目的: 分析医院门急诊不合理处方用药原因与对策,为合理用药提供参考。方法: 抽取医院 2020 年 1 月—9 月门急诊处方 28 080 张,依据药品说明书和相关法规等要求,点评与分析其用药的合理性,对不合理处方的原因提出管理对策。结果: 28 080 张处方中,不合理处方 1 333 张,处方不合理率为 4.75%;在不合理处方中,其不合理原因 1 406 例次;其含抗菌药物处方 261 张（占 19.58%）,含中成药处方 379 张（占 28.43%）,处方平均药品数为（2.83±1.97）种;不合理处方 TOP 5 的科室为普通内科（18.90%）、皮肤科（9.83%）、眼科（8.10%）、耳鼻咽喉科（7.88%）和妇科（5.48%）;不合理处方主要类型有：处方未写明“临床诊断”或临床诊断书写不全的 413 例次（占29.37%）;用法、用量不适宜的 206 例次（占 14.65%）;适应证不适宜的 192 例次（占 13.66%）;联合用药不适宜的 151 例次（占 10.74%）;用法、用量含糊不清的 114 例次（占 8.11%）;医师未按照《抗菌药物临床应用指导原则》中管理规定,开具抗菌药物处方的 88 例次（占 6.26%）。结论: 医院处方质量总体较好,不合理的突出问题有待改进,应定期开展处方用药合理性点评,以确保患者用药的安全性和有效性。

Objective: To analyze the causes of unreasonable reasons drug usage in outpatient and emergency departments and their countermeasures, and to provide reference for rational drug usage. Methods: A total of 28 080 prescriptions of outpatient and emergency were selected from the hospital from January to September 2020. According to the drug instructions and relevant regulations, the rationality of drug use was evaluated and analyzed, and management countermeasures were put forward for the causes of unreasonable prescriptions. Results: In 28 080 prescriptions, 1 333 prescriptions were unreasonable, and the rate of irrational prescriptions was 4.75%. Among the unreasonable prescriptions, there were 1 406 cases of unreasonable reasons. There were 261 prescriptions containing antibacterials (19.58%), 379 prescriptions containing Chinese patent medicine (28.43%), and the average number of drugs was (2.83±1.97) kinds. The TOP 5 departments with unreasonable prescriptions were general internal medicine (18.90%), dermatology (9.83%), ophthalmology (8.10%), otolaryngology (7.88%) and gynecology (5.48%). The main types of unreasonable prescriptions were as follows: 413 cases did not specify "clinical diagnosis" or incomplete clinical diagnosis, accounting for 29.37%;206 cases of improper usage and dosage accounted for 14.65%. The proportion of unsuitable indications was 13.66% in 192 cases.151 cases (10.74%) were unsuitable for combined drug usage. The usage and dosage were unclear in 114 cases (8.11%). Physicians did not comply with the management provisions in the "Guiding Principles for Clinical Application of Antibacterials", and 88 cases of antibacterials prescriptions were issued, accounting for 6.26%. Conclusions: The overall quality of hospital prescriptions is good, but the prominent unreasonable problems need to be improved. The regular evaluation on the rationality of prescription medication should be carried out to ensure the safety and effectiveness of medication for patients.