临床药师在抗菌药物临床应用专项整治工作中的实践

Practice of Special Rectification for Clinical Use of Antibiotics among Clinical Pharmacists

目的:探讨临床药师在抗菌药物临床应用专项整治工作中的参与方式与积极作用。方法:通过医院信息系统(HIS),调取某院2009年6-12月(干预前)和2011年6-12月(第1阶段干预后)、2012年6-12月(第2阶段干预后)的抗菌药物应用基础数据和病历资料,统计分析住院患者人均应用抗菌药物费用、住院患者抗菌药物费用占药品总费用的比例、住院患者抗菌药物使用率、住院患者抗菌药物使用强度(AUD)、特殊使用级抗菌药物用量占抗菌药物总用量的比例、住院患者病原学送检率、围术期患者预防用抗菌药物使用率等7项指标。结果:与干预前比较,第2阶段干预后住院患者人均应用抗菌药物费用、住院患者抗菌药物费用占药品总费用的比例、住院患者抗菌药物使用率、住院患者抗菌药物AUD、特殊使用级抗菌药物用量占抗菌药物总用量的比例、住院患者病原学送检率改善明显,变化幅度分别为-68.09%、-63.82%、-46.89%、-36.18%、-77.73%、73.86%;Ⅰ、Ⅱ类切口手术预防用抗菌药物使用率变化幅度为-57.19%、-37.93%。结论:有效开展专项整治工作对加强抗菌药物临床应用管理效果显著,其中临床药师的技术干预可发挥重要作用。

OBJECTIVE： To explore the positive role of clinical pharmacist and the way to participate in special rectification for clinical use of antibiotics. METHODS： The baseline and medical information of antibiotics use were collected from HIS during Jun.- Dec. 2009 （before intervention） and Jun.--Dec. 2011 （at the first stage after intervention） and Jun.--Dec. 2012 （at the second stage after intervention）. The indexes were analyzed statistically, including antibiotics cost per capita of inpatients, the proportion of antibiotics cost in total drug cost, the proportion of antibiotics in the inpatients, AUD of inpatients, the proportion of antibiotics for special use in total amount, the pathogenic detection rate of inpatients and the proportion of prophylactic use of antibiotics for perioperative period. RESULTS： Compared with before intervention, above indexes were improved significantly at the second stage after intervention, increasing by - 68.09 %, - 63.82 %, - 46.89 %, - 36.18 %, - 77.73 % and 73.86 % ; the variation range of utilization ratio of antibiotics were -57.19 % for type Ⅰ incision surgery and -37.93 % for type Ⅱ incision surgery. CONCLUSIONS： The special rectification has significant effect on the management of clinical antibiotics use, and the interventions of clinical pharmacists could play an important role.