住院患者抗菌药物使用持续综合管理效果  

Effect of continuous comprehensive management on use of antibiotics of hospitalized patients

作　　者：翟文杰 王姝 郭秉荣 王雪晴 ZHAI Wen-jie;WANG Shu;GUO Bing-rong;WANG Xue-qing(Jinzhong First People′s Hospital,Jinzhong,Shanxi 030600,China;不详)

机构地区：[1]晋中市第一人民医院临床药学与试验中心,山西晋中030600 [2]山西医科大学药学院,山西晋中030600

出　　处：《中华医院感染学杂志》2023年第14期2175-2179,共5页Chinese Journal of Nosocomiology

基　　金：山西省卫生健康委员会科研基金资助项目(2023148)。

摘　　要：目的分析住院患者持续综合管理抗菌药物使用的效果。方法调取晋中市第一人民医院2018年1月-2021年12月住院患者抗菌药物使用情况,对抗菌药物使用率、医嘱合理率和不合理类型统计分析。从科室、抗菌药物级别和种类等方面分析医院“处方点评—专家会议复审—考核反馈—追踪点评”模式对抗菌药物使用的管理效果。结果总计抽取病例数10013份,其中抗菌药物使用病例数4403份,抗菌药物点评医嘱总数7131份,2018-2021年抗菌药物使用率为56.56%~39.74%,呈下降趋势(P<0.05);抗菌药物合理率为96.26%~97.52%,呈上升趋势(P<0.05)。外科系统抗菌药物合理率(95.13%)低于内科系统,非限制级抗菌药物合理率(95.54%)低于限制级和特殊级,差异具有统计学意义(P<0.05)。帕累托图显示不合理问题主要类型是疗程长(92/252,36.51%)、遴选药品不适宜(48/252,19.05%)和用药无指征(35/252,13.89%)。结论医院持续综合管理模式对住院患者抗菌药物的合理使用有显著促进作用,仍需要加强“外科医生”、“住院医师”等重点人群的培训,着重培训理论知识薄弱环节,以持续改进抗菌药物的合理使用。OBJECTIVE To analyze the effect of continuous comprehensive management on use of antibiotics of the hospitalized patients.METHODS The use of antibiotics of the patients who were hospitalized in Jinzhou First People’s Hospital from Jan 2018to Dec 2021was investigated.The rate of use of antibiotics,reasonable rate of doctor’s advice and unreasonable types were statistically analyzed.The effect of‘prescription assessment-expert meeting review-assessment feedback-follow-up review’mode on management of use of antibiotics was analyzed from the aspects of departments,grades of antibiotics and types.RESULTS A total of 10013cases of patients,including 4403cases of use of antibiotics and 7131items of doctor’s advice,were extracted.The utilization rate of antibiotics ranged between 56.56%and 39.74%from 2018to 2021,showing a downward trend(P<0.05);the rate of reasonable use of antibiotics ranged between 96.26%and 97.52%,showing a upward trend(P<0.05).The rate of reasonable use of antibiotics was lower in surgery departments(95.13%)than in internal medicine departments,the rate of reasonable use of non-restricted antibiotics was 95.54%,lower than that of restricted and special antibiotics,and there were significant differences(P<0.05).Pareto diagram showed that the major types of unreasonable use of antibiotics included long treatment course(92/252,36.51%),inappropriate selection of drugs(48/252,19.05%)and use of antibiotics without indications(35/252,13.89%).CONCLUSION The continuous comprehensive management mode has remarkable effect on promoting the reasonable use of antibiotics for the hospitalized patients,and it is necessary to further strengthen the training of key populations such as surgeons and resident doctors and focus on training of weak links of theoretical knowledge so as to continuously improve the reasonable use of antibiotics.

关 键 词：持续综合管理 处方点评 住院患者 抗菌药物 合理用药 临床药学 

分 类 号：R197.32[医药卫生—卫生事业管理]