Research On Establishing An Indicator System For Evaluating The Rationality Of Prophylactic Application Of Antimicrobial Agents During Preoperative Period

Currently, there is a common phenomenon of irrational use of antimicrobial agents overthe world, in which the prophylactic application of antibiotics during preoperativeperiod is most serious. The Ministry of Health has promulgated and implemented “theBasic Principles of Clinical Use of Antimicrobial agents” in2004and other guides tostandardize surgical perioperative prophylaxis. Many medical institutions in domesticexplore or evaluate rationality of the perioperative application of antimicrobial agentsin hospitals，depending on related guides, detailed rules and regulations, many hospitalstake intervention measures of rational utilization of antimicrobial agents but there is nota evaluation standard for perioperative application of antimicrobial agents. To establishan indicator system for assessing the rationality of prophylactic application ofantibiotics during preoperative period and in this way all the key links of application ofantimicrobial agents during preoperative period included in the system. The aim of theresearch is to assess the rationality of prophylactic application of antibiotics duringpreoperative period with a comprehensive evaluation method and to promote the levelof rational use of antimicrobial agents, so as to improve health care quality and reducewaste of resources. Objective This study, based on theoretical research, aims to establish a evaluationindicator system for assessing the rationality of prophylactic application of antibioticsduring preoperative period in China, and develop a comprehensive evaluation modeland testify its feasibility by selecting suitable case, and thus to help related regulatoryauthority to improve the level of rational use of antimicrobial agents.Method Systematic analysis, literature review were conducted to establish frameworkof the evaluation indicator system for assessing the rationality of prophylacticapplication of antibiotics during preoperative period, and expert consultation methodwas used to establish the evaluation indicator system and got the weight of theindicators. Synthetic scoring method was adopted to construct the comprehensiveevaluation model, on this base, select276patients with electronic medical record whohave prophylactic used antibiotics and retrospective review their cases then evaluate therationality of prophylactic application of antibiotics with the established comprehensiveevaluation model. SPSS (version11.01) were used to manage statistics analysis. Theresult of comprehensive evaluation was divided into four grades with X-X, X,X+Xone-wayANOVAwas used to testify the reliability of the result of grades.Result The framework of the rationality about prophylactic application of antibioticsduring preoperative period evaluation indicator system includes4first-rankindicators: indication of medication, drug selection, medication scheme, Results ofmedication and22second-rank indicators.This study carried out two rounds of expert’s consultation.30questionnaires weredistributed in the first round and28valid, rating93.33％; the average age was46.14±8.01,96.42%(27/28) of them were qualified the vice-senior professional titles,64.28%(18/28) of them has been working in their position for15years or above. The major ofthe panel covering clinical pharmacy (10), clinical medicine (10), clinical pharmacology (2), nursing (2), health supervision (1), epidemiology and health statistical (1) andhospital infection management (1), laboratory medicine (1),28questionnaires weredistributed in the second round and25valid, rating89.29%; the average age was45.00±5.38,96.00%(24/25) of them were qualified the vice-senior professionaltitles,84.00%(21/25) of them has been working in their position for15years and above.The major of the panel covering clinical pharmacy (8), clinical medicine (9), clinicalpharmacology (2), nursing (2), health supervision (1), epidemiology and healthstatistical (1) and hospital infection management (1), laboratory medicine (10).In the first round the judgement criteria(Ca) is0.93, the mean of familiarity is0.75,the experts’ agreement coefficient (ω) is0.84(>0.7). In the second round the judgementcriteria (Ca) is0.8, the mean of familiarity is0.74, the experts’ agreement coefficient (ω)is0.77(>0.7), that is meaning the degree of the experts’ agreement is high, the result iscredible.After two rounds of the Delphi survey, the experts’ agreement coefficient (ω)reached0.466(2=46.14, P=0.000）for the first-rank indicators,0.41（62=218.606，P=0.000）for the second-rank indicators. The completed evaluation system wasestablished using expert consultation for the conception, indicator development andscreening, the evaluation indicator system was established and the weight of theindicators were got. Grade was credible. The result of comprehensive evaluation:0~54.50are severe unreasonable cases,54.50~61.97are moderate unreasonable cases,61.97~69.43are mild unreasonable cases, the score more than69.43are reasonablecases.Conclusion1. Each indicator of the rationality of prophylactic application ofantibiotics during preoperative period evaluation indicator system was weighted aftertwo rounds Delphi survey. And the indicator system can quantitative measure therationality level of prophylactic application of antibiotics during preoperative period. The indicator system has met the basic requirements in feasibility and reliability inmeasurements by analyzing the experts’ authority, the experts’ coefficient ofconcordance and other statistics analysis, which could be used to measure the rationalitylevel of prophylactic application of antibiotics during preoperative periodcomprehensively and effectively, and seems suitable for comprehensive evaluation ofprophylactic application of antibiotics rationality during preoperative period.2. Synthetic scoring method was adopted to establish the comprehensiveevaluation model, the result of comprehensive evaluation was divided into four gradeswith X-X, X, X+X,one-way ANOVA was used to testify the reliability of thegrades. The analysis result was positive, which indicated the constructed comprehensiveevaluation model is scientific and feasible.3. we established a evaluation indicator system about rationality of prophylacticapplication of antibiotics during preoperative period exploratory, which included all thekey links of antimicrobial agents application during preoperative period. The system canguide medical workers to pay attention to the key links of prophylactic application ofantibiotics in clinical and can reduce the possibility of irrational use of application ofantibiotics. The established evaluation indicator system can assess the rationality ofprophylactic application of antibiotics during preoperative period comprehensively andeffectively and promote the level of rational use of antimicrobial agents, as well asimprove health care quality and reduce waste of resources.