Abstract Aim To analyze prescription review results in Beijing and to provide references for improving prescription rationality. Methods This study included outpatient prescriptions which were randomly extracted in Beijing from 2020 to 2022. Drug names were used as search keywords. The changes in prescriptions number and irrationality rate over the past three years were analyzed. Drugs associated with irrational prescriptions were sampled and the reasons for their irrational use were analyzed. Results Approximately 1.9 million prescriptions were sampled for 2020-2021, and more than 4 million prescriptions were sampled for 2022. The proportion of Modern medicine (abbreviated medicine) prescriptions of oncology treatment gradually increased while the proportion of Traditional Chinese Medicine(TCM) prescriptions gradually decreased from 2020 to 2022. The irrationality rate of medicine prescriptions briefly decreased in 2021 before increasing again in 2022. The irrationality rate of TCM prescriptions gradually decreased, and the average irrationality rate of medicine prescriptions was higher than that of TCM. Notably, the rationality of several drugs didn’t improve over the past three years, which included fluorouracil (injection), lobaplatin，bleomycin，Goserelin Acetate Sustained-release Depot ，Pabolizumab，vaginal preparations of recombinant human interferon. Conclusion Prescription review can improve prescription rationality and systematically identify off-label drug use, becoming an important way to expand drug clinical use and improve drug regulatory policies. The use of TCM in oncology treatment is becoming more rational, while the rational use of medicine still needs to be improved. Doctors should regulate their prescribing behavior and strive to increase the rationality of prescriptions.

Objectives Through searching and summarizing the medication-related disputes and claims in Beijing, we found the factors that were most likely to cause disputes during the medication process. These provided a basis for further exploration of medication-related dispute prevention and control measures. Methods We took all medication-related dispute archives from the Beijing People’s Mediation Committee of Medical Disputes（BPMCMD）database from January 2013 to December 2019 as the research object, and used pre-designed forms for data extraction and entry. Results Medication-related disputes accounted for 2.43% of the total number of disputes, of which 158 disputes got the payment from hospitals. There were obviously more disputes between women than men. The most disputes occurred in outpatient clinics, followed by hospitalization and emergency treatment. Disputes were most likely to occur in pharmacy, respiratory medicine, pediatrics, neurology and orthopedics. Antibacterial drugs were the most common drugs that caused disputes, followed by herbal medicines or Chinese patent drugs, antineoplastic drugs, analgesic drugs, psycholeptics drugs and antithrombotic agents. Medication errors mainly concentrated in inappropriate drugs (within guidelines, but otherwise contraindicated); wrong drugs or strength dispensed; drug dose too high and no indications for drug. The main cause of disputes was adverse drug events. The total compensation for seven years was 15.19 million yuan. Conclusions We comprehensively displayed the dispute data from the patient, the doctor, the drug, and the compensation, etc. The research would help Beijing and other regions formulate the strategies to reduce medication errors, improve patient safety, and reduce medication-related dispute

Objectives: A lot of medication risks related to high-dose methotrexate (HDMTX) therapy still remain to be identified and standardized. This study aims to establish an evidence-based practice guideline for individualized medication of HDMTX. Methods: The practice guideline was launched by the Division of Therapeutic Drug Monitoring, Chinese Pharmacological Society. The guideline was developed following the WHO handbook for guideline development and the methodology of evidence-based medicine (EBM). The guideline was initially registered in the International Practice Guidelines Registry Platform (IPGRP-2017CN021). Systematic reviews were conducted to synthesis available evidence. A multicenter cross-sectional study was conducted by questionnaires to evaluate patients’ perception and willingness on individualized medication of HDMTX. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used to rate the quality of evidence and to grade the strength of recommendations. Results: Multidisciplinary working groups were included in this guideline, including clinicians, pharmacists, methodologists, pharmacologists and pharmacoeconomic specialists. A total of 124 patients were involved to integrate patient values and preferences. Finally, the guideline presents 28 recommendations, regarding evaluation prior to medication (renal function, liver function, pleural effusion, comedications, genetic testing), pre-treatment and routine dosing regimen, therapeutic drug monitoring (necessity, method, timing, target concentration), leucovorin rescue (initial timing, dosage regimen and optimization), management of toxicities. Of them, 12 are strong recommendations. Conclusions: We developed an evidence-based practice guideline with respect to HDMTX medication using a rigorous and multidisciplinary approach. This guideline provides comprehensive and practical recommendations involving the whole process of HDMTX medication to health care providers.