PDCA循环管理干预骨科Ⅰ类切口手术围术期抗菌药物预防应用的效果评价

Effect Evaluation of PDCA Cycle Management on Perioperative Prophylactic Application of Antibiotics in TypeⅠIncision Surgery of Orthopedics Department

目的:评价PDCA循环管理干预骨科Ⅰ类切口手术围术期抗菌药物预防应用的效果。方法:采用回顾性分析方法,选取我院PDCA循环管理干预前(2013年1-12月,干预前组)512例、第1轮PDCA循环管理干预后(2014年1-12月,第1轮干预组)861例和第2轮PDCA循环管理干预后(2015年1-12月,第2轮干预组)1 070例行骨科Ⅰ类切口手术患者的出院病历,对比分析持续干预前后围术期抗菌药物预防应用情况。结果:经2轮PDCA循环管理干预后,我院骨科内固定术的构成比显著增加,抗菌药物使用率、品种合理率、术前0.5~1h用药率、疗程合理率和有指征使用抗菌药物的比例分别由干预前的50.20%、98.08%、93.77%、6.61%和82.10%上升至58.41%、100%、99.04%、52.00%和99.04%;预防用抗菌药物的品种由干预前的4种减少到2种,且选用头孢唑啉的比例较干预前显著增加,选用克林霉素的比例显著下降;术后预防用药疗程由干预前的(4.63±2.42)d缩短至(1.61±0.75)d,且用药疗程<24h和疗程为24~48 h的患者比例显著升高,疗程>72 h的患者比例显著下降,差异均有统计学意义(P<0.05)。结论:PDCA循环管理提高了我院骨科Ⅰ类切口手术围术期抗菌药物预防应用的合理率;但我院预防用抗菌药物的疗程尚未完全控制在24h以内,有待进一步持续干预。

OBJECTIVE：To evaluate the effects of PDCA cycle management on perioperative prophylactic application of antibiotics in type Ⅰ incision surgery of orthopedics department.METHODS：In retrospective analysis,512 discharge medical records,861 ones and 1 070 ones were selected from our hospital before PDCA cycle management（Jan.-Dec.2013,before intervention group）,after first cycle of PDCA cycle management（Jan.-Dec.2014,first intervention group） and after second cycle of PDCA cycle management（Jan.-Dec.2015,second intervention group）,respectively.The perioperative prophylactic application of antibiotics was analyzed comparatively before and after continuous intervention.RESULTS：After 2 cycles of PDCA cycle management intervention,the constituent ratio of internal fixation in orthopedics department increased significantly;utilization ratio of antibiotics,the rate of rational type,medication ratio 0.5-1 h before surgery,the rate of rational treatment course,the proportion of antibiotics use in accordance with indications increased from 50.20%,98.08%,93.77%,6.61%,82.10%to 58.41%,100%,99.04%,52.00%,99.04%,respectively.The number of antibiotics type decreased from 4 to 2;the proportion of cephazolin increased significantly while that of clindamycin decreased significantly compared to before intervention.Postoperative prophylactic medication course decreased from（4.63 ± 2.42） d to（1.61 ± 0.75） d;the proportion of patients with medication course 〈24 h or ranged 24-48 h increased significantly,while those with medication course〉72 h decreased significantly,with statistical significance（P〈0.05）.CONCLUSIONS：PDCA cycle management improves the rational rate of perioperative prophylactic application of antibiotics in type I incision surgery of orthopedics department in our hospital.The prophylactic medication course of our hospital is not yet fully controlled within 24 h so it should be further intervened.