MTP-KPI干预模式在患儿Ⅰ类手术切口预防使用抗菌药物中的应用评价

Application valuation of MTP-KPI intervention on perioperative antibiotic prophylaxis of children with typeⅠincision surgery

目的观察监测-培训-计划法(MTP)联合关键绩效指标法(KPI)干预模式在儿童Ⅰ类手术切口预防使用抗菌药物中的应用效果,进一步规范抗菌药物在围手术期的合理使用。方法将2014年1-12月的344例Ⅰ类手术切口患儿纳入对照组,2015年1-12月的456例Ⅰ类手术切口患儿纳入干预Ⅰ组,2016年1-12月的426例Ⅰ类手术切口患儿纳入干预Ⅱ组,根据对照组预防用抗菌药物的点评结果,建立清洁手术预防用抗菌药物的合理性评价指标(预防用药率、选用抗菌药物合理率、给药时机合理率、用药疗程合理率和术后感染率),干预Ⅰ组采用MTP干预模式,干预Ⅱ组采用MTP-KPI干预模式,比较干预前后合理性评价指标的改善情况。结果通过MTP-KPI模式干预,干预Ⅱ组Ⅰ类手术切口的预防用药率为9.86%,低于对照组37.79%,低于干预Ⅰ组14.25%,差异有统计学意义(P<0.05);干预Ⅱ组的选用抗菌药物合理率、给药时机合理率、用药疗程合理率分别为95.24%、95.24%、88.10%,高于对照组0.8%、75.31%、72.38%,高于干预Ⅰ组58.46%,90.77%,86.15%,同时腹外疝手术的预防用药评价指标均有显著改善;对照组、干预Ⅰ组、干预Ⅱ组的术后感染率分别为0.29%、0.44%和0.23%,差异无统计学意义。结论 MTP-KPI干预模式对提高Ⅰ类手术切口预防用抗菌药物的合理性有显著效果,可行性高。

OBJECTIVE To observe the application effect of Monitoring-Training-Planing （MTP） combined with Key Performance Indicator （KPI） intervention on prophylaxis use of antibiotics for the type I incision surgery, so as to promote the perioperative rational use of antibiotics.METHODS From Jan.2014 to Dec.2014,totally 344 patients who underwent the type Ⅰincision surgery were selected as control group, 456 patients who underwent the type Ⅰincision surgery in from Jan.2015 to Dec.2015 were set as intervention groupⅠ,while 426 patients from Jan.2016 to Dec.2016 were intervention group II.The rational antibiotic use evaluation indicators of the typeⅠincision surgery were established based on the drug review of control group, including the utilization rate of antibiotics, the rate of rational use of antibiotics, reasonable medication occasion and duration, and postoperative infection rate.The improvements of the evaluation indicators were compared among control group,the MTP invention in intervention groupⅠand MTP combined with KPI invention in intervention group Ⅱ.RESULTS Through MTP-KPI intervention,the utilization rate of antibiotics of the type I incision surgeries dropped from 37.79% in control group to 14.25% in intervention groupⅠ,to 9.86% in intervention group Ⅱ, and the differences were significant（P〈0.05）.The rate of rational use of antibiotics, reasonable medication occasion and duration increased from 0.80%,75.38% and 72.31% in control group to 58.46%,90.77% and 86.15% in intervention groupⅠ,to 95.24%,95.24% and 88.10% in intervention group Ⅱ, and the differences were significant （P〈0.05）.The prophylaxis use of antibiotics for the abdominal external hernia surgery had obvious improvement.The infection rates after the intervention of control group, intervention groupⅠ and intervention group Ⅱ were 0.29%, 0.44% and 0.23%, and there was no significant difference.CONCLUSION The MTP-KPI intervention mode can effectively improve the rational use of antibiotics for the type Ⅰ incision surgery,and it is feasible in the hospital.