PDCA循环管理干预骨科Ⅰ类切口手术围术期抗菌药物预防应用的效果评价

发布时间：2018-10-31 09:02

【摘要】：目的:评价PDCA循环管理干预骨科Ⅰ类切口手术围术期抗菌药物预防应用的效果。方法:采用回顾性分析方法,选取我院PDCA循环管理干预前(2013年1-12月,干预前组)512例、第1轮PDCA循环管理干预后(2014年1-12月,第1轮干预组)861例和第2轮PDCA循环管理干预后(2015年1-12月,第2轮干预组)1 070例行骨科Ⅰ类切口手术患者的出院病历,对比分析持续干预前后围术期抗菌药物预防应用情况。结果:经2轮PDCA循环管理干预后,我院骨科内固定术的构成比显著增加,抗菌药物使用率、品种合理率、术前0.5~1h用药率、疗程合理率和有指征使用抗菌药物的比例分别由干预前的50.20%、98.08%、93.77%、6.61%和82.10%上升至58.41%、100%、99.04%、52.00%和99.04%;预防用抗菌药物的品种由干预前的4种减少到2种,且选用头孢唑啉的比例较干预前显著增加,选用克林霉素的比例显著下降;术后预防用药疗程由干预前的(4.63±2.42)d缩短至(1.61±0.75)d,且用药疗程24h和疗程为24~48 h的患者比例显著升高,疗程72 h的患者比例显著下降,差异均有统计学意义(P0.05)。结论:PDCA循环管理提高了我院骨科Ⅰ类切口手术围术期抗菌药物预防应用的合理率;但我院预防用抗菌药物的疗程尚未完全控制在24h以内,有待进一步持续干预。
[Abstract]:Objective: to evaluate the effect of PDCA circulation management on perioperative antimicrobial application in orthopedic incision. Methods: by retrospective analysis, 512 cases of PDCA circulatory management intervention before intervention (January to December 2013, pre-intervention group) were selected, after the first round of PDCA cycle management intervention (January to December 2014). 861 patients in the first round intervention group and 1 070 patients in the second round PDCA circulation management intervention group (January to December 2015, second intervention group) were discharged from hospital after orthopedic type I incision operation. The application of antimicrobial agents in perioperative period before and after continuous intervention was compared and analyzed. Results: after two rounds of PDCA circulatory management intervention, the composition ratio of orthopedic internal fixation in our hospital increased significantly, the utilization rate of antimicrobial agents, the reasonable rate of variety, and the rate of administration 0.5 h before operation were significantly increased. The reasonable rate of treatment and the proportion of antimicrobial agents with indications increased from 50.20 and 98.08 to 58.41% and 99.04%, respectively, from 6.61% and 82.10% to 58.41% and 99.04%, respectively. The variety of prophylactic antibiotics decreased from 4 before intervention to 2, and the proportion of cefazolin and clindamycin decreased significantly compared with those before intervention. The course of prophylactic medication was shortened from (4.63 卤2.42) days before intervention to (1.61 卤0.75) days after intervention, and the proportion of patients who had a course of 24 hours and a course of treatment of 24 ~ 48 hours was significantly increased, and the proportion of patients with 72 hours of treatment decreased significantly. The difference was statistically significant (P0.05). Conclusion: PDCA circulation management has improved the rational rate of prophylactic use of antibiotics in perioperative period of orthopedic incision, but the course of treatment of prophylactic antibiotics in our hospital has not been completely controlled within 24 hours, and further continuous intervention is needed.
【作者单位】：南宁市第一人民医院药学部;桂林医学院药学院;
【分类号】：R969.3;;R978.1

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