摘要
目的:评价采取专项处方点评模式干预对我院清洁手术围术期抗菌药物预防使用的效果。方法:通过采取成立专家组和处方点评小组、统一制订的清洁手术围术期预防使用抗菌药物点评表、参考《抗菌药物临床应用指导原则(2015年版)》《关于进一步加强抗菌药物临床应用管理工作的通知》等文件和相关药品说明书设立点评标准、借助行政干预和质量考核等干预措施,建立专项处方点评模式,采用分层抽样方法(按科室、手术种类分层)抽取我院2015年1-6月(干预前)与2016年1-6月(干预后)的清洁手术患者出院病历各180份,制订统一的清洁手术围术期专项处方点评表,分别从抗菌药物预防使用率、用药指征、给药时机、药品选择、用法用量、用药疗程、联合用药等方面对纳入的每份病历进行点评。结果:我院清洁手术围术期抗菌药物预防使用率从干预前的96.7%下降至干预后的25.0%(P<0.05),无用药指征率、术前给药时机不合理率、药品选择不合理率、用法用量不合理率、用药疗程不合理率、联合用药不合理率分别从干预前的71.3%、72.4%、65.5%、23.0%、97.1%、17.8%下降至干预后的4.4%、0、8.9%、11.1%、22.2%、0(P<0.05)。干预前,我院清洁手术围术期抗菌药物预防使用共涉及8大类20个品种,有86例患者使用了2种及以上的抗菌药物,其中31例为联合用药,55例为前后更换药品。干预后,我院清洁手术围术期抗菌药物预防使用共涉及3大类4个品种,无联合用药和前后更换药品。结论:专项处方点评模式可以明显提高我院清洁手术围术期抗菌药物合理用药水平。
OBJECTIVE：To evaluate the effects of special prescription comment model intervention on prophylactic application of antibiotics during perioperative period of clean operation in our hospital. METHODS： By founding specialist group and prescription comment group,formulating unified form for evaluating prophylactic application of antibiotics during perioperative period of clean operation,establishing comment criteria referring to Guidelines for Clinical Antibiotics Use（2015 edition）,Noticeon Further Strengthening the Management of Clinical Antibiotics Use, drug package inserts and so on; havivg the aid of administrative intervention and quality assessment,The special prescription comment model was established.Based on stratified sampling（according to the clinical departments,kind of procedure）,Each 180 medical records were collected from our hospital during Jan.-Jun. 2015（before intervention） and Jan.-Jun. 2016（after intervention）. The unified form for perioperative period of clean operation was formulated to comment each medical record in respects of prophylactic utilization rate of antibiotics,medication indication, medication timing, drug selection, usage and dosage, medication course, drug combination, etc.RESULTS：After the following intervention measures were adopted,such as The prophylactic utilization rate of antibiotics of our hospital during perioperative period of clean operation decreased from 96.7% before intervention to 25.0% after intervention（P〈0.05）. The rates of drug use without indication,irrational medication timing before surgery,irrational drug selection,irrational usage and dosage,irrational medication course and irrational drug combination were decreased from 71.3%,72.4%,65.5%,23.0%,97.1%,17.8% before intervention to 4.4%,0,8.9%,11.1%,22.2%,0 after intervention（P〈0.05）respectively.Before intervention,8 categories 20 kinds of antibiotics were used prophylactically in our hospital during perioperative period of clean operation;86 patients used 2 kinds of or more antibiotics,among which there were 31 cases of drug combination and 55 cases of drug replacement. After intervention,3 categories 4 kinds of antibiotics were used prophylactically in our hospital during perioperative period of clean operation; there was no drug combination and drug replacement. CONCLUSIONS： Special prescription comment model can obviously improve rational use of antibiotics during perioperative period of clean operation.
出处
《中国药房》
CAS
北大核心
2018年第3期293-297,共5页
China Pharmacy
基金
重庆市卫生和计划生育委员会医学科研项目(No.2017MSXM193)
关键词
清洁手术
围术期
抗菌药物
专项处方点评模式
干预
Clean operation
Perioperative period
Antibiotics
Special prescription comment model
Intervention
