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OBJETIVO: identificar as estratégias para o uso seguro de antimicrobianos adotadas pela enfermagem no ambiente hospitalar. MÉTODO: revisão integrativa, realizada no período de junho a julho de 2020, nas bases de dados da LILACS, MEDLINE, CINAHL e EMBASE. Selecionaram-se artigos de 2015 a junho de 2020. Para a análise dos níveis de evidência, adotou-se o método Grading of Recomendations Assessment, Developing and Evaluation. RESULTADOS: encontraram-se oito artigos, distribuídos em estratégias gerenciais e assistenciais de enfermagem, relacionadas ao uso seguro de antimicrobianos. DISCUSSÃO: dentre as principais estratégias gerenciais, destacam-se o papel de educador do enfermeiro e a formação de comitês de monitoramento multidisciplinar; e dentre as assistenciais, as especificidades técnicas da administração de antimicrobianos. CONCLUSÃO: as principais estratégias práticas de Enfermagem encontradas foram educação profissional no uso racional e monitoramento multidisciplinar na resistência antimicrobiana no ambiente hospitalar. Acredita-se que a identificação dessas estratégias contribua para o desenvolvimento de melhores práticas na segurança medicamentosa.
OBJECTIVE: to identify the strategies for the safe use of antimicrobials adopted by Nursing in the hospital environment. METHOD: an integrative review, carried out from June to July 2020, on the LILACS, MEDLINE, CINAHL, and EMBASE databases. Articles from 2015 to June 2020 were selected. For the analysis of the evidence levels, the Grading of Recommendations Assessment, Development and Evaluation was adopted. RESULTS: eight articles were found, distributed in Nursing management and care strategies, related to the safe use of antimicrobials. DISCUSSION: among the main managerial strategies, the role of the educator and the setting up of multidisciplinary monitoring committees stand out; and, among the care strategies, the technical specificities of antimicrobial stewardship. CONCLUSION: the main Nursing practical strategies found were professional education in the rational use and multidisciplinary monitoring of antimicrobial resistance in the hospital environment. It is believed that the identification of these strategies will contribute to the development of better practices in drug safety.
OBJETIVO: identificar las estrategias para el uso seguro de antimicrobianos adoptadas por la enfermería en el ámbito hospitalario. MÉTODO: revisión integradora, realizada de junio a julio de 2020, de las bases de datos de LILACS, MEDLINE, CINAHL y EMBASE. Se seleccionaron artículos de 2015 a junio de 2020. Para el análisis de niveles de evidencia se adoptó el método Grading of Recomendations Assessment, Developing and Evaluation. RESULTADOS: se encontraron ocho artículos, distribuidos en estrategias gerenciales y asistenciales de enfermería, relacionados con el uso seguro de antimicrobianos. DISCUSIÓN: entre las principales estrategias gerenciales se destaca el rol de la enfermera educadora y la conformación de comités de seguimiento multidisciplinarios; y entre las asistenciales, las especificidades técnicas de la administración de antimicrobianos. CONCLUSIÓN: las principales estrategias prácticas de enfermería encontradas fueron la formación profesional en el uso racional y el seguimiento multidisciplinario de la resistencia a los antimicrobianos en el ámbito hospitalario. Se cree que la identificación de estas estrategias contribuye al desarrollo de mejores prácticas en seguridad de medicamentos.
Subject(s)
Humans , Drug Resistance, Bacterial , Patient Safety , Antimicrobial Stewardship/organization & administration , Hospital Administration , Nursing Care , Nursing, TeamABSTRACT
Objetivo: Definir fluxos de trabalho multidisciplinares para padronização do serviço. Definição do elenco de medicamentos a ser monitorado e estudar resultados preliminares. Métodos: Criação de grupo de trabalho e tabulação dos dados em planilhas Excel ® com as principais intervenções executadas em fevereiro/2019. Resultados: Observou-se que 35% dos tratamentos foram mantidos conforme prescrição inicial. 18% tiveram a duração de tratamento reduzida e 9% não foram autorizados pela CCIH devido a inconformidades. Também foi feita a correção de dose para função renal em 8% das prescrições. Calculou-se o valor do tratamento/dia para cada antimicrobiano. As intervenções descritas representam uma economia direta de R$ 1905,08 reais. Não foram contabilizadas as despesas com materiais médico-hospitalares, transporte/logística e recursos humanos. O percentual de intervenções da farmácia clinica ocorre principalmente na etapa de prescrição devido ao rastreio pela dose individualizada. Também foram realizadas intervenções nas etapas de preparo, diluição e estabilidade. Reações adversas foram detectadas, notificadas e monitoradas devido a necessidade de manejo clínico. Conclusões: Este trabalho demonstra a economia financeira gerada pela atuação da equipe multidisciplinar e também reforça a necessidade de ampliação dos serviços farmacêuticos clínicos e logísticos, já que o trabalho no controle de dispensação individualizado associado a intervenções clínicas são mais eficazes. A complexidade do processo exige monitorização interdisciplinar em todas as etapas do tratamento visando a segurança do paciente.
