应用PDCA法践行临床药师主导的抗菌药物联合用药管理

Clinical Pharmacists Dominated Management of Antibiotic Combinations by Using PDCA Method

目的评价临床药师应用计划-执行-检查-处置(PDCA)法践行抗菌药物联合用药管理的效果。方法调查医院2019年1—12月抗菌药物联合用药情况,2020年7—12月运用PDCA法进行临床药师主导的抗菌药物联合用药管理,对比实践前后抗菌药物联用比例,抗菌药物使用金额占比及使用强度等相关指标。结果应用PDCA法后,抗菌药物联合用药管理的目标指标差异有统计学意义(P<0.05)。抗菌药物联合用药比例下降53.1%,其中二联、三联及四联用药比例分别下降48.81%,68.41%和77.90%;抗菌药物使用金额、使用强度和相关不良反应报告数量分别下降23.4%,6.39%和37.3%。在医务处的指导和各临床科室的支持下,通过科学设定各科室的抗菌药物强度目标值,创新抗菌药物联合用药医嘱审核模块,建立重点科室抗菌药物处方审核/点评制度等,构建了临床药师主导的抗菌药物联合用药管控体系。结论临床药师应用PDCA法主导抗菌药物联合用药管理,降低了医院抗菌药物联用比例和不合理率,提高了抗菌药物合理用药水平。

Objective To evaluate the application of PDCA(Plan-Do-Check-Action)cycles to the management of antibiotic combinations in a hospital.Methods The situation of antibiotic combinations therapy in a hospital was investigated from January to December of 2019.PDCA method was used to conduct clinical pharmacist-led management of antibiotic combinations from July to December of 2020.The proportion of antibiotic combinations,the cost of antibiotics use and intensity,and other related indicators before and after intervention were compared.Results After a series of intervention measures led by clinical pharmacists,the related assessment indexes of antibiotics combination management were statistically significant compared with those in before(P<0.05).The proportion of antibiotic combinations decreased by 53.1%,among which the proportions of dual,triple,and quadruple combination of antibiotics decreased by 48.81%,68.41%,and 77.90%,respectively.The amount of costing and intensity of antibiotics used decreased by 23.4%and 6.39%,and the number of adverse drug antibiotics related reactions decreased by 37.3%.Under the guidance of the medical department and the support of the clinical departments,a control system of antibiotic combinations management led by clinical pharmacists was established by scientifically setting the target value of antibacterial drug intensity,innovating the antibiotic medical order review module,and establishing review system for antibiotic prescriptions in key departments.Conclusion Using PDCA method,clinical pharmacist antibiotic combinations management has reduced the proportion and unreasonable antibiotic combinations,which improved the level of rational use of antibiotics in our hospital.