闭环管理模式用于妇科围术期抗菌药物管理效果评价

Effect of Closed-Loop Management Mode on the Management of Perioperative Antibiotics in Gynecologic Surgery

目的探讨闭环管理模式用于妇科围术期抗菌药物管理的效果。方法基于药品说明书、国内外专家共识及指南设置妇科围术期抗菌药物预防性使用规则,包括用药指征、用药时机、药物选择、用法用量、重复用药和用药疗程;利用医嘱前置审核系统,形成事前干预、事中审核、事后点评、结果反馈、临床改进的闭环管理模式。收集医院2021年1月至6月(管理前,828例)和2022年1月至6月(管理后,710例)妇科手术患者的病历资料,其中Ⅰ类切口手术797例(包括管理前432例、管理后365例)和Ⅱ类切口手术741例(包括管理前396例、管理后345例)。回顾性分析妇科围术期抗菌药物的使用合理性。结果管理后,用药指征合理率由55.68%(461/828)升至81.69%(580/710),药物品种选择合理率由62.80%(520/828)升至83.38%(592/710),用药时机合理率由75.24%(623/828)升至96.20%(683/710),用药疗程合理率由24.76%(205/828)升至69.58%(494/710),用法用量合理率由94.57%(783/828)升至100.00%(710/710),差异均有统计学意义(P<0.05);Ⅰ类切口手术联合用药比例由58.33%(252/432)降至30.41%(111/365),差异均有统计学意义(P<0.05);38.63%(141/365)的Ⅰ类切口手术预防用药疗程超过24 h,20.29%(70/345)的Ⅱ类切口手术预防用药疗程超过48 h。结论基于医嘱前置审核系统的闭环管理模式的应用,可明显提高妇科围术期抗菌药物使用的合理性,保障患者用药安全。

Objective To investigate the effectiveness of the closed-loop management model in the management of perioperative antibiotics in gynecologic surgery.Methods Based on the drug package insert,the consensus and guidelines of experts at home and abroad,the preventive use rules of prophylactic use of antibiotics in the perioperative period of gynecologic surgery were set up,including medication indications,medication timing,drug selection,usage and dosage,repeated medication,and medication duration.With the help of the pre-review system of medical orders,the closed-loop management model of pre-intervention,in-process review,post-review,result feedback,and clinical improvement was formed.The medical records of patients who underwent gynecologic surgery from January to June 2021(before management,828 cases)and from January to June 2022(after management,710 cases)were collected,including 797 cases of ClassⅠincision surgery(432 cases before management and 365 cases after management)and 741 cases of ClassⅡincision surgery(396 cases before management and 345 cases after management).The rationality of prophylactic use of antibiotics in the perioperative period of gynecologic surgery was retrospectively analyzed.Results After management,the reasonable rate of medication indications increased from 55.68%(461/828)to 81.69%(580/710),the reasonable rate of drug variety selection increased from 62.80%(520/828)to 83.38%(592/710),the reasonable rate of medication timing increased from 75.24%(623/828)to 96.20%(683/710),the reasonable rate of medication treatment course increased from 24.76%(205/828)to 69.58%(494/710),and the reasonable rate of usage and dosage increased from 94.57%(783/828)to 100.00%(710/710),with statistically significant drfferences(P<0.05).The proportion of combined medication for ClassⅠincision surgery decreased from 58.33%(252/432)to 30.41%(111/365),with statistically significant differences(P<0.05).Precisely 38.63%(141/365)of ClassⅠincision surgery had a prophylactic medication course exceeding 24 h,and 20.29%(70/345)of ClassⅡincision surgery had a prophylactic medication course exceeding 48 h.Conclusion The application of the closed-loop management model based on the pre-review system for medical orders can significantly improve the rationality of prophylactic use of antibiotics in the perioperative period of gynecologic surgery and ensure the patients'medication safety.