# Establishment, maintenance and application effect analysis of the prescription pre-review system in a tertiary hospital in China

## TL;DR

A prescription pre-review system was implemented in a Chinese hospital to improve medication safety and reduce irrational prescriptions.

## Contribution

The study introduces a prescription pre-review system with 7 warning levels and 3015 rules to standardize prescribing practices.

## Key findings

- The number and proportion of unreasonable prescriptions decreased significantly after implementing the PPRS.
- Monthly evaluations showed a consistent decline in irrational prescriptions during the study period.
- The system improved prescription rationality and pharmacist involvement in patient care.

## Abstract

Implementing a full-sample prescription review system has become imperative for hospitals to address the limitations of post-review practices and ensure patient medication safety. In this study, we investigate the preliminary application impact of the prescription pre-review system (PPRS)and its rules maintenance in our hospital, while also evaluating the pharmaceutical service value resulting from the implementation of prescription pre-review.

We incorporated levels of prescribing warnings into the PPRS, while establishing and maintaining a database of appropriate medication practices. In addition, we evaluated the rationality of intravenous infusion prescriptions and key monitored drug prescriptions before and after the implementation of PPRS, and briefly evaluated the irrational prescriptions.

A comprehensive range of 7 warning levels was established, reflective of the degree of prescription irrationality. Besides, a total of 3015 user rules were created to regulate medication behavior. The number and proportion of unreasonable prescriptions during January to March 2023 demonstrated a noteworthy reduction when compared to the corresponding period in 2022. Moreover, the continuous evaluation of systematic alert prescriptions during January to March 2023 indicated a remarkable monthly decline.

The introduction of the PPRS has ushered in a paradigm shift in the evaluation of prescription rationality. This transformative system has played a pivotal role in standardizing doctor’s prescribing patterns, thereby promoting the rational utilization of drugs in clinical practice. By ensuring patient safety, elevating the quality of care, and enhancing the value of pharmacists, the PPRS has emerged as a catalyst for positive change in the healthcare setting.

The online version contains supplementary material available at 10.1186/s12913-025-12901-8.