Shephard M K, Nova C Venda, Thakrar P, Hodgson T
Eastman Dental Hospital, University College London Hospitals NHS Trust and Eastman Dental Institute, University College London.
Br Dent J. 2017 Dec;223(9):693-698. doi: 10.1038/sj.bdj.2017.887. Epub 2017 Oct 27.
Introduction Prescribing checklists are a means of managing risk related to systemic medications in oral medicine practice.Methods Checklists for workup and monitoring for azathioprine, mycophenolate mofetil (MMF) and dapsone were introduced to an oral medicine clinic. Compliance with the checklists was audited at six and 12-24 months post introduction, and compared to previous clinical practice.Results Azathioprine: compliance with viral serology screening improved from <10% to over 80% at 6 months post checklist introduction, and was 100% at 12 months. Documentation of counselling improved from 48% to 85% at six months, and was 100% at 12 months. Compliance with tuberculosis risk assessment improved from 5% to 50% at six months but declined to 4% at 12 months. Compliance with monitoring blood tests improved slightly. MMF: compliance with viral serology screening increased from nil to 100% at six months. Documented evidence of counselling increased from 20% to 100%. Monitoring blood test compliance for the first six weeks of therapy improved. Dapsone: documentation of patient counselling improved from 25% pre-checklist, to 50% at six months and 60% at 24 months. Monitoring blood test compliance improved at six months but had decreased by 24 months.Discussion and conclusion Clinical checklists led to a modest improvement in prescribing safety in our clinics. The usefulness of checklists depends on cultural changes and clinician engagement. Electronic medication safety programs may be a useful future strategy.
引言 处方检查表是口腔医学实践中管理与全身用药相关风险的一种手段。
方法 将硫唑嘌呤、霉酚酸酯（MMF）和氨苯砜的检查和监测检查表引入一家口腔医学诊所。在引入检查表后的6个月以及12 - 24个月对检查表的依从性进行审核，并与之前的临床实践进行比较。
结果 硫唑嘌呤：引入检查表后6个月，病毒血清学筛查的依从性从<10%提高到80%以上，12个月时达到100%。咨询记录在6个月时从48%提高到85%，12个月时达到100%。结核病风险评估的依从性在6个月时从5%提高到50%，但在12个月时降至4%。血液检查监测的依从性略有提高。MMF：病毒血清学筛查的依从性在6个月时从0提高到100%。咨询的书面证据从20%增加到100%。治疗前六周血液检查监测的依从性有所提高。氨苯砜：患者咨询记录从检查表实施前的25%提高到6个月时的50%和24个月时的60%。血液检查监测的依从性在6个月时有所提高，但到24个月时有所下降。
讨论与结论 临床检查表使我们诊所的处方安全性有适度提高。检查表的实用性取决于文化变革和临床医生的参与度。电子药物安全项目可能是未来一种有用的策略。
