Rationality Analysis of Off-lable Use in Outpatient and Emergency Department of Cardiology in Children's Specialized Hospital Based on Pre-prescription Review System

OBJECTIVE To evaluate the annual outpatient and emergency prescriptions in cardiology department of children's specialized hospital and to analyze the status of off-lable rational drug use. METHODS Retrospective analysis was used to summarize all the unreasonable positive prescriptions of outpatient and emergency prescriptions in cardiology department in 2021 after the daily review by the pre-prescription review system. The unreasonable false positive prescriptions were jointly reviewed by both pharmacists and physicians. Then, off-lable drug use was further determined based on evidence-based medical evidence and statistical analysis was conducted with Excel software. RESULTS A total of 84 821 prescriptions in outpatient and emergency department of cardiology in 2021 were collected, and 335 unreasonable positive prescriptions were obtained from the reviewed of rational drug use software, involving 360 drug information items. After the clinical pharmacist and physicians in pediatric cardiovascular specialty jointly reviewed the positive unreasonable prescriptions screened out by the pre-review system, 169 false positive and unreasonable prescriptions were determined. The 189 items of medical orders were involved. The main reasons for false positives were that the pediatric off-label drug use had not been improved in the system, and the system was unable to review the clinical special notes of prescription orders, resulting in system misjudgment. Excluding systematic misjudgments, 144 items of off-label drug use were accumulated, Including 81(56.25%) off-lable indications, 45(31.25%) off-lable usage and dosage, 8(5.56%) off-lable repeated medication, 8(5.56%) off-lable drug interactions and 2(1.39%) off-lable routes of administration. CONCLUSION Off-label drug use exists in pediatric cardiology department, mainly manifested as off-label indication and off-lable usage and dosage. In order to further standardize the rational drug use, hospital can constantly improve the standardized management and system rules of off-label drug use, so as to comprehensively promote the rational and standardized drug use in clinic.