临床药师促进某院Ⅰ类切口手术围手术期预防使用抗菌药物科学化管理实践

Clinical Pharmacists Promoted Scientific Management of Perioperative Prophylactic Use of Antibiotics for TypeⅠIncision in a Hospital

目的:观察临床药师运用PDCA循环管理法在加强某院Ⅰ类切口手术围手术期预防性使用抗菌药物管理的应用效果,探讨促进医院Ⅰ类切口手术围手术期抗菌药物预防使用科学化管理。方法:临床药师探寻佐证证据,逐步实施两轮PDCA循环管理以进行阶段性改进,通过计划、执行、检查、处理4个阶段,比较实施PDCA循环管理干预前后Ⅰ类切口手术围手术期抗菌药物的预防使用比例、品种选择、用法用量、用药时机、用药疗程等指标合理率,评价实施效果。结果:经过两轮干预后,有效提高了Ⅰ类切口手术围手术期抗菌药物预防用药合理率。第1轮PDCA循环管理干预后,抗菌药物预防用药合理率自32.45%提高至82.53%(P<0.05),预防用药品种选择合理率自65.62%提高至94.13%(P<0.05),预防用药剂量合理率自84.38%提高至96.99%(P<0.05),预防用药时机合理率自48.43%提高至94.88%(P<0.05),预防用药疗程合理率自50%提高至85.84%(P<0.05),但Ⅰ类切口手术围手术期抗菌药物预防用药比例、术中抗菌药物追加给药合理率均无明显改变(P>0.05)。第2轮PDCA循环管理干预后,Ⅰ类切口手术围手术期抗菌药物预防用药比例由33.98%下降至25.42%(P<0.05),术中抗菌药物追加给药合理率由86.14%提高至93.53%(P<0.05)。结论:临床药师经过佐证证据探寻开展两轮PDCA科学化管理循环,使得本院Ⅰ类切口手术围手术期预防使用抗菌药物比例、抗菌药物品种选择、给药时机选择、疗程等各项指标的合格率均有显著改善,提高了Ⅰ类切口手术围手术期预防使用抗菌药物的合理性水平。

Objective:To observe the application effect of PDCA cycle management by clinical pharmacists in improving the qualified rate of prophylactic use of antibiotics during perioperative period in a hospital,and to explore the scientific management practice of promoting perioperative prophylactic use of antibiotics for type I incision in a hospital.Methods:Clinical pharmacists search for supporting evidence to improve the twice periodically PDCA step by step,through the planning,implementation,inspection,handling 4 stages,compared the effect of ratio of prophylactic antibacterialsuse,prevention of drug varieties,usage,dosage,timing,duration of medication in perioperative period of type I incision before and after circulation.Results:After two cycle intervention,the qualified rate of perioperative preventive drugs for type I incision surgery was effectively improved.After the first PDCA cycle,the qualified rate of prophylactic drugs increased from 32.45%to 82.53%(P<0.05),the qualified rate of variety selection of prophylactic drugs increased from 65.62%to 94.13%(P<0.05),the qualified rate of dosage of prophylactic drugs increased from 84.38%to 96.99%(P<0.05),the qualified rate of timing of prophylactic drugs increased from 48.43%to 94.88%(P<0.05),and the qualified rate of course of prophylactic drugs increased from 50%to 85.84%(P<0.05),but there was no significant change in the proportion of perioperative prophylactic drugs and the qualified rate of intraoperative additional drugs for type I incision(P>0.05).After the second PDCA cycle,the proportion of perioperative prophylactic drugsfor typeⅠincision decreased from 33.98%to 25.42%(P<0.05),and the qualified rate of intraoperative additional drugs increased from 86.14%to 93.53%(P<0.05).Conclusion:Clinical pharmacists promote two rounds of PDCA management cycle through searching scientific evidence,make our type I incision proportion of perioperative preventive use of antimicrobial agents,varietyselection,timing,duration of medication the indicators were significantly improved,improve type I incision perioperative prevention level of the rationality of the use of antimicrobial agents.