抗菌药物临床应用质量控制实施与成效研究

The implementation and results of quality control project of clinical application of antibacterial drugs

目的运用有效的质量控制管理方法,通过现代化、信息化的综合干预措施,促进抗菌药物的临床合理应用。方法建立抗菌药物专项质控管理评价体系,实施三级质控管理及细化控制目标;通过开发及应用"阳光监测系统"、"抗菌药物分级管理系统"及"Ⅰ类切口手术和介入治疗抗菌药物使用管理系统"等多套软件管理系统,实行多途径的信息化质控管理;开展抗菌药物临床合理应用专项病历检查及典型病历讨论会等,从而实现抗菌药物临床应用的全程监控。结果通过多元化的质量控制手段,已经收到良好的工作成效:整治工作前后对比,门诊抗菌药物使用率由19.0%降至8.9%;住院抗菌药物使用率由61.6%降至38.9%;Ⅰ类手术切口预防使用抗菌药物率由84.2%降至30.2%;介入治疗预防使用抗菌药物率由82.1%降至10.3%;抗菌药物使用强度由65.4DDD降至37.7DDD,整治前后各组之间差异均有统计学意义(P<0.01)。结论通过多元化质量控制手段可以实现抗菌药物使用的规范化管理,促进了抗菌药物的临床合理应用。

OBJECTIVE To use the effective methods of quality control, so as to promote the proper use of antimicrobial drugs by modern and informationalized intervention. METHODS In order to effectively monitor the clinical application of antibacterial drugs, we established the quality control management evaluation system in three levels and detailed control objectives. By developing and applying many software management systems, like Sunshine Monitory System, Antibiotics Level-to-Level Administration System and Management System for Proper Esing of Antibiotics in Surgical Incision and Interventional Therapy, we achived informationized quality control in multiple ways. We implemented special medical records check and typical record seminars for proper using of antibiotics in clinic, so as to achieve a whole-process monitor in clinical antibiotics using. RESULTS A good effect could be seen until now, by using diversified measures for quality control： compare between before and after the renovation activities, the rates of antibiotics used in outpatients decreased from 19~//00 to 8. 9%; the rates of antibiotic used in inpatients decreased from 61. 6% to 38. 9%, the rates of antibiotic used in type I incision operations for prevention decreased from 84.2% to 30.2%, the rates of antibiotic used in interventional therapy for prevention decreased from 82.1% to 10.3 %, and the intensity of antibiotic using in inpatient decreased from 65.4DDD to 37.7DDD. The differences were significant （P〈0.01）. CONCLUSION We promote the proper clinical use of antibacterial drugs after standardization management of antibacterial drugs use diversity quality control methods.