妇科手术抗菌药物预防使用信息化管理效果评价

Evaluation of Antimicrobial Stewardship Efficacy Based on the Information Technology in Gynecological Perioperative Antibiotic Prophylaxis

目的通过对围术期抗菌药物预防使用实施信息化用药过程管理,进一步规范妇科手术预防用药。方法构建围术期抗菌药物预防使用规则知识库并与电子医嘱实现无缝衔接,手术用抗菌药物均直接配送到手术准备室,从2013年7月开始对妇科手术抗菌药物医嘱逐渐实施信息化用药过程管理,评估信息化管理实施后妇科手术预防用药规范化程度的改进情况。结果 2013年1月—6月(信息化管理前)妇科手术586例,2014年1月—6月(信息化管理后)妇科手术532例,围术期抗菌药物预防使用率由信息化管理前的72.9%下降至管理后的67.1%(P<0.05),其中Ⅰ类切口手术由59.6%下降至35.2%(P<0.01);术前30 min^2 h使用时机符合率达90.9%;信息化管理后Ⅰ类切口手术术前、术后预防用药品种选择合理率分别为84.9%和80.6%,非Ⅰ类切口手术分别为99.3%和94.2%,均较信息化管理前同期显著提高(P<0.01);信息化管理后妇科手术预防使用抗菌药物时间平均为(1.39±0.81)d,69.2%预防使用不超过24 h,90.2%不超过48 h,较信息化管理前有显著改进。结论信息化用药过程管理可进一步规范妇科围术期抗菌药物预防使用。

OBJECTIVE To improve gynecological perioperative antibiotic prophylaxis by means of antimicrobial stewardship intervention based on the information technology. METHODS Constructing medication rules in perioperative antibiotic prophylaxis and establishing the EMRs embedded antimicrobial stewardship platform, antibiotics preoperative prophylaxis were deliveried directly to preoperation room. Gynecological perioperative antibiotic prophylaxis was compared before and after process intervention based on the above information technology（IT）. RESULTS The 586 cases and 532 cases of gynecological surgeries were operated before（Jan-Jun, 2013） and after IT process intervention（Jan？Jun, 2014）, respectively. Rate of gynecological perioperative antibiotic prophylaxis was significantly decreased during IT process intervention in 2014（67.1%） compared to 72.9% in the same period of 2013 before intervention（P〈0.05）, among which the rate of perioperative antibiotic prophylaxis in type Ⅰ incision gynecological surgeries was significantly decreased from 59.6% to 35.2%（P〈0.01）. Antibiotics were applied 90.9% in 0.5？2 h before incision. Appropriate antibiotic selection before and after operation were 84.9% and 80.6% respectively in type I incision gynecological surgeries, 99.3% and 94.2% respectively in other type incision gynecological surgeries during IT process intervention in 2014, they were significantly improved with comparison to that of before intervention in 2013（P〈0.01）. The duration of perioperative antibiotic prophylaxis was（1.39±0.81）d in 2014, of which 69.2% was not exceed 24 h and 90.2% was not exceed 48 h, was significantly improved with comparison to that of before intervention in 2013. CONCLUSION Antimicrobial stewardship based on the information technology can significantly improve the rational use of gynecological perioperative antibiotic prophylaxis.