Effect of comprehensive quality control intervention on the use of antibiotics and standardized medical record writing in the elderly patients with closed fracture / 中国综合临床

ABSTRACT

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). The eligible rate of the pre-operative informed consent document signing was 100% (61/61) in the intervention group, and the eligible rate of the operative record completion time was 100% (61/61) higher than that in the non-intervention group (84.7% (50/59), 79.7% (47/59)), the difference was statistically significant (χ 2 values were 7.98 and 13.79; P values were 0.005 and <0.001). The loss rate of preoperative alternative therapy (0) and postoperative communication (0) were significantly lower than those of non-intervention group (11.9% (7/59), 10.2% (6/59)) (χ 2 values were 5.68 and 4.56; P values were 0.017 and 0.033). Conclusion:The implementation of comprehensive quality control intervention mode reduced the application of unreasonable antibiotics and standardized the writing of inpatient medical records. It is of great significance for the rational use of antibiotics and the standardization of medical record writing in the elderly patients with closed fracture.