医院和科室上下联动事前-事中-事后闭环服务抗菌药物管理模式构建与实践
Construction and Practice of a Closed-Loop Antimicrobial Management Model with Prescription Services in Advance,in the Matter and Afterward Based on the Upper and Lower Linkage Between the Hospital and Departments
杨全军 1罗莉 2朱文君 2干润 1屠祎惺 1辛博 1杨黎 1陈燕 1张剑萍 1郭澄 1刘义成2
作者信息
- 1. 上海交通大学医学院附属第六人民医院,上海 200233
- 2. 上海交通大学医学院附属第六人民医院,上海 200233;上海交通大学中国医院发展研究院公立医院党建研究所,上海 200233
- 折叠
摘要
目的 促进抗菌药物的合理应用.方法 基于循证证据建立医院和科室上下联动事前-事中-事后闭环服务的抗菌药物管理模式.分析闭环服务的关键节点和服务内容,落实网络化服务体系,完善特殊患者和限制级抗菌药物专项服务等闭环服务的网络干预系统,并比较实施前(2020年)和实施后(2021年至 2023年)医院抗菌药物使用强度(AUD)及不合理医嘱类型.结果 2021年、2022年、2023 年医院AUD分别为 39.40 DDDs、32.10 DDDs、38.09 DDDs,均较 2020 年的 57.80 DDDs低,且符合我国综合医院AUD的限定标准(40 DDDs).2021 年,抗菌药物不合理医嘱类型排名前 3 的分别为抗菌药物预防/治疗方案不合理、药物选择不合理、联合用药不合理;2022 年,抗菌药物不合理医嘱类型排名前 3 的分别为抗菌药物预防/治疗方案不合理、用药疗程不合理、给药途径和剂量不合理;2023 年,抗菌药物不合理医嘱类型排名前 3 的分别为给药途径和剂量不合理、用药疗程不合理、抗菌药物预防/治疗方案不合理.结论 医院和科室上下联动事前-事中-事后闭环服务的抗菌药物管理模式可有效降低医院AUD,促进抗菌药物不合理医嘱类型的转变,从药物治疗方案优化逐步过渡到抗菌药物剂量和疗程精细化.
Abstract
Objective To promote the rational use of antibiotics.Methods Based on the evidence-based approach,a closed-loop antimicrobial management model with prescription services in advance,in the matter and afterward based on the upper and lower linkage between the hospital and departments was established.The key nodes and service content of closed-loop services were analyzed,the networked service system was implemented,the network intervention system for closed-loop services such as special patients and restricted antibacterial drug special services was improved.The antibacterial use density(AUD)and unreasonable types of medical orders in the hospital before implementation(2020)and after implementation(from 2021 to 2023)were compared.Results The AUD of the hospital in 2021,2022,and 2023 were 39.40 DDDs,32.10 DDDs,and 38.09 DDDs,respectively,which were lower than the 57.80 DDDs in 2020 and met the limited standard of AUD(40 DDDs)for general hospitals in China.In 2021,the top three types of unreasonable medical orders for antibiotics were unreasonable antimicrobial prevention/treatment plans,unreasonable drug selection,and unreasonable combination therapy.In 2022,the top three types of unreasonable medical orders for antibiotics were unreasonable antimicrobial prevention/treatment plans,unreasonable medication duration,and unreasonable administration routes and doses.In 2023,the top three types of unreasonable medical orders for antibiotics were unreasonable administration routes and doses,unreasonable medication courses,and unreasonable antimicrobial prevention/treatment plans.Conclusion The closed-loop antimicrobial management model with prescription services in advance,in the matter and afterward based on the upper and lower linkage between hospitals and departments can effectively reduce the AUD,promote the transformation of unreasonable types of medical orders of antibiotics,and gradually transition from optimizing drug treatment plans to refining antibiotic dosage and course of treatment.
关键词
医院和科室上下联动/事前-事中-事后闭环服务/抗菌药物/合理用药/抗菌药物使用强度/医嘱Key words
upper and lower linkage between the hospital and departments/prescription services in advance,in the matter and afterward/antibiotics/rational drug use/antibacterial use density/medical orders引用本文复制引用
基金项目
国家自然科学基金面上项目(82272925)
上海市浦江人才项目(A类)(21PJ1411900)
上海市第六人民医院院级管理类科研基金(X-4221)
上海市第六人民医院医疗服务能级提升工程医政管理优化项目(X-4108)
出版年
2024
国家科技期刊平台
NSTL
万方数据