PDCA循环管理在围术期抗菌药物预防使用中的应用

Application of PDCA Cycle Management in the Perioperative Prophylactic Use of Antibiotics

目的：评价PDCA循环管理在围术期抗菌药物预防使用中的作用。方法：选取我院2011年1-3月（PDCA循环管理实施前）186例和2013年10-12月（PDCA循环管理实施后）192例甲状腺手术、乳腺手术、腹股沟疝手术、白内障手术、骨科内固定取出术、血管造影术以及腹腔镜下胆囊切除术出院病例,对实施PDCA循环管理前后围术期抗菌药物预防使用情况进行比较。结果：实施PDCA循环管理后,围术期抗菌药物预防使用率由实施前的100%降至13.54%（P〈0.01）;围术期抗菌药物使用品种趋于合理,围术期未使用抗菌药物的比例由实施前的0上升至86.46%（P〈0.01）;术前0.5-2 h预防使用抗菌药物的比例由0上升至9.38%（P〈0-05）;围术期预防使用抗菌药物的时间≤24 h的比例由0.54%上升至10.94%（P〈0-05）;联合用药率由15-05%下降至0（P〈0-05）;各项不合理用药情况显著改善,与实施PDCA循环管理前比较差异有统计学意义（P〈0.01）。结论：PDCA循环适用于围术期抗菌药物预防使用管理,使围术期不合理预防使用抗菌药物现象得到了有效遏制,并逐浙符合管理目标。

OBJECTIVE ： To evaluate the effect of PDCA cycle management in the perioperative prophylactic use of antibiotics. METHODS ： Totally 186 patients from our hospital during Jan.-Mar. 2011 （before PDCA cycle management） and 192 patients discharged in Oct.-Dec. 2013 （after PDCA cycle management） with thyroid surgery, breast surgery, inguinal hernia surgery, cataract surgery, orthopedic implant removal surgery, angiography and laparoscopic cholecystectomy were collected to compare the application of periopera- tive prophylactic use of antibiotics before and after PDCA cycle. RESULTS ： After PDCA cycle management, the utilization rate of peri- operative prophylactic use of antibiotics was decreased from 100% to 13.54% （P〈0.01） ; the kinds ofperioperative antibiotics were ra- tionalized and the proportion of no perioperative antibiotics was increased from 0 to 86.46% （P〈0.01） ; the proportion of prophylactic of antibiotics 0.5-2 h before surgery was increased from 0 to 9.38 % （P〈 0-05） ; the proportion of perioperative prophylactic use of antibiot- ics for no more than 24 h was increased from 0.54% to 10.94% （P〈0-05） ; combination rate was decreased from 15-05% to 0 （P〈 0-05） ; irrational drug use was obviously improved, compared with before PDCA cycle management, there was significant difference （P〈0.01）. CONCLUSIONS： PDCA cycle management is suitable for the perioperative prophylactic use of antibiotics irrational perioper- ative prophylactic use of antibiotics can be inhibited effectively and up to the standard gradually.