临床药师针对性干预骨科Ⅰ类切口手术抗菌药预防使用的效果分析

Analysis of the effect of clinical pharmacist’s intervention on the prevention and use of antibiotics in class Ⅰ incision operation in orthopaedics department

目的探讨临床药师针对性干预骨科Ⅰ类切口手术抗菌药预防使用的效果。方法随机抽取2017年9月-2018年7月本院骨科Ⅰ类切口手术病历162份,将2017年9月-2018年1月Ⅰ类切口手术病历94份设为干预前,将2018年3月-7月Ⅰ类切口手术病历68份设为干预后。比较干预前后骨科Ⅰ类切口手术抗菌药预防使用情况、不合理情况、使用品种、使用时长。结果干预前预防用药率为93.6%,干预后预防用药率为85.3%。干预后品种选择错误、用药时机错误、用药疗程过长发生率低于干预前。干预前骨科Ⅰ类切口手术预防使用的抗菌药涉及8个品种,磺苄西林、拉氧头孢使用频率排名前二。干预后预防使用的抗菌药品种下降到4种,以第二代头孢菌素为主。干预后用药疗程未超过24 h占比高于干预前。结论临床药师针对性的药学干预可提高骨科Ⅰ类切口手术预防使用抗菌药的合理性,并促进医院抗菌药管理的持续改进。

Objective To explore the effect of targeted intervention by clinical pharmacist of prophylactic antibacterial agents in orthopedic class Ⅰ incision surgery.Methods From September 2017 to July 2018,162 cases of class Ⅰ incision operation in orthopedics department of our hospital were randomly selected.94 cases of class Ⅰ incision operation from September 2017 to January 2018 were set as pre intervention,and 68 cases of class Ⅰ incision operation from March 2018 to July 2018 were set as post intervention.Before and after the intervention,the prophylactic use,unreasonable use,variety and duration of antibiotics were compared.Results The rate of prophylactic use was 93.6% before intervention and 85.3% after intervention.After the intervention,the incidence of wrong choice of varieties,wrong timing of medication and long course of medication was lower than before the intervention.Before the intervention,8 kinds of antibiotics were used for the prevention of class Ⅰ incision operation in orthopaedics department,and the frequency of sulbenicillin and raoxicef was the second highest.After intervention,the number of antibiotics used for prevention decreased to 4,mainly the second generation cephalosporins.After intervention,the proportion of medication course less than 24 hours was higher than that before intervention.Conclusion The targeted pharmaceutical intervention of clinical pharmacists can improve the rationality of the use of antibiotics in the prevention of class Ⅰ incision operation in orthopedics department,and promote the continuous improvement of antimicrobial management in hospital.