Guo Yuanyuan, Bu Yishan, Zhang Yi
Department of Pharmacy, Tianjin First Central Hospital, Tianjin, People's Republic of China.
Risk Manag Healthc Policy. 2025 Sep 10;18:2991-3007. doi: 10.2147/RMHP.S542186. eCollection 2025.
To explore the application of Lean Six Sigma (LSS) combined with pre-prescription review system in reducing the irrational rate of emergency prescriptions.
The emergency prescriptions of our hospital in May 2022 to May 2023 and June 2023 to December 2024 were selected as the research objects. Based on the pre-prescription review system and LSS, a comparative analysis was carried out regarding the irrational rate of emergency prescriptions, the changing trend of the irrational rate, the types of irrational prescriptions and their departmental distribution, patients' satisfaction, and the proportion of doctors' returning and modifying irrational prescriptions before and after the implementation of intervention measures.
After the adoption of LSS and Review system, the irrational rate of emergency prescriptions was significantly reduced (<0.001); The irrational prescription rate decreased by 0.07% (<0.001, 95% CI=[-0.06, 0.20]) month by month; The main types of irrational prescriptions remained unchanged, but except for combination medication, incompatibility and repeated medication, all types of irrational prescriptions were significantly lower than those before the intervention (<0.05); Before and after the intervention, the irrational prescriptions were mainly issued by emergency internal medicine and urology emergency department, and the pediatric emergency department increased after the intervention; Patients' satisfaction was significantly improved after intervention (<0.05); The proportion of physicians returning to correct irrational prescriptions increased significantly after the intervention (<0.001).
LSS combined with pre-prescription review system can effectively reduce the irrational rate of emergency prescriptions, optimize emergency medication management, and ensure patient medication safety.
探讨精益六西格玛（LSS）结合处方前置审核系统在降低急诊处方不合理率中的应用。
选取我院2022年5月至2023年5月以及2023年6月至2024年12月的急诊处方作为研究对象。基于处方前置审核系统和LSS，对干预措施实施前后急诊处方不合理率、不合理率变化趋势、不合理处方类型及其科室分布、患者满意度以及医生退回修改不合理处方的比例进行对比分析。
采用LSS与审核系统后，急诊处方不合理率显著降低（<0.001）；不合理处方率逐月下降0.07%（<0.001，95%CI=[-0.06, 0.20]）；不合理处方主要类型未变，但除联合用药、配伍禁忌和重复用药外，各类不合理处方均显著低于干预前（<0.05）；干预前后，不合理处方主要由急诊内科和泌尿外科急诊开具，干预后儿科急诊有所增加；干预后患者满意度显著提高（<0.05）；干预后医生退回修改不合理处方的比例显著增加（<0.001）。
LSS结合处方前置审核系统可有效降低急诊处方不合理率，优化急诊用药管理，保障患者用药安全。
