摘要
目的:为医院管控泌尿外科围手术期抗菌药物的预防使用提供参考。方法:针对某院泌尿外科围手术期抗菌药物预防使用中的不合理现象,以Ⅱ类切口手术及特殊诊疗预防用药为例,通过制订手术类型风险分级制度、形成不同感染风险的Ⅱ类切口手术及尿路结石手术等围术期用药临床路径、建立追踪监督机制等建立院内泌尿外科围手术期预防用抗菌药物的管控模式并进行干预;比较干预前后3个月内泌尿外科抽取的相关手术病历(干预前186份、干预后179份)中抗菌药物预防使用率等围手术期预防用药的合理性指标,以及泌尿外科干预前、后3个月内的抗菌药物使用强度(AUD)、抗菌药物使用金额等,评估管控效果。结果:在抽查病历中,与干预前比较,干预后抗菌药物预防使用率由97.3%(181/186)降低至91.6%(164/179)、药物选择合理率由17.7%(32/181)升高至71.3%(117/164)、给药时机正确率由9.9%(18/181)升高至32.3%(53/164)、术后预防疗程合理率由17.1%(31/181)升高至37.2%(61/164),差异均有统计学意义(P<0.05或P<0.01)。干预后泌尿外科3个月AUD平均值从约83 DDD降至约70 DDD,抗菌药物使用金额平均值从689 669.23元下降至531 040.11元。结论:建立的Ⅱ类切口手术及特殊诊疗围术期抗菌药物预防使用的管控模式,有效地降低了泌尿外科抗菌药物预防使用率、AUD、抗菌药物金额,促进了围手术期抗菌药物的合理应用。
OBJECTIVE:To provide reference for perioperative prophylactic use of antibiotics in urinary surgery department.METHODS:In response to irrational perioperative prophylactic use of antibiotics in urinary surgery department,taking type Ⅱincision surgery and special diagnosis and treatment and preventive drug use as an example,the management and control mode for perioperative prophylactic use of antibiotics was established and intervened in urinary surgery department so as to intervene in antibiotics use through formulating surgical type risk classification system,forming perioperative medication clinical pathways such as type Ⅱ incision surgery and urinary calculi surgery with different infection risk, establishing tracking and supervision mechanism. The rationality indexes of perioperative prophylactic medication such as the rate of prophylactic antibiotics use were compared among related medical records collected from urinary surgery department within 3 months before and after intervention(186 records before intervention,179 records after intervention). Antibiotics use density(AUD) and amount of antibiotics in urinary surgery department were compared within 3 months before and after intervention to evaluate management and control effect.RESULTS:Among surveyed medical records,compared with before intervention,the rate of prophylactic antibiotics use was decreased from 97.3%(181/186)to 91.6%(164/179);the rate of rational drug selection was increased from 17.7%(32/181)to71.3%(117/164);correct rate of medication timing was increased from 9.9%(18/181)to 32.3%(53/164);the rate of rational post-operative prevention course was increased from 17.1%(31/181)to 37.2%(61/164),with statistical significance(P<0.05 or P<0.01). Average AUD was deceased from 83 DDD to 70 DDD within 3 months after intervention,and the amount of antibiotics was decreased from 689 669.23 yuan to 531 040.11 yuan. CONCLUSIONS:Established management and control mode for perioperative prophylactic use of antibiotics in type Ⅱ incision surgery and special diagnosis and treatment and preventive drug use can effectively reduce the rate of prophylactic antibiotics,AUD and amount of antibiotics in urinary surgery department,and promote rational use of antibiotics during perioperative period.
作者
亓志刚
贺晴
陆一
沈崇德
金柯
董亮
张秀红
QI Zhigang;HE Qing;LU Yi;SHEN Chongde;JIN Ke;DONG Liang;ZHANG Xiuhong(Dept. of Pharmacy,Wuxi People’s Hospital Affiliated to Nanjing Medical University,Jiangsu Wuxi 214023,China;Wuxi People’s Hospital Affiliated to Nanjing Medical University,Jiangsu Wuxi 214023,China;Dept. of Urinary Surgery,Wuxi People’s Hospital Affiliated to Nanjing Medical University,Jiangsu Wuxi 214023,China;Intensive Care Unit,Wuxi People’s Hospital Affiliated to Nanjing Medical University,Jiangsu Wuxi 214023,China)
出处
《中国药房》
CAS
北大核心
2019年第15期2022-2026,共5页
China Pharmacy
基金
江苏省科技项目(No.BK20140122)
江苏省药学会-奥赛康医院药学基金项目(No.A201729)
关键词
抗菌药物
管控模式
泌尿外科
Ⅱ类切口手术
抗菌药物使用强度
Antibiotics
Management and control mode
Urinary surgery department
Type Ⅱ incision surgery
Antibiotics use density
