IMPROVING THE MEDICAL NECESSITY OF CONTROLLED DRUGS IN OUT-PATIENT CLINICAL NOTE

INTRODUCTION:

In Taiwan, part of addictive anesthetic,
psychotropic medications and several kinds of
drugs that were considered necessary to
strengthen management by “Act of the
Administration of Controlled Drugs” and
“Medical Quality and Patient Safety Work
Goals“, that were promulgated by government
agency to control the safety of Controlled
Drugs using over the years.
Articles 12 and 19 of the “Physician Act” and
Articles 6 in “Act of the Administration of
Controlled Drugs” clearly record that doctors
must have a legitimate purpose of treatment
before prescribing controlled drugs, and the
chief complaint must be stated when
prescribing , diagnosis or disease name,
treatment, treatment or medication, and other
necessary information. Therefore, in order to
understand the medical necessity of controlled
drugs, our hospital established an
interdisciplinary team to analyze and improve
the clinical note of controlled drugs.

METHOD:

Randomly select outpatient
controlled drugs records for
whole week every quarter, and
random sampling at most three
clinical note from each doctor,
and use the Likert Scale to
score the detail in clinical note
that mentioned the condition to
use the controlled drugs, and
through the Student's t-test to
conduct drill-down analysis by
physician, department, and
drug types.

KEYWORD:

CLINICAL NOTE、CONTROLLED DRUGS、
MEDICAL NECESSITY

RESULTS:

The first time of scoring the medical necessity of
controlled drugs was 1.93 points. Due to the situation,
interdisciplinary team started several interventions：
1. Submitting the individual resultsts to each doctor,
that them known the scoring criteria.
2. Ranking the resultsts and publishing in the meeting
that whole hospital‘s directors participated.
3. Focus on the physicians who with one score and
prescribing numerous controlled drugs at the same
time, and discussing the results face to face.
4. Publication of excellent medical records. Providing
advice on medical record.
After three cycles of scoring and interventions. The
latest scoring result of the hospital's overall average is
2.27 points. (P values were 0.001 and 0.008)

FINDINGS AND DISCUSSION:

"Medical Necessity"refers to the avoidance of medical
waste, excessive medical treatment, and ineffective
medical treatment. Although the actual record and
content of the clinical note may vary depending on the
individual doctor. After several interventions by
interdisciplinary team, there is a significant improvement
in the scoring results of physicians and departments. In
order to achieve the purpose of avoiding medical waste
and excessive medical treatment.