某三级甲等医院抗菌药物临床应用分析及管理模式探讨

Analysis of Clinical Application and Management Mode of Antibiotics in A GradeⅢ,Level A Hospital in Ningxia

目的:探讨宁夏回族自治区人民医院(以下简称"我院")借助信息化系统开展抗菌药物临床应用管理模式。方法:将2017—2019年我院门急诊及住院病房抗菌药物临床应用情况作为研究对象,进行回顾性分析,包括临床使用率、用药频度(defined daily dose system,DDDs)、销售金额、微生物送检率及合理用药点评情况,综合评价管理模式。结果:与2017年比较,2018年、2019年我院门诊、急诊和住院患者抗菌药物使用率明显降低,门诊、急诊患者静脉输液使用率明显降低,住院患者Ⅰ类切口手术抗菌药物预防性使用率明显降低,住院患者抗菌药物单一使用率明显升高、联合用药率明显降低,住院患者非限制使用级抗菌药物使用率明显升高、限制使用级抗菌药物使用率明显降低,且2019年上述指标明显优于2018年,差异均有统计学意义(P <0.01)。与2017年比较,2018年、2019年门诊、住院患者抗菌药物销售金额占药品总销售金额的比例明显降低,住院患者非限制使用级抗菌药物销售金额占药品总销售金额的比例明显升高、限制使用级及特殊使用级抗菌药物销售金额占药品总销售金额的比例明显降低,差异均有统计学意义(P <0.05或P <0.01)。与2017年比较,微生物送检率明显升高,且2019年明显高于2018年,差异均有统计学意义(P <0.01)。与2017年比较,门急诊处方点评及住院医嘱点评中不合理处方/医嘱所占比例明显降低,差异均有统计学意义(P <0.05或P <0.01)。3年来,抗菌药物的DDDs发生变化。结论:通过大数据建立抗菌药物管理客观评价体系,使医院抗菌药物临床应用更合理,对医院抗菌药物临床应用管理具有指导意义。

OBJECTIVE:To probe into the management mode of clinical application of antibiotics in People's Hospital of Ningxia Hui Autonomous Region(hereinafter referred to as“our hospital”)with the help of information-based system.METHODS:The clinical application of antibiotics in outpatient and emergency department and inpatient wards of our hospital from 2017 to 2019 were selected as the research object.Retrospective analysis was conducted on clinical application rate,defined daily dose system(DDDs),consumption sum,microbiological test rate and review of rational drug application.And the management mode was comprehensively assessed.RESULTS:Compared with 2017,in 2018 and 2019,the application rate of antibiotics in outpatient,emergency and inpatient department in our hospital decreased significantly,the application rate of intravenous infusion in outpatient and emergency department decreased significantly,the preventive application rate of antibiotics in inpatients with type I incision surgery decreased significantly,the single application rate of antibiotics in inpatients decreased significantly and the combined application rate decreased significantly,the application rate of non-restricted-use antibiotics in inpatients increased significantly,and the application rate of restricted-use antibiotics decreased significantly,moreover,the above indicators in 2019 were significantly better than those in 2018,and the differences were statistically significant(P<0.01).Compared with 2017,in 2018 and 2019,the proportion of the consumption sum of antibiotics for outpatients and inpatients to the total consumption sum of drugs decreased significantly,the proportion of the consumption sum of non-restricted-use antibiotics to the total consumption sum of drugs increased significantly,the proportion of the consumption sum of restricted-use and special-use antibiotics in the consumption sum of drugs decreased significantly,the differences were statistically significant(P<0.05 or P<0.01).Compared with 2017,the microbiological test rate increased significantly,and the microbiological test rate in 2019 was significantly higher than that in 2018,with statistically significant differences(P<0.01).Compared with 2017,the proportion of irrational prescriptions/medical orders in outpatient and emergency prescription review and inpatient medical order review decreased significantly,and the difference was statistically significant(P<0.05 or P<0.01).Over the past 3 years,the DDDs of antibiotics changed.CONCLUSIONS:The establishment of objective evaluation system for antibiotics management through big data makes the clinical application of antibiotics more rational and has guiding significance for the clinical application and management of antibiotics in the hospital.