Objective: Define multidisciplinary protocols for service standardization. Definition of the list of drugs to be monitored and study preliminary results. Methods: Creation of a working group and tabulation of the data in Excel® with the main interventions executed in February / 2019. Results: It was observed that 35% of the treatments were maintained according to the initial prescription. 18% had a reduced treatment duration and 9% were not authorized by CCIH due to nonconformities. Dose correction for renal function was also performed in 8% of prescriptions. The interventions described represent a direct savings of R $ 1905.08. The expenses with medical-hospital materials, transport / logistics and human resources were not accounted for. The percentage of clinical pharmacy interventions occurs mainly at the prescription stage due to individualized dose screening. Conclusions: This work demonstrates the financial economy generated by the multidisciplinary team and also confirm the need for expansion of clinical and logistic pharmaceutical services.
Subject(s)
Anti-Infective AgentsABSTRACT
Objective To investigate current situation of Chinese clinical microbiological laboratories participating in management of healthcare-associated infection and antimicrobial use.Methods Fourteen provinces (municipalities), autonomous regions and army hospitals in seven regions of China were selected, the participation of clinical microbiological laboratories in the consultation of HAI diseases, specimen quality control, antimicrobial use, and management of multidrug-resistant organisms (MDROs) before 2000 and every five years from 2000 to 2015 were investigated, the surveyed results were analyzed statistically.Results A total of 187 hospitals were investigated, in 2015, 96 and 172 hospitals (51.34％, 91.98％) participated in the consultation of infectious diseases and multi-department collaborative management on MDROs respectively.However, 44 hospitals (23.53％) still manually performed statistical analysis on drug susceptibility, only 26 hospitals (13.90％) had the ability of identifying homology of pathogens.Rate of MDRO surveillance data feedbacked to clinical departments increased from 66.84％ (n=125) in 2010 to 95.72％ (n=179) in 2015, the frequency of feedback was mainly monthly and quarterly;rate of antimicrobial susceptibility results feedbacked to clinic departments increased from 62.03％ (n=116) to 94.12％ (n=176), 82.35％ (n=154) of clinical microbiological laboratories conducted quarterly feedback;the quality control rate of microscopic sputum smear before sputum culture increased from63.10％ (n=118) to 87.17％ (n=163);rate of bilateral double blood culture increased from 35.83％ (n=67) to 72.73％ (n=136);rates of other aseptic body fluid culture (except blood and urine) increased from 4.86％ to 5.74％;differences were all significantly different between 2010 and 2015 (all P＜0.05).Conclusion Clinical microbiological laboratories have played an important role in promoting the development of HAI management in China, especially during the period of 2011-2015.However, the homology analysis on HAI pathogens, informatization of result feedback, and sterile body fluid specimens detection need to be further strengthened.
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Objective To investigate the application of antimicrobial agents in a tertiary first-class hospital before and after implementing special rectification activity on clinical antimicrobial use.Methods Data about antimicrobial use in a hospital in Sichuan Province between January 2011 and December 2013 were collected and analyzed retro-spectively,data included antimicrobial varieties,the ratio of antimicrobial prescription in outpatient department to emergency department,percentage of antimicrobial application expense in the total hospitalization expense,antimi-crobial use rate and use density,antimicrobial use rate and use density of special use antimicrobial agents,microbial detection for patients receiving restricted and special antimicrobials.Results Before implementing rectification of an-timicrobial use,there were 88 kinds of antimicrobial agents in hospital,after implementing rectification,there were 50 kinds of antimicrobial agents.The ratio of antimicrobial prescription in outpatient department to emergency de-partment,and the percentage of antimicrobial expense in the total hospitalization expense were both lower than be-fore rectification (both P tion,antimicrobial use become more rational,but management still needs further and continuous improvement.
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OBJECTIVE: To analysis the improvement of perioperative antibiotic prophylaxis in 3 kinds of surgical incisions after we strengthened the management of antibiotics in our hospital and provide reference for clinical rational use of antibiotics. METHODS: Random selected 139 medical records from January to October in 2011as the control group, and random selected 150 medical records from January to October in 2012 as the monitoring group. Compared the surgical site infection rates, antimicrobial utilization rate, the average number of medication days, the cost of antimicrobial drugs and the rationality of the antibiotics, etc. between the two groups in order to investigate if the monitoring group significantly improved. RESULTS: There was no significant difference (p=1.00) in Surgical site infection rates between the two groups. The antimicrobial utilization rate (P<0.001), the average number of medication days (P=0.001), the average cost of hospitalization (P=0.006), the average drug costs (P<0.001), the average antibacterial drug costs (P<0.001), the average antibacterial drug cost/the average cost of hospitalization (P<0.001), the reasonable rate for the choice of the drug (P=0.003), the reasonable rate for the intraoperative medication time (P=0.007) in the monitoring group were significantly better than the control group in type 1incision operation; in type 2incision operation the average number of medication days (P=0.05), the average antibacterial drug costs (P=0.015), the average antibacterial drug costs/the average inpatient costs (P=0.03), the reasonable rate for the preoperative medication time (P<0.001), thereasonable rate for the postoperative medication (P=0.001) in the monitoring group were significantly better than the control group; and in type 3 incision operation only the average antibacterial drug costs/the average inpatient costs (P=0.046) and the reasonable rate for the intraoperative medication time (P=0.057) in the monitoring group were significantly better than the control group. COMCLUSION The Measures to strengthen the management of antimicrobial drugs in our hospital can improve the rational use of antimicrobial agents in type 1incision operation. However, we need to further strengthen the management of preventive antibacterial drugs in type 2and type 3 incision operation.