我院呼吸内科2013年抗菌药物应用分析及药学服务模式探讨

Exploration of the Rational Use of Antibiotics in the Department of Respiratory Medicine and Pharmacy Services Mode in Our Hospital in 2013

目的:探讨我院呼吸内科临床药师开展药学服务的模式。方法:回顾性分析我院呼吸内科2013年1-6月(干预前)和2013年7-12月(干预后)抗菌药物及药品不良反应(ADR)相关数据。利用临床药学管理系统等信息软件,对临床药师干预前后呼吸内科抗菌药物使用强度(AUD)、联合使用情况、微生物标本送检率、特殊使用级抗菌药物使用情况、抗菌药物分级使用情况等指标进行全面评价。结果:经过干预,抗菌药物AUD从139.01 DDDs/(100人·d)下降至102.09 DDDs/(100人·d),用药不合理率从12.71%下降至2.93%(P<0.01),单一用药率从45.23%上升至51.54%(P<0.05),三联及三联以上用药比从17.55%下降至12.43%(P<0.01),限制使用级抗菌药物比例从69.44%上升至74.44%(P<0.05),特殊使用级抗菌药物比例从12.10%下降至7.40%(P<0.01),微生物送检率从71.41%上升至95.95%(P<0.01),特殊使用级抗菌药物备案率从15.00%上升至92.45%(P<0.01),呼吸内科ADR报告占医院比例从13.33%上升至25.09%(P<0.01)。结论:临床药师在呼吸内科进行干预后,抗菌药物使用更加合理,所采用的药学服务模式切实可行。

OBJECTIVE： To investigate pharmacy services mode in the department of respiratory medicine in our hospital. METHODS： The antibiotics and adverse drug reactions （ADR） in the department of respiratory medicine in our hospital before （during Jan.-Jun. 2013） and after （during Jul.-Dec. 2013） the intervention were retrospective analyzed. Clinical pharmacy manage ment system was conducted to comprehensively evaluate the indicators before and after the intervention by clinical pharmacists in the department of respiratory medicine, including antibiotic use density （AUD）, combination use, submission rate of microbial speci- mens, usage of special antibiotics, and utilization grading of antibiotics, etc. RESULTS ： After intervention, the AUD was decreased from 139.01 DDDs/（100 cases, d） to 102.09 DDDs/（100 cases, d） and the irrationality rate was decreased from 12.71% to 2.93% （P〈0.01）. The rate of single use was increased from 45.23% to 51.54% （P〈0-05）, the rates of multiple uses was decreased from 17-55% and 12.43% （P〈0.01）, the restriction antibiotics usage rate was increased from 69.44% to 74.44% （P〈0-05）, the special antibiotics use was decreased from 12.10% to 7.40% （P〈0.01）, the submission rate of microbial specimens was increased from 71.41% to 95.95 % （P〈 0.01 ）, the rate of special antibiotics use was increased from 15.00 % to 92.45 % （P〈 0.01 ） and the ADR reports in the department of respiratory medicine was increased from 13.33% to 25.09% （P〈0.01）. CONCLUSIONS： After the inter- vention of clinical pharmacists in the department of respiratory medicine, the use of antibiotics is more rational. The working mode of pharmacy services is practical and feasible.