PDCA质量控制管理模式对抗菌药物临床应用的效果

Effect of PDCA quality control management model on clinical application of antibiotics

目的通过PDCA循环法建立抗菌药物临床应用质量控制标准,分析其在规范抗菌药物临床应用中的效果。方法依据PDCA循环理论,采用回顾性分析方法,比较医院PDCA质量控制管理模式干预前(2019年7月—2020年6月)与干预后(2020年7月—2021年6月)抗菌药物使用情况。结果采用PDCA质量控制模式干预后,门急诊抗菌药物使用率由17.65%降至13.24%,达到目标值(<20%);限制使用级金额占比由71.98%降至35.48%;排序前十位限制使用级金额占比由73.20%降至46.68%;抗菌药物金额占比由6.61%降至1.93%;人均药费由265.90元降至225.36元。住院患者抗菌药物使用率由79.09%降至58.58%,达到目标值(<60%);使用强度由83.57 DDDs降至40.84 DDDs,略高于目标值(<40 DDDs);限制使用级送检率由58.35%提高至70.62%;抗菌药物金额占比由39.82%降至30.76%;人均抗菌药物费用由690.79元降至335.60元;人均药费由2074.22元降至1753.99元。住院患者Ⅰ类切口(清洁手术)患者抗菌药物预防使用率由58.33%降至29.87%,达到目标值(<30%);平均预防用药时间由46.50 h降至20.48 h,用药未超过24 h;限制使用级金额占比由58.49%降至4.00%;人均药费由2455.32元降至739.37元。干预前,预防用药中选择限制使用级抗菌药物头孢孟多、头孢替安为主,干预后,转变为有循证医学证据的非限制使用级克林霉素、头孢唑林,所有病例均未发生切口感染现象,切口均达到甲级愈合。结论通过PDCA循环法建立的抗菌药物临床应用质量控制标准可实现抗菌药物使用的规范化管理,促进临床合理应用。

Objective To establish the quality control standard of clinical application of antibacterial drugs by PDCA cycle method,and analyze its effect in regulating clinical application of antibacterial drugs.Methods Based on the PDCA cycle theory,a retrospective analysis was conducted to compare the use of antibiotics in the PDCA quality control management mode before intervention(July 2019—June 2020)and after intervention(July 2020—June 2021)in a hospital.Results After using PDCA quality control mode,the utilization rate of antibiotics in outpatient and emergency department decreased from17.65%to 13.24%,reaching the target value(<20%).The consumption rate of restricted use class decreased from71.98%to 35.48%.The proportion of the top 10 restricted use level decreased from 73.20% to 46.68%;The proportion of antibacterial drugs decreased from 6.61% to 1.93%;The per capita drug cost decreased from 265.90 yuan to 225.36 yuan.The utilization rate of antibiotics in inpatients decreased from 79.09% to 58.58%,reaching the target value(<60%).The use intensity decreased from 83.57 DDDs to 40.84 DDDs,slightly higher than the target value(<40 DDDs).The detection rate of restricted use grade increased from 58.35% to 70.62%;The proportion of antibacterial drugs decreased from 39.82% to 30.76%;The per capita cost of antibiotics decreased from 690.79 yuan to 335.60 yuan;The per capita drug cost decreased from 2074.22 yuan to 1753.99 yuan.The utilization rate of antibiotics in inpatients with class I incision(clean operation)decreased from 58.33% to 29.87%,reaching the target value(<30%).The average duration of prophylactic medication decreased from 46.50 h to 20.48 h,and the medication did not exceed 24 h.The amount of restricted use decreased from 58.49% to 4.00%;The per capita drug cost decreased from 2455.32 yuan to 739.37 yuan.Before the intervention,antibiotics cefmendol and cefotiam of restricted use were selected as the main prophylactic drugs.After the intervention,they were changed to clindamycin and cefazolin of unrestricted use with evidence-based medical evidence,no incision infection occurred in all cases,and the incision healing reached grade A.Conclusion The quality control standard for the clinical application of antibiotics established by PDCA cycle method can realize the standardized management of the use of antibiotics and promote the rational clinical application.