门急诊抗菌药物处方月点评5年的效果评价

Monthly prescription comment on antimicrobial agents at outpatient and emergency department for 5 years： performance of antimicrobial stewardship

目的回顾性分析落实抗菌药物门急诊处方月点评制度5年的处方合理率，评价其推进抗菌药物临床合理应用的效果。方法基线调查期抽查2012年6—11月门急诊抗菌药物处方1 780份，对处方进行集中点评。改进观察期分两个阶段，第一阶段为2012年12月至2015年2月，对门急诊抗菌药物处方采取人工抽查进行每月点评；第二阶段为2015年3月至2017年6月，对门急诊抗菌药物处方采取处方点评软件抽查进行每月点评。采用Excel 2010及SPSS 16.0软件对数据进行卡方检验和线性回归分析。结果门急诊抗菌药物处方合理率从基线调查期的80.56%（1 434/1 780）提升至第二阶段的99.47%（166 506/167 400），差异有统计学意义（P〈0.001）;信息系统干预后问题处方百分比较干预前降低5.18个百分点。结论坚持门急诊抗菌药物处方月点评制度，充分利用信息化手段不断完善处方点评方法，跟进绩效考核等多种管理措施，使不合理处方改进成效明显，对于临床用药安全发挥重要作用。

ObjectiveTo retrospectively analyze the implementation of the antimicrobial agents prescription monthly review at the emergency and outpatient departments for the past five years, for evaluation of its action in promoting rational application of antimicrobial drugs.MethodsAt the baseline investigation stage, 1780 prescriptions on antibiotics in emergency and outpatient department from June 2012 to November 2012 were randomly selected for centralized evaluation. The period of correction and observation falls into two stages. The first stage ranged from December 2012 to February 2015, when the prescription of antibiotics was sampled manually for monthly review. The second stage ranged from March 2015 to June 2017, when a prescription review software for prescription comment was introduced for the sample purpose. The data so acquired were subject to chi-square test and linear regression analysis using Excel 2010 and SPSS 16.0.ResultsThe rational rate of prescription for antibiotics at the emergency department increased from 80.56% of the baseline stage to 99.47% of the second stage （166 506/167 400）, scoring a difference of statistical significance （P〈0.001）. With intervention of the prescription review software, the percentage of irrational use of antimicrobial agents dropped by 5.18% compared to the baseline stage.ConclusionsMonthly prescription review on antimicrobial agents at the outpatient and emergency departments could promote the rational use of antimicrobial agents and play an important role in clinical drug safety. Information system and performance assessment contributed to the effect of prescription review.