Study on the Process Quality Evaluation of Antibiotics Management in a Tertiary General Hospital / 中国药房

ABSTRACT

OBJECTIVE:To provide reference for improving the process quality of antibiotics management.METHODS:Based on the international Antibiotics Stewardship(AMS) strategy goal,according to process quality evaluation method of "structure-process-result" medical quality evaluation model,antibiotics management intervention of a tertiary general hospital during 2011-2016 was analyzed statistically in respects of general information,department involved,intervention types,intervention reasons,drug types involved,etc.The proportion of antibiotics in outpatients,emergency patients and inpatients,the proportion of antibiotics for prophylactic use in type Ⅰ incision surgery patients were evaluated before (2011) and after intervention (2014).RESULTS:A total of 2 137 intervention records were collected.The department involved in the intervention was mainly surgical department,including 12 surgical departments as gynecology department,otolaryngology department and orthopedics department (55.97％).In the type of intervention,the intervention of used drug type was relatively high (44.77％).The main reasons for intervention included inappropriate usage and dosage,improvement of treatment effect,unreasonable amount of solvent,incomplete clinical diagnosis or clinical diagnosis deletion in prescriptions,inappropriate indication,and repeated administration (90.55％).The drugs involved were mainly β-lactam (including carbapenems) and enzyme inhibitor (62.43％).After intervention,the utilization rates of antibiotics in outpatients,emergency patients and inpatients decreased from 27.70％,49.42％,60.42％ to 17.57％,38.65％,47.21％,respectively.The proportion of antibiotics for prophylactic use decreased from 85.75％ to 30.33％ in type Ⅰ incision surgery patients.The proportion of surgery with antibiotics for prophylactic use ＜24 h in total cases of antibiotics for prophylactic use increased from 54.52％ to 68.84％ (all P＜0.05).Average antibiotics cost of outpatients and inpatients decreased from (30.12 ± 10.19),(727.36 ± 120.45) yuan to (30.03 ± 1.34),(609.32 ± 48.83) yuan,respectively.There still were some problems,including lacking of economic intervention for drug use,lacking of multi-disciplinary collaborative management,imperfect information system,etc.,which delayed the promotion of professional antibiotics management.CONCLUSIONS:Referring to AMS strategy,the hospital should establish multidisciplinary management mechanismto strengthen the process management of antibiotics use.The role of information system in the management of antibiotics use should be given full play,and the intervention of antibiotics use economy should be increased so as to realize the specialization of antibiotics management process.