综合质控干预对老年闭合性骨折患者合理应用抗菌药物及规范病历书写的效果评价  

Effect of comprehensive quality control intervention on the use of antibiotics and standardized medical record writing in the elderly patients with closed fracture

作　　者：曹海涛[1] 蒋雨宸 陈超 李冀[1] 梁卫东[1] Cao Haitao;Jiang Yuchen;Chen Chao;Li Ji;Liang Weidong(Department of Orthopedics,Tangshan Second Hospital,Hebei Province,Tangshan 063000,China;Department of Orthopedics,Affiliated Hospital of North China University of Technology,Tangshan 063000,China)

机构地区：[1]河北省唐山市第二医院骨科,唐山063000 [2]华北理工大学附属医院骨科,唐山063000

出　　处：《中国综合临床》2022年第4期308-313,共6页Clinical Medicine of China

基　　金：河北省医学科学研究重点课题计划项目(20201443)。

摘　　要：目的探讨综合指控干预对老年闭合性骨折患者抗菌药物使用及病历书写规范的效果评价。方法选取2017年1月至2019年6月在唐山市第二医院及华北理工大学附属医院骨外科住院的老年闭合性骨折(年龄≥60岁)120例患者作为观察对象。应用计算机随机数字法将120例患者分为干预组61例和非干预组59例。干预组患者在围手术期施行药学服务与质控管理干预;非干预组患者在围手术期常规应用抗菌药物及常规书写病历。比较两组患者抗菌药物使用效果、抗菌药物费用及两组医疗文书书写规范效果。正态分布的计量资料组间比较采用独立样本t检验,计数资料组间比较采用χ2检验。结果与非干预组比较,干预组的围手术期抗菌药物使用率[49.2%(30/61)]、无指征用药率[4.9%(3/61)]、选药不合理率[6.6%(4/61)]、用药时机不合理率[6.6%(4/61)]、不合理联合用药率[3.3%(2/61)]均低于非干预组[81.4%(48/59)、16.9%(10/59)、22.0%(13/59)、20.3%(12/59)、18.6%(11/59)],差异均有统计学意义(χ^(2)值分别为13.65、4.49、5.91、4.93、7.33,P值分别为<0.001、0.034、0.015、0.026、0.007);干预组抗菌药物费用[(283.86±59.86)元]低于非干预组[(820.45±136.27)元],差异有统计学意义(t=27.478,P<0.001)。干预组的术前知情告知类文书签署合格率[100%(61/61)],手术记录完成时限合格率[100%(61/61)]高于非干预组[84.7%(50/59)、79.7%(47/59)],差异均有统计学意义(χ^(2)值分别为7.98、13.79;P值分别为0.005、<0.001)。术前手术替代治疗方案缺失率(0)、术后医患沟通缺失率(0)低于非干预组[11.9%(7/59)、10.2%(6/59)],差异均有统计学意义(χ^(2)值分别为5.68、4.56,P值分别为0.017、0.033)。结论实施综合质控干预模式减少了不合理抗生素的应用,规范了住院病历书写;对老年闭合性骨折患者临床上合理使用抗菌药物及病历书写规范有较大的意义。Objective To explore the effect of comprehensive accusation intervention on the use of antibacterial drugs and the writing of medical records in elderly patients with closed fracture.Methods A total of 120 elderly patients(aged≥60 years)with fracture were enrolled from January 2017 to June 2019 in the department of orthopaedics and traumatology of the Second Hospital of Tangshan University and the Affiliated Hospital of North China University of Technology.According to random number table method,120 patients were divided into intervention group(61 cases)and non intervention group(59 cases)by computer random number method.The patients in the intervention group received pharmaceutical care and quality control management intervention during the perioperative period;The patients in the non intervention group were routinely treated with antibiotics and wrote medical records.The use effect of antibiotics,the cost of antibiotics and the effect of standardized writing of medical documents were compared between the two groups.Independent sample t-test was used for comparison between measurement data groups with normal distribution,and χ^(2) test was used for comparison between counting data groups.Results Compared with the non-intervention group,the rate of perioperative use of antibiotics(49.2%(30/61)),the rate of drug use without indication(4.9%(3/61)),the rate of irrational drug selection(6.6%(4/61)),the rate of irrational drug use(6.6%(4/61)),and the proportion of irrational combined use of antibiotics(3.3%(2/61))were significantly lower than that in the non-intervention group(81.4%(48/59),16.9%(10/59),22.0%(13/59),20.3%(12/59),18.6%(11/59)),the difference was statistically significant(χ^(2) values were 13.65,4.49,5.91,4.93 and 7.33,respectively;P values were<0.001,0.034,0.015,0.026 and 0.007,respectively).The cost of antibiotics in the intervention group((283.86±59.86)yuan)was lower than that in the non intervention group((820.45±136.27)yuan),and the difference was statistically significant(t=27.478,P<0.001).Th

关 键 词：老年闭合性骨折 Ⅰ类切口 病历书写 抗菌药物使用 药师干预 综合质控员干预 

分 类 号：R683[医药卫生—骨科学]