探讨多部门合力在医院抗菌药物整治活动中的促进作用

Contributions Made by Joint Efforts of Mulitiple Departments to Rational Use of Antibacterial Drugs

目的分析医院管理者领导下的多部门共同配合对医院抗菌药物合理应用管理取得的成效与分析。方法统计2011年7月至2012年6月解放军307医院门诊抗菌药物处方点评和清洁手术抗菌药物预防使用病历资料;分析2010至2012年年度监测指标和抗菌药物使用频度结果;抗菌药物管理工作组依据PDCA原则每月通报临床抗菌药物使用结果,分析不合理用药问题,实施不断反馈与干预。结果该院抗菌药物合理应用指标有显著改观,用药不适宜处方比例由81.2%下降至47.7%。清洁手术预防使用抗菌药物使用率由98.4%下降至68.6%;用药时机合理率由27.4%提升至85%;用药疗程48 h内手术比例由18%提升至65.4%。抗菌药物的使用率由46.7%下降至41.9%;病原学送检率由20%提高至37%。存在问题主要表现在清洁手术预防使用抗菌药物疗程偏长,抗菌药物使用强度居高不下,特殊级抗菌药物使用率增加,细菌耐药问题亟待控制。结论多部门和多学科联动是促进医院抗菌药物应用管理持续改进的必要条件和有效因素,值得广泛推广。

Objective To evaluate the effect of concerted efforts of differtent departments on proper use of antibacterial drugs. Methods The rationality of prescriptions of antibacterial drugs used for outpatients and surgical was evaluated cleaning. Monitoring indicators and the frequence of antibacterial drugs used in our hospital from 2011 to 2012 was analyzed;PDCA principles were utilized by the antibacterial control group to intervene in the irra- tional use of antibacterial drugs. Results The awareness of rational drug use was significantly improved. The propor- tion of inappropriate prescription medications decreased from 81.2% to 47.7%. The rate of prophylactic applica- tion with antimicrobial drugs dropped from 98.4% to 68.6%. Reasonable rates of medication time rose from 27.4% to 85%. The proportion of surgery within 48 hours of medication increased from 18% to 65.4%. The rate of antibacterial drug use dropped from 46.7% to 41.9% while the pathogenic detection rate was increased from 20% to 37%. Hospital infection was well controlled and monitoring indicators of antibacterial drurgs wassteadily improved. Conclusion Cooperated efforts by different departments and disciplines are crucial to sustainale improve- ment of the use of antimicrobial agents.