AMS和PDCA循环法在医院抗菌药物管理中的应用效果评价  

Effect on AMS and PDCA circle in hospital antibiotics management

作　　者：张宏亮[1] 黄振光[1] 章忠明[1] 蒋敦科[1] 覃金爱[1] 玉艳红[1] 李萌[1] 郑诗庭 刘滔滔[1] ZHANG Hongliang;HUANG Zhenguang;ZHANG Zhongming;JIANG Dunke;QIN Jin’ai;YU Yanhong;LI Meng;ZHENG Shiting;LIU Taotao(First Affiliated Hospital,Guangxi Medical University,Nanning 530021,China;不详)

机构地区：[1]广西医科大学第一附属医院,广西南宁530021

出　　处：《现代医院》2021年第2期205-208,211,共5页Modern Hospitals

基　　金：广西自然科学基金项目(2017GXNSFBA198177);广西中医药适宜技术开发与推广项目(GZSY20-10)。

摘　　要：目的运用抗菌药物科学化管理(AMS)的策略,结合PDCA循环的方法,探索适合医院降低抗菌药物使用强度的实践举措。方法成立多学科团队的AMS小组,进行现状调研,分析使用强度偏高的原因并进行要因分析,最终确定抗菌药物知识缺乏、没有分科目标值、抗菌药物信息系统缺失和奖惩不完善四条要因。根据要因拟定相关对策,通过一系列多手段的宣教和培训,对信息系统进行流程改造和新功能开发。此外还完善相关制度,加大抗菌药物处方点评和奖惩力度,每个病区成立自己的抗菌药物管理小组,设专人对该抗菌药物相关指标进行监控。最后制定抗菌药物使用强度的分科目标制,让每个病区都发挥主观能动性。结果抗菌药物使用强度降至40DDDs以下,达到了既定目标。抗菌药物使用不合理率从10%以上降至小于2%。结论 AMS策略和PDCA循环法结合,既能发挥管理职能的优势,也能发挥技术支撑的作用。可以提高抗菌药物合理应用的水平,也可以达到降低抗菌药物使用强度的目的,值得推广借鉴。Objective To explore the measures for reducing the antibiotics use density(AUD) in our hospital by using antimicrobial stewardship(AMS) combined with PDCA cycle.Methods A multidisciplinary AMS team was established to conduct a research and study the reasons of the high AUD. Finally, four primary causes were identified, including lack of antimicrobial knowledge, no disciplinary target value, antimicrobial information system scarcity and incomplete rewards and punishment system. Therefore, relevant countermeasures were adopted, which involved a series of education and training methods, process change on information system and new functional development. Besides, related systems were improved to increase the antimicrobial prescription evaluation and the rewards and punishment system. Each ward set up its AMS team and assigned specialists to monitor the relevant antimicrobial indicators. The disciplinary target system was finally made to determine the AUD so as to allow every ward to play its subjective initiative.Results The stated goal was achieved with the AUD reducing to less than 40 DDDs, the unreasonable rate of antibiotics use dropped from above 10% to less than 2%.Conclusion The combination of AMS and PDCA cycle can improve the rational antibiotics use, and lower the AUD, which is worth promotion.

关 键 词：抗菌药物使用强度 AMS PDCA 

分 类 号：R197.323.4[医药卫生—卫生事业管理] R197.323.1[医药卫生—公共卫生与预防医学]