德尔菲法建立抗菌药物医嘱干预工具及其临床应用

Establishing and clinical application of antibacterial physician order intervention tool by Delphi method

目的:构建适用于重症医学科(intensive care unit,ICU)的抗菌药物医嘱干预工具,并验证其临床适用性。方法:采用德尔菲专家问询法,建立医嘱干预工具,并将纳入2022年2—12月成都市新都区人民医院收治的160例ICU病例作为研究对象,分为对照组和实验组,临床药师按照干预工具相关内容对实验组患者医嘱进行干预,比较2组病例基线水平,抗菌药物使用强度(antibiotics use density,AUD)以及抗菌药物使用金额。结果:两轮问卷的回收率分别为100.00%及82.61%;两轮专家的权威系数分别为0.900、0.910,肯德尔系数分别为0.246、0.403。最终确立了5个一级条目,29个二级条目。实验组和对照组基线无差异,实验组AUD较对照组明显较低,差异具有统计学意义(P<0.05),同时抗菌药物使用金额较对照组有下降趋势,但差异不具有统计学意义(P>0.05)。结论:基于德尔菲法建立ICU抗菌药物医嘱干预工具具有较高的科学性,同时展现出一定的临床应用价值。

OBJECTIVE To construct a physician order intervention tool for antibiotics suitable for intensive care unit(ICU)and verify its clinical value.METHODS Delphi method was utilized for establishing a consultation questionnaire for medication intervention.From February to December 2022,160 ICU patients were selected as research subjects and divided into control and experimental groups.Experimental group orders were assisted by clinical pharmacists according to the relevant content of intervention tools.Finally comparative analysis was performed for baseline profiles,antibiotics use density(AUD)and expense of antimicrobial drug between two groups.RESULTS Rcovery rates of two rounds of questionnaires were 100.00%and 82.61%.Authority coefficients of two rounds of experts were 0.900 and 0.910.Kendal coefficient(W)of two rounds of experts was 0.246 and 0.403 respectively.Finally,5 first-level and 29 second-level items were identified.No difference existed at baseline.AUD of experimental group was significantly lower than that of control group(P<0.05).Expense of antibiotics dosing showed a downward trend as compared to control group.However,the difference was not statistically significant(P>0.05).CONCLUSION Delphi-based intervention tool for physician orders of antibiotics in ICU is highly scientific.It has demonstrated some clinical application value.