某三级综合医院开展抗菌药物管理的过程质量评价研究

发布时间：2018-08-17 16:32

【摘要】：目的:为改进抗菌药物管理的过程质量提供参考。方法:基于国际上施行的抗菌药物科学化管理(AMS)策略目标,依据"结构-过程-结果"医疗质量评价模型中的过程质量评价方法,对某三级综合医院2011-2016年抗菌药物管理中实施干预的基本情况及所涉及科室、干预类型、干预原因、干预涉及的药品种类等进行统计,并对干预前(2011年)和干预后(2014年)的门诊、急诊和住院患者抗菌药物使用比例、Ⅰ类切口手术患者预防使用抗菌药物比例等相关指标进行评价。结果:共收集2 137例次干预记录;干预涉及的科室以外科为主,包括妇科、耳鼻喉科、骨科等12个外科科室(占55.97%);干预类型中,对药物使用种类的干预较高(占44.77%);干预原因以用法用量不适宜、提高治疗效果、溶剂用量不合理、开具处方未写临床诊断或临床诊断书写不全、适应证不适宜、重复给药等为主(占90.55%);干预涉及的药物以β-内酰胺类(包括碳青霉烯类)及其酶抑制剂为主(占62.43%)。干预后,门诊、急诊和住院患者的抗菌药物使用率分别由27.70%、49.42%和60.42%下降至17.57%、38.65%和47.21%;Ⅰ类切口手术患者预防使用抗菌药物比例由85.75%下降至30.33%;预防使用抗菌药物24 h的手术占预防使用抗菌药物总例数的比例由54.52%上升至68.84%(均P0.05);门诊、住院患者平均抗菌药物费用分别由(30.12±10.19)、(727.36±120.45)元下降至(30.03±1.34)、(609.32±48.83)元。但还存在一些问题,包括缺乏对药物使用经济性的干预,缺少多学科协作管理、信息系统不完善等延缓了抗菌药物专业化管理的推进等。结论:该院应借鉴AMS策略,建立多学科的管理机制加强抗菌药物使用的过程管理,充分发挥信息系统在抗菌药物使用管理中的作用,并加大对抗菌药物使用经济性的干预,以实现抗菌药物管理过程的专业化。
[Abstract]:Objective: to provide reference for improving the process quality of antimicrobial drug management. Methods: based on the (AMS) strategy of scientific management of antimicrobial drugs in the world, the evaluation method of process quality was used in the medical quality evaluation model of "structure-process-result". The basic situation of the intervention in the management of antimicrobial drugs in a tertiary general hospital from 2011 to 2016 and the departments involved, the types of intervention, the causes of intervention, the types of drugs involved in the intervention, and the outpatient clinics before (2011) and after the intervention (2014) were analyzed. The proportion of antimicrobial agents used in emergency and inpatients and the proportion of prophylactic use of antimicrobial agents in patients undergoing incision operation were evaluated. Results: a total of 2,137 intervention records were collected, and the departments involved were mainly surgical departments, including gynecology, otolaryngology, orthopedics and other 12 surgical departments (55.97%). The intervention of drug use type was higher (44.77%), the reason of intervention was that the dosage of usage was not appropriate, the effect of treatment was improved, the dosage of solvent was unreasonable, the prescription was not written clinical diagnosis or the writing of clinical diagnosis was not complete, and the indication was not suitable. The main drugs involved in the intervention were 尾-lactam (including carbapenem) and its enzyme inhibitors (62.43%). After the intervention, the outpatient service, The antimicrobial use rate of emergency and inpatient patients decreased from 27.70% to 49.42% and 60.42% to 17.577.65% and 47.21% respectively. The proportion of total bacterial drug cases increased from 54.52% to 68.84% (P0.05). The average antimicrobial cost of inpatients decreased from (30.12 卤10.19), (727.36 卤120.45) to (30.03 卤1.34), (609.32 卤48.83). However, there are still some problems, including the lack of economic intervention in drug use, the lack of multidisciplinary cooperative management, the imperfection of information system, and so on, which delay the promotion of specialized management of antimicrobial agents. Conclusion: the hospital should draw lessons from the AMS strategy, establish a multidisciplinary management mechanism to strengthen the process management of the use of antimicrobial agents, give full play to the role of information system in the management of the use of antibiotics, and increase the economic intervention in the use of antimicrobial agents. In order to realize the specialization of antimicrobial drug management process.
【作者单位】：南京医科大学药学院;江阴市人民医院药学部;
【基金】：国家自然科学基金资助项目(No.71673147)
【分类号】：R95

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