the use of proton pump inhibitors in outpatient departments according to the manual of PPIs and with the reference of relevant guidelines， expert consensus and literature. Outpatient PPIs prescriptions before（from January to March 2016） and after（from January to March 2017） PDCA intervention were selected according to PDCA management procedures. 500 outpatient prescriptions containing PPIs were randomly selected every month. It means that 1，500 PPIs were investigated before and after the intervention to analyze the effect of intervention. Results Established standard of negative lists included a total of 8 projects： the negative list of indications， the negative list of preventive medications， the negative list of selecting medications， the negative list of dosage forms or routes， the negative list of usage and dosage， the negative list of drug combination， the negative list of adverse drug reactions and the negative list of repeated drug use. The total rate of negative lists of PPI in outpatient prescriptions under PDCA management decreased from 45.53% （683/1500） before intervention to 7.93%（119/1500） after intervention. The negative list rate of indications decreased from 21.26% to 3.80%（P<0.05）， and the negative list rate of preventive medications decreased from 5.20% to 0.73%（P<0.05）. The negative list of usage and dosage decreased from 9.67% to 1.53%（P<0.05）. The negative list of drug combination and adverse drug interactions decreased from 7.27% to 1.53%（P<0.05）. The intervention reached the target we expected. Conclusion PDCA management approach has a significant effect in the intervention of negative list of proton pump inhibitors in out-patient prescription.

[eywords] PDCA management approach； Proton pump inhibition； Negative list； Intervention

质子泵抑制剂（proton pump inhibitors，PPIs）为苯并咪唑的替代物，能迅速穿过胃壁细胞膜，作用于H+-K+-ATP 酶，强力抑制胃酸分泌，阻断了胃酸分泌的最后通道，是目前作用最强的胃酸分泌抑制剂。我院应用的PPIs有奥美拉唑、埃索美拉唑、兰索拉唑、泮托拉唑、雷贝拉唑。统计发现我院门诊的PPIs使用存在不合理的情况，甚至出现滥用现象，这些突出问题亟待相应“负面清单”标准来加以规范。“负面清单”标准，是指以负面清单为基础的一整套具体的内容、工具、程序、制度和方法的总称。针对PPIs的使用管理情況，我院引入了PDCA循环管理法，又称质量环，该管理方法由美国质量管理专家W. E. Deming博士提出的。……