临床药师参与下的清洁手术抗菌药物预防性使用变化

Explore the pharmacentical care method of perioperative preventive use of antibiotics in cleaning operations by clinical pharmacists

目的探讨临床药师在清洁手术抗菌药物预防性使用过程中的药学服务方法,提高和规范清洁手术围术期抗菌药物预防性使用的合理性。方法选取2014年1月~6月全院清洁手术未实施干预措施的出院病例为干预前组,2014年6月~12月实施行政干预措施的出院病例为干预中组,2015年1月~6月实施行政干预结合临床药师药学服务的出院病例为干预后组,进行干预前、中、后清洁手术预防性抗菌药物使用合理性的对照研究。结果相比与干预前组和中组,干预后组清洁手术围术期抗菌药物预防性使用合理性显著提高,总体抗菌药物使用率由100.00%、77.08%下降至58.34%（P〈0.05）,其中腹股沟疝修补术（包括补片修补术）、普通甲状腺手术、普通乳腺手术抗菌药物预防使用率由99.24%、21.82%下降至8.79%（P〈0.05）。术前给药时机合理率由8.33%、55.38%上升至83.83%（P〈0.05）;术后用药疗程合理率由39.66%、76.24%上升至91.72%（P〈0.05）。抗菌药物品种由7大类9个品种、3大类8个品种减少至2大类6个品种。结论行政干预结合临床药师的药学服务模式可行、有效,能显著降低清洁手术围术期抗菌药物预防性使用率,提高抗菌药物使用过程的规范性、合理性,对抗菌药物的安全、有效使用具有良好的促进作用。

Objective To explore the pharmacentical care method of perioperative preventive use of antibiotics in cleaning operations by clinical pharmacists, to improve and standardize the retionlity of perioperative preventive use of antibiotics in cleaning operations in our hospital. Methods In the hospital, select the patients in cleaning operations without intervention from June to December in 2014 for the former group; select the patients with administrative intervention from June to December in 2014 for the middle group; select the patients with Administrative intervention combined with clinical pharmacist pharmaceutical care from January to June for the last group, to get a comparative study of the rationality of the use of preventive antibiotics before and after intervention. Results The rationality of prophylactic use of antibiotics during perioperative period of clean operation was significantly improved in the last group compared with the former group and middle group. the usage rate of antibacterials from 100%,77.08% down to 58.34%（P 〈 0.05）, the inguinal hernia surgery（including patch repair）, common thyroid surgery, common breast surgery usage rate from 99.24%, 21.82% down to 8.79%（P 〈 0.05）. Antimicrobial varieties reduced from 7 types 9 varieties,3 types 8 varieties to 2 types 6 varieties. Conclusion Administrative intervention combined with clinical pharmacist pharmaceutical care is feasible and effective, which can decrease the usage rate of preventive antibiotics during perioperative period of cleaning operation, Improve the standardization and rationality of the application of antibacterials and also has good promotion effect on the safe and effective application of antibacterials.