闭环管理模式在儿童I类切口预防使用抗菌药物的应用评价

Application Evaluation of Closed-loop Management Model in the Prevention of Antibiotics in Children’s Type I Incision

关键词:  闭环管理模式  I类切口  抗菌药物  关键指标监测

Key words:  closed loop management mode  type I incision  antibiotics  key index monitoring

摘要:

目的 评价基于关键指标监测的闭环管理模式在提高儿童I类切口预防用药合理性的应用成效。方法 选取2018年1月-2021年12月杭州市儿童医院所有I类切口的病例,对其预防使用抗菌药物进行合理性点评,获取预防用药率、选药品种合理率、用药时机合理率和用药疗程合理率4项关键指标数据。以改进前的2018年监测数据为基础,分析不合理用药问题并制定相应对策实施改进,以每月监测数据为主线,实时开展各项持续质量改进项目,比较改进前后的关键指标变化。结果 2018-2021年,I类切口预防用药率分别为19.67%,21.69%,22.52%,24.56%,无明显降低,但除骨科外,其余I类切口预防使用率从10.99%下降至8.56%,8.83%,6.50%;选药品种合理率分别为94.68%,99.24%,99.50%,100.00%;用药时机合理率从80.85%上升至89.31%,99.00%,99.66%;用药疗程合理率从70.21%上升至87.79%,99.50%,97.29%(P<0.05)。结论 基于关键指标监测的闭环管理模式可以促进儿童I类切口围手术期预防使用抗菌药物的合理使用,可行性高,值得推广。

Abstract:

OBJECTIVE To evaluate the application effect of closed-loop management mode based on key index monitoring in improving the rationality of preventive medication for type I incision in children. METHODS From Jan. 2018 to Dec. 2021, all cases of type I incision in Hangzhou Children's Hospital were selected to evaluate the rationality of the preventive use of antibiotics, and the data of four key indicators, such as the rate of preventive use, the rational rate of drug selection, the rational rate of administration time and the duration. Based on the monitoring data before the improvement in 2018, analyzed the problems of irrational drug use and formulate corresponding countermeasures to implement the improvement. Took the monthly monitoring data as the main line, carried out various continuous quality improvement projects in real time, and compared the changes of key indicators before and after the improvement. RESULTS From 2018 to 2021, the drug use rates of class I incision prevention were 19.67%, 21.69%, 22.52% and 24.56% respectively. There was no significant decrease, but the use rates of other class I incision prevention decreased from 10.99% to 8.56%, 8.83% and 6.50%. The rational rates of selected drugs were 94.68%, 99.24%, 99.50% and 100.00% respectively. The rational rate of administration time increased from 80.85% to 89.31%, 99.00% and 99.66%, and the rational rate of medication course increased from 70.21% to 87.79%, 99.50% and 97.29%(P<0.05). CONCLUSION The closed-loop management mode based on key index monitoring can promote the rational use of antibiotics in the perioperative period of class I incision in children. It is feasible and worth popularizing.