DMAIC流程管理前后Ⅰ类切口手术预防使用抗菌药物合理性分析

Analysis on application rationality of prophylactic antibacterial drugs for typeⅠ incision surgery before and after DMAIC process management

目的:采用DMAIC流程管理提高医院Ⅰ类切口手术围手术期预防性使用抗菌药物的合理水平,并对该管理方法的有效性做出评价。方法:从2016年10月起采用DMAIC流程管理,对2016年10月-2017年4月期间的Ⅰ类切口手术病历进行专项点评并进行用药干预;对管理前后Ⅰ类切口手术抗菌药物预防使用合理率进行对比分析。以2016年10月结果作为对照,将2017年3月点评结果作为一轮干预后结果,2017年4月点评结果作为二轮干预后结果。结果:经DMAIC流程管理后,预防用药品种、给药时机、术中追加、术后用药、方案的合理率分别由22.61%、57.01%、81.53%、85.03%、86.62%提高至79.71%、75.36%、99.28%、93.48%、96.38%,差异具有显著性(P<0.05);用药率和指征合理率相对持平;两轮干预后预防用药品种排名前3名均为合理药物。结论:医院Ⅰ类切口手术预防使用抗菌药物的合理性经DMAIC流程管理后得到显著提高,该管理方法有效,并可作为持续改善合理用药水平的工具。

OBJECTIVE To improve the application rationality of prophylactic antibacterial drugs for typeⅠincision surgery by means of DMAIC process management,and to evaluate the effectiveness of this management method.METHODS By using DMAIC process management from October 2016,a special review and medication intervention was conducted on medical records of typeⅠincision surgery from October 2016 to April 2017.And a comparative analysis was performed for reasonable rate of prophylactic antibacterial drugs before and after the management.The assessment in October 2016 was viewed as the comparison group,and the assessment in March 2017 was taken as experimental group one,the assessment in April 2017 as experimental group two.RESULTS The reasonable rate in the aspects of the variety of drugs,dosing time,the utilization during surgery,the course of drugs after surgery and prophylactic regimen increased from 22.61%,57.01%,81.53%,85.03%,86.62% to5.71%,75.36%,99.28%,93.48%,96.38%.And such differences above were statistically significant（P〈0.05）.The usage rate and the reasonable rate of indications of prophylactic antibacterial drugs remained fairly flat.Antibiotic types of the top three on the variety ranking list were all rational.CONCLUSION The application rationality of prophylactic antibacterial drugs for typeⅠincision surgery has been effectively improved due to DMAIC process management and it can be taken as an effective method for further improvement.