2289份住院患者医嘱抗菌药物应用合理性分析

摘要

目的:了解深圳市盐田区人民医院(以下简称“我院”)住院患者抗菌药物应用的合理性,为规范医院抗菌药物的应用及建立有效的干预措施提供参考.方法:每月随机抽取我院2015年1月-2016年12月14个病区10％的出院患者医嘱,共2 289份(2015、2016年各1 150、1 139份),对抗菌药物应用的合理性进行分析.结果:2015、2016年医嘱数排序居前3位的科室均为儿科、产科及呼吸内科;2015、2016年Ⅱ、Ⅲ类切口手术抗菌药物使用率均为100.00％,应用抗菌药物的医嘱数分别为695、637份,不合理医嘱数分别为182、125份,2016年Ⅰ、Ⅱ、Ⅲ类切口手术抗菌药物不合理使用率均较2015年下降.围术期不合理预防性应用抗菌药物类型为给药时间不合理、用药疗程不合理、药物选择不合理及适应证不合理;我院不合理治疗性应用抗菌药物类型主要为用法与用量不适宜、适应证不适宜、越级使用抗菌药物、遴选药品不适宜.结论:我院抗菌药物存在一定的不合理应用情况,通过干预,合理用药水平得到了提升.临床药师应积极发挥自身优势,促进临床合理用药.%OBJECTIVE:To investigate the application rationality of antibiotics in Shenzhen Yantian District People's Hospital (hereinafter referred to as " our hospital"),so as to provide reference for standardization of application of antibiotics and establishment of effective intervention measures.METHODS:From 2015 to 2016,10％ medical records were selected randomly from 14 clinical departments in each month (1 150 cases in 2015,1 139 cases in 2016),with a total of 2 289 cases.Analysis was conducted on application rationality of antibiotics.RESULTS:In 2015 and 2016,the top three departments ranked by number of medical orders were respectively department of pediatrics,obstetrics and respiration medicine;the application rate of antibiotics was 100.00％,with medical orders of 695 and 637 cases.Irrational medical orders were respectively 182 and 125 cases.Compared with 2015,the irrational application rate of antibiotics in type Ⅰ,Ⅱ and lⅢ incision decreased significantly.The irrational types of medical orders of perioperative prophylactic application of antibiotics mainly performed as improper administration occasion,irrational treatment course,improper drug selection and improper indications.The main types of irrational medical orders of therapeutic application of antibiotics were respectively inappropriate usage and dosage,inappropriate indications,over level of application of antibiotics and improper selection pf drugs.CONCLUSIONS:There are some irrational phenomenon in application of antibiotics in our hospital,after intervention,the level of rational drug application has been increased.The clinicians are suppose to actively play their own advantages and promote the rational drug application in clinic.