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To analyze the rationality of outpatient and emergency nebulization medication prescriptions in a tertiary pediatric specialty hospital based on the hospital’s rational drug use system, identify the main types, distribution characteristics, influencing factors of irrational prescriptions, and provide evidence for standardizing clinical medication use.
All outpatient and emergency prescriptions containing nebulized drugs from January to December 2024 were collected. Prescriptions were initially screened using the Puhua Hecheng rational drug use system, followed by manual review by pharmacists according to standards such as the "clinical practice guidelines for nebulized inhalation therapy in pediatric respiratory diseases (2024 edition)". A retrospective analysis was conducted on irrational prescriptions.
A total of 233 736 prescriptions were included. Initial screening identified 8 569 positive irrational prescriptions, and after review, 3 681 were confirmed as true positive irrational prescriptions, resulting in an overall irrationality rate of 1.57% (3 681 prescriptions/233 736 prescriptions). Irrational prescriptions were mainly from outpatient departments 70.33% (2 589 prescriptions/3 681 prescriptions), with emergency departments accounting for 29.67% (1 092 prescriptions/3 681 prescriptions). School-age children (36.00%, 1 325 prescriptions/3 681 prescriptions) and preschool children (35.51%, 1 307 prescriptions/3 681 prescriptions) were the high-risk groups. The departmental distribution showed a "long-tail distribution," with the top 10 departments accounting for 60.69% (2 234 prescriptions/3 681 prescriptions), primarily the respiratory center, gastroenterology department, and internal medicine teaching and research department. Among irrational prescription types, inappropriate indication was the most common (86.80%, 3 853 cases/4 439 cases), followed by inappropriate usage and dosage (9.89%,439 cases/4 439 cases), duplicate medication (1.85%, 82 cases/4 439 cases) and inappropriate route of administration (1.46%, 65 cases/4 439 cases). Among medication categories, inhaled corticosteroids (71.13%, 3 065 cases/4 309 cases) had the highest incidence of issues, with budesonide suspension for inhalation accounting for 60.43% (2 604 cases/4 309 cases), followed by bronchodilators, with ipratropium bromide solution for inhalation accounting for 23.25% (1 002 cases/4 309 cases).
The overall rationality of nebulized drug prescriptions in the outpatient and emergency departments of the hospital is favorable. Irrational medication issues are dominated by inappropriate indications, mainly concentrated in young children and departments with high-frequency use of nebulized drugs. To improve the rationality of clinical medication, a full-process management system of "prevention-control-optimization" should be established by strengthening guideline training, optimizing audit rules of the rational drug use system, and enhancing targeted management in key departments.
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| 科 Family | 属数 Number of genus | 种数 Number of species | 占总种数比例 Percentage of total species (%) | 属 Genus | 种数 Number of species | 占总种数比例 Percentage of total species (%) |
|---|---|---|---|---|---|---|
| 鹅膏菌科Amanitaceae | 2 | 11 | 5.26 | 鹅膏菌属 Amanita | 10 | 4.78 |
| 小菇科 Mycenaceae | 2 | 12 | 5.74 | 丝盖伞属 Inocybe | 5 | 2.39 |
| 多孔菌科 Polyporaceae | 8 | 14 | 6.70 | 蜡蘑属 Laccaria | 5 | 2.39 |
| 红菇科 Russulaceae | 3 | 23 | 11.00 | 小皮伞属 Marasmius | 6 | 2.87 |
| 小菇属 Mycena | 11 | 5.26 | ||||
| 光柄菇属 Pluteus | 5 | 2.39 | ||||
| 红菇属 Russula | 17 | 8.13 | ||||
| 栓菌属 Trametes | 5 | 2.39 |
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