路径化管控对消化内科抗菌药物使用的干预成效

Intervention effect of pathway-based management on antibiotics in gastroenterology department

目的:建立消化内科抗菌药物使用的药学临床路径,为临床合理用药提供实践依据。方法:针对消化内科抗菌药物使用中存在的问题,组织多学科参与药事查房,药师与医师联合制定内镜治疗围操作期抗菌药物预防性使用及胆道感染、急性胰腺炎抗感染治疗的药学临床路径。建立追踪反馈机制,比较路径化管理前后用药合理率及运行指标,评估干预效果。结果:路径化管理后,抗菌药物联合用药率显著下降、用药疗程缩短,给药时机、药物选择、用法用量合理率均明显改善(P<0.05),抗菌药物使用总体合理率由37.44%(73/195)上升至68.65%(127/185)(P<0.01),抗菌药物使用强度由72.29DDD降至32.52DDD,抗菌药物每月使用金额由29.11万元下降至12.25万元。结论:路径化管理可有效促进消化内科抗菌药物合理使用,降低抗菌药物使用强度及医疗成本,可作为临床合理用药的长效管理机制。

Objective: To provide practical references for clinical rational drug use by establishing a pharmacy clinical pathway of antibiotics in gastroenterology department. Methods: The multidisciplinary pharmaceutical ward rounds were implemented focusing on problems of antibiotics in gastroenterology department, during which pharmacists and physicians jointly developed the pharmacy clinical pathways for perioperative prophylactic use of antibiotics in endoscopy, anti-infective regimen of biliary tract infection and acute pancreatitis, established the feedback and tracking mechanisms. And the rationality and indicator of antibiotics before and after clinical pathway management were compared to evalutate the intervention effect. Results: After the management of clinical pathway, the combination rate of antibiotics was significantly decreased, the course of medication was significantly decreased, and the rational rate of the timing of administration, drug selection, usage and dosage were significantly improved(P < 0.05). The total rational rate of antibiotics increased from 37.44%(73/195) to 68.65%(127/185)(P < 0.01), the antibiotics use density decreased from 72.29DDD to 32.52DDD, and the expense of antibiotics decreased from 291 100 yuan per month to 122 500 yuan per month. Conclusion: Pathway-based management could effectively promote the rational use of antibiotics in gastroenterology department and reduce antibiotics use density and medical costs, which could be a long-term management mechanism for clinical rational drug use.