持续质量改进对甲状腺Ⅰ类手术围术期预防用药的管理作用  

Effect of continuous quality improvement on preventive use of antibiotics during perioperative period of type I incision operation of thyroid gland

作　　者：范国才[1] 吴明东[2] 王卫华[1] 

机构地区：[1]丽水市遂昌县人民医院普外科,浙江丽水323300 [2]丽水市人民医院临床药学科,浙江丽水323000

出　　处：《中华医院感染学杂志》2013年第10期2437-2438,2441,共3页Chinese Journal of Nosocomiology

摘　　要：目的探讨持续质量改进(CQI)对甲状腺Ⅰ类手术围术期预防用药的管理作用,以指导临床合理使用抗菌药物。方法对2010年1-9月甲状腺Ⅰ类手术围手术期使用抗菌药物情况进行回顾性分析,制定相关持续改进方案,测定实施结果。结果经过CQI,2011年1-9月与2010年1-9月同期比较,抗菌药物使用率由100.00%下降至35.80%,用药疗程合理率由5.93%提高至95.68%,抗菌药物选择合理率由31.86%上升至99.38%,术前30min～2h用药比率由19.26%上升至97.53%,药物联用比率由5.93%降至0,人均抗菌药物费用由(232.82±68.12)元降低至(34.43±16.62)元,均存在显著差异(P<0.01)。结论持续质量改进明显提高Ⅰ类手术围术期合理应用抗菌药物水平,降低医疗费用,且所有患者均无手术部位感染发生。OBJECTIVE To investigate the effect of continuous quality improvement（CQI） on preventive use of antibiotics during perioperative period of type Ⅰ incision operations of thyroid gland so as to guide the reasonable clinical use of antibiotics. METHODS The preventive use of antibiotics during perioperative period of type Ⅰ incision operations of thyroid gland from Jan to Sep 2010 was retrospectively analyzed, since then the measures for CQI were implemented , and the effect was determined. RESULTS Through CQI, the utilization rate of antimicrobial drugs decreased from 100. 00% during Jan-Sep 2010 to 35.80% during Jan-Sep 2011, the rate of reasonable medication course increased from 5. 93% to 95. 68%, the rate of reasonable use of antibiotics increased from 31.86% to 99.38%, the medication ratio at 30 min-2 h before the surgery increased from 19.26% to 97.53%, the rate of combined use of antibiotics decreased from 5. 93% to 0%, and the average cost of antibacterial drug decreased from （232.82±68.12） yuan to（34.43 ± 16.62） yuan, the difference was statistically significant （P〈0.01）. CONCLUSION Rational utilization of antibiotics can be improved and the medical cost can be reduced by CQI during the perioperative period of type Ⅰ incision operation, and there are no cases of patients with surgical site infections.

关 键 词：持续质量改进 甲状腺手术 围手术期 抗菌药物 

分 类 号：R197.323[医药卫生—卫生事业管理]