【摘要】 目的 通过构建病区医嘱前置审核平台，协助专科临床药师在一级药学监护的基础上开展个性化医嘱审核，以提升合理用药精细化管理水平。方法 专科临床药师从患者疾病特点、重点监控指标和药物相关因素制定分级药学监护计划。通过改造后的信息平台，选择实际进行一级药学监护的住院患者为干预对象，实施全医嘱前置审核，并对比分析平台实施前(2022年1—6月)与实施后(2023年1—6月)的住院医嘱干预效果和质量。结果 实施后的医嘱干预成功率33.57%，对比实施前的12.86%，提升了20.71%，差异有统计学意义(P<0.05)。医嘱不合理问题数由实施前的36个降为实施后的9个，下降了75%，差异有统计学意义(P<0.05)。前置审核中双签通过率下降了34.29%，必须修改、双签复核及通过概率有所提升。同时，药师、医生沟通频率提升了31.43%，其中，面对面沟通频率提升35.71%。结论 病区医嘱、前置审核该平台不仅优化了药师资源配置，提升了合理用药水平，并为临床药师的绩效考核提供参考，具有推广价值。更多还原

【Abstract】 Objective This study aims to establish a pre-prescription review platform in hospital wards to assist specialized clinical pharmacists in conducting personalized order reviews based on primary pharmaceutical monitoring,thereby improving the precision management of rational medication use.Methods Specialized clinical pharmacists developed a graded pharmaceutical monitoring plan based on patient disease characteristics,key monitoring indicators,and drug-related factors.Using the upgraded information platform,hospitalized patients under primary pharmaceutical monitoring were selected as the intervention group.A comprehensive pre-prescription review was conducted,and the intervention effects and order quality were compared between the periods before (January to June 2022) and after (January to June 2023) platform implementation.Results After platform implementation,the success rate of order interventions increased to 33.57%,20.71% improvement compared to the pre-implementation rate of 12.86%,with a statistically significant difference (P<0.05).The number of unreasonable orders decreased from 36 to 9,the number of inappropriate prescriptions decreased by 75%，also showing a statistically significant difference (P<0.05).The dual-signature approval rate in pre-prescription reviews decreased by 34.29%,while the rates of required modifications,dual-signature recheck,and approvals increased.Additionally,communication frequency between pharmacists and doctors increased by 31.43%,with face-to-face communication rising by 35.71%.Conclusion The platform not only optimized the allocation of pharmacist resources and improved the rational use of medications but also provided a reference for the performance evaluation of clinical pharmacists,demonstrating significant potential for broader application.更多还原