PDCA循环理论促进医院抗菌药物管理持续改进的效果探讨

Effects of PDCA Cycle Theory in Promoting Continuous Improvement of Hospital Antimicrobial Management

目的:为规范抗菌药物的合理应用、持续改进抗菌药物临床应用管理提供依据。方法:运用PDCA循环理论对医院抗菌药物的临床应用实施干预。选取2016年1月至2017年6月广州市某医院使用抗菌药物的患者为研究对象[根据医院开展专项整治活动时间及持续改进过程分为干预前(2016年1—6月)、干预期(2016年7—12月)、巩固期(2017年1—6月)],以抗菌药物使用强度、使用率、微生物送检率和Ⅰ类切口手术围术期抗菌药物预防性应用情况等为观察指标,对比干预前后抗菌药物控制指标的变化情况。结果:实施干预后,抗菌药物使用强度由干预前的46.61 DDDs/(100人·d)降至巩固期的31.30 DDDs/(100人·d);门、急诊和住院患者抗菌药物使用率分别由干预前的19.70%、30.03%和41.44%降至巩固期的13.99%、26.10%和38.94%;总体微生物送检率由干预前的51.16%升至巩固期的61.27%;使用特殊使用级抗菌药物的微生物送检率由干预前的90.83%升至巩固期的100%;Ⅰ类切口手术围术期抗菌药物预防性使用率由干预前的37.49%降至巩固期的16.86%,术前0.5~1.0 h给药病例数所占比例由80.00%升至95.36%,抗菌药物品种选择合理率由88.65%升至95.36%,疗程<24 h病例数所占比例由33.78%升至92.86%。结论:PDCA循环理论对促进医院抗菌药物管理持续改进的效果明显。

OBJECTIVE： To provide a basis for standardizing the rational application of antibiotics and continuously improving the clinical application management of antibiotics. METHODS： PDCA circle theory was used to intervene the application of antibiotics. Patients who used antibiotics in a hospital in Guangzhou from Jan. 2016 to Jun. 2017 were selected as the subjects[according to the time of the special rectification activities and continuous improvement process of the hospital,the study was divided into before intervention（ Jan.-Jun. 2016）,intervention period（ Jul.-Dec. 2016）,and consolidation period（ Jan.-Jun. 2017） ]; the use intensity,the use rate of antibiotics,the microbial test rate and the rate of preventive application of antibioticsof type I incision surgery in perioperative period were used as observation indicators,and changes of control indicators of antibiotics were compared before and after intervention. RESULTS： After intervention,the use intensity decreased from 46. 61 DDDs/（ 100 people·d）before intervention to 31. 30 DDDs/（ 100 people·d） during consolidation period. The use rate of antibiotics in patients from department of emergency, outpatient and inpatient decreased from 19. 70%, 30. 03%, 41. 44% before intervention to 13. 99%,26. 10% and 38. 94% during consolidation period. The microbial test rate increased from51. 16% before intervention to 61. 27% during consolidation period. The microbial test rate for the use of special grade antibiotics increased from 90. 83% before intervention to 100% during consolidation period. And the rate of preventive application of antibioticsof type I incision surgery in perioperative period decreased from 37. 49% before intervention to16. 86%; the proportion of cases administered 0. 5-1. 0 h before surgery increased from 80. 00% to 95. 36%; the rational rate of selection of antibiotics increased from 88. 65% to 95. 36%; the proportion of cases with treatment 24 h increased from 33. 78% to 92. 86%. CONCLUSIONS： The PDCA cycle theory has an obvious effect on promoting continuous improvement of hospital antibacterial drug management.