中国临床药学杂志

目的 探讨临床药师主导的PDCA循环管理法在吸入用布地奈德混悬液适应证管理中的应用效果，以促进吸入用布地奈德混悬液的临床合理用药。方法 分别收集2023年10至12月（干预前）、2024年2至4月（第1次干预阶段）和2024年5至7月（第2次干预阶段）儿科门急诊开具的吸入用布地奈德混悬液处方。以干预前处方作为基线数据，统计布地奈德用药的适应证分布，采用Micromedex的Thomson分级系统进行评价。对有循证医学证据支持的布地奈德超说明书用药适应证按照医院超说明书用药管理流程进行备案，并设置布地奈德精细化超说明书用药审方规则。2024年2月起临床药师利用PDCA循环管理法对布地奈德用药适应证进行管理，比较干预前和干预后的月均用药金额和处方适应证合理率，以及第1次干预阶段和第2次干预阶段审方效能变化。结果 经过2次干预，与干预前比较，吸入用布地奈德混悬液的适应证合理率从（18.93±3.61）%提升至（80.93±2.12）%；月均用药金额由48 153.84元降至21 465.04元（P<0.05）；与干预前比较门急诊处方中布地奈德适应证的审核率从36.13%降至9.22%(P<0.05)，审核后医师修改率从9.08%提高至72.41%(P<0.05)。结论 将临床药师主导的PDCA循环管理法应用于吸入用布地奈德混悬液适应证的管理中可以有效提高吸入用布地奈德的用药合理性，降低医疗成本，提高审方效率，值得推广。

AIM To investigate the effectiveness of a clinical pharmacist-led PDCA cycle management approach in the indication-specific management of budesonide suspension for inhalation, aiming to promote its rational clinical use. METHODS Prescriptions for budesonide suspension for inhalation were collected from pediatric emergency and outpatient departments during 3 distinct periods: October to December 2023(pre-intervention), February to April 2024(first intervention phase), and May to July 2024(second intervention phase). Using the pre-intervention prescriptions as baseline data, the distribution of indications for budesonide was analyzed and evaluated using the Thomson classification system from Micromedex. For evidence-supported off-label indications, documentation was completed based on the hospital's offlabel medication management protocol, and refined prescription review rules for off-label budesonide use were established. From February 2024, a PDCA cycle intervention was implemented by clinical pharmacists, with key indicators such as the monthly average drug cost, indication rationality rate, and overall prescription rationality rate compared before and after the intervention, as well as the changes in the efficacy of prescription audit in the two-stage intervention. RESULTS The rationality rate of budesonide indications improved significantly from(18.93 ± 3.61)%(pre-intervention) to(80.93 ± 2.12)%(post-intervention, P < 0.05). The monthly average drug cost decreased from 48 153.84 Yuan to 21 465.04 Yuan(P < 0.05). Compared with the prior intervention, the off-label prescription review rate among outpatient and emergency cases dropped from 36.13% to 9.22%(P < 0.05), while the revision rate of prescriptions by physicians after pharmacist review increased from 9.08% to 72.41%(P < 0.05). CONCLUSION The clinical pharmacist-led PDCA cycle management approach, combined with evidence-based medicine, effectively standardizes the use of budesonide indications, prevents irrational use of budesonide suspension for inhalation, reduces healthcare costs, and enhances the efficiency of prescription audit, which is worthy of promotion.