PDCA循环法对临床药师主导的抗菌药物管理项目实施效果的影响  

Effects of PDCA Cycles on Implementation of Antimicrobial Stewardship Program Led by Clinical Pharmacists

作　　者：马英杰 马丽萍 MA Yingjie;MA Liping(Dept.of Pharmacy,Beijing Shijitan Hospital,Capital Medical University,Beijing 100038,China;Beijing Key Laboratory of Bio-Characteristic Profiling for Evaluation of Rational Drug Use,Beijing 100038,China;International Cooperation & Joint Laboratory of Bio-Characteristic Profiling for Evaluation of Rational Drug Use,Beijing 100038,China;Dept.of Clinical Trial Organization Office,Peking University Shougang Hospital,Beijing 100144,China)

机构地区：[1]首都医科大学附属北京世纪坛医院药剂科,北京100038 [2]临床合理用药评价北京市重点实验室,北京100038 [3]临床合理用药评价国际合作联合实验室,北京100038 [4]北京大学首钢医院临床试验机构办,北京100144

出　　处：《中国医院用药评价与分析》2020年第6期723-726,728,共5页Evaluation and Analysis of Drug-use in Hospitals of China

基　　金：北京市优秀人才“青年拔尖团队”项目(No.2018000021223TD09)。

摘　　要：目的:探讨某三级甲等综合医院(以下简称“该院”)应用PDCA循环管理优化临床药师主导抗菌药物管理项目(antimicrobial stewardship program,ASP)对抗菌药物合理应用的影响。方法:基于ASP策略,在该院干部综合科病区实施综合干预措施,包括抗菌药物首次用药医嘱前置审核;带有干预和反馈的用药审核;针对抗菌药物治疗持续时间>10 d的患者予以干预管理。对医师进行培训,对患者开展用药教育。并采用PDCA循环管理优化ASP,将实施PDCA循环前(2018年7—10月)、实施PDCA循环后(2018年11月至2019年10月)的抗菌药物使用金额占药品总收入的比例、住院患者抗菌药物使用率、住院患者抗菌药物使用强度、住院患者特殊使用级抗菌药物使用强度以及接受抗菌药物治疗患者微生物检验标本送检率进行比较。结果:采取ASP并通过PDCA循环不断优化干预措施后,住院患者抗菌药物使用金额占药品总收入的比例由25.71%降至17.87%,住院患者抗菌药物使用率由50.46%降至40.53%,均呈显著降低趋势,与干预前的差异均有统计学意义(P<0.05);住院患者抗菌药物使用强度由37.34 DDDs/(100人·d)降至27.68 DDDs/(100人·d),住院患者特殊使用级抗菌药物使用强度由10.94 DDDs/(100人·d)降至6.00 DDDs/(100人·d);接受抗菌药物治疗患者微生物检验标本送检率由48.19%升至66.36%,呈升高趋势,与干预前的差异有统计学意义(P<0.05)。结论:本研究由临床药师主导ASP,采取PDCA循环管理不断对ASP干预措施进行优化,提高了该院干部综合科病区抗菌药物合理应用水平。但是还存在一些问题,在今后的工作中需要进一步完善。OBJECTIVE:To probe into the effects of PDCA cycles on implementation of antimicrobial stewardship program(ASP)led by clinical pharmacists in a gradeⅢ,class A general hospital(hereinafter referred to as“the hospital”).METHODS:Based on the strategy of ASP,comprehensive intervention measures were implemented in the comprehensive department ward of the hospital,including first-time premedication review,medication review with intervention and feedback,patients with>10 d duration of antibiotics.Training for clinicians and education for patients on medication were performed.The ASP was optimized by using PDCA cycles management,the proportion of consumption sum of antibiotics to the total drugs,application rate of antibiotics in inpatients,use intensity of antibiotics in inpatients and special application grade antibiotics in inpatients,and microbiological test specimen submission rates for patients receiving antimicrobial therapy were compared before PDCA cycle(from Jul.to Oct.2018)and after PDCA cycle(from Nov.2018 to Oct.2019).RESULTS:After the adoption of ASP and continuous optimization of intervention measures through PDCA cycles,the proportion of consumption sum of antibiotics to the total drugs in inpatients decreased from 25.71%to 17.87%,and the application rate of antibiotics in inpatients decreased from 50.46%to 40.53%,both of which showed the significant decrease trend,with statistically significant differences compared with before PDCA cycle(P<0.05).The use intensity of antibiotics in inpatients decreased from 37.34 DDDs/(100 people·d)to 27.68 DDDs/(100 people·d),and the use intensity of special application grade antibiotics in inpatients decreased from 10.94 DDDs/(100 people·d)to 6.00 DDDs/(100 people·d).The rate of microbiological test specimen submission rates for patients receiving antimicrobial therapy increased from 48.19%to 66.36%,showing the increasing trend,and the difference was statistically significant compared with before PDCA cycle(P<0.05).CONCLUSIONS:In this study,the clinical pharmac

关 键 词：抗菌药物 抗菌药物管理项目 合理用药 临床药师 PDCA循环 

分 类 号：R978.1[医药卫生—药品]