| BackgroundThe application of antibiotics has an immeasurable function on controlling bacterial infection and reducing fatality rate. However, the phenomena of antibiotics abuse in medical establishments at different levels, especially in primary level. The main features of antibiotics abuse are as follows:regarding antibiotics as insurance medicine or placebo; causing waste of medicine and increasing the medical burden of patients; accelerating the generating of drug-resistant strain and decreasing the curative effect of antibiotics immensely; causing the dysbacteriosis and superinfection and increasing the risk of nosocomial infection. Therefore, it's essential to know about the application status of antibiotics in hospitals and provide scientific basis for formulating policy of reasonably usage of antibiotics.According to the stipulation of administrative measures of prescription published by Ministry of Health, item 44th, medical establishments should establish review mechanism of prescription, fill in evaluation form of prescription, make dynamic monitoring and early warning on prescription, register unreasonable prescription in time and inform it to the public, intervene unscientific drug taking behavior in time. This stipulation can effectively improve the level of drug management system and technical manual standard, and also increases the awareness of scientifically and reasonably drug using of medical workers and patients. By means of review mechanism of prescription in nedical institutions, the work of effective management on antibiotics and early warning mechanism can supplement each other, which is very beneficial for carrying out clinical pharmacy work. However, executive standards of prescription evaluation haven't been established, which makes some challenges in the work of prescription review.Objective1. To provide basis for formulating policy of reasonably usage of antibiotics, antibiotics usage rates of outpatient sections and wards and antibacterial use density (AUD) of wards from 2013 to 2015 of one hospital of Liaocheng were statistically analysed;2. To provide basis for enhancing the prescription quality and promoting reasonably usage of medicine, prescription quality from 2013 to 2015 of this hospital were statistically analysed and the reasons of unqualified prescriptions were also analysed.MethodsThe data of outpatient prescriptions and medical records in Hospital Information System of one hospital of Liaocheng from 2013 to 2015 was collected to obtain the information of antibiotics usage of outpatient sections and wards and then calculate the percentages of antibiotics usage and AUD. All of the outpatient prescriptions of one week in every quarter from 2013 to 2015 were randomly selected and experts were invited to evaluate these prescriptions according to the stipulation of administrative measures of prescription published by Ministry of Health, item 44th. The percentages of qualified prescriptions were also calculated and the reasons of unqualified prescriptions were analysed.Results1. The application status of outpatient antibiotics:There were 68 outpatient sections every year from 2013 to 2015. Outpatient sections ranking the top three antibiotics usage rates in 2013 are as follows:pediatric medicine, oral surgery and respiration medicine. Outpatient sections ranking the top three antibiotics usage rates in 2014 are as follows:oral surgery, pediatric medicine, and respiration medicine. Outpatient sections ranking the top three antibiotics usage rates in 2015 are as follows: pediatric medicine, oral surgery and pediatric surgery. Although pediatric medicine had been ranked in the top three for three successive years, there was a decreasing tendency of antibiotics usage rates (P<0.001). The outpatient section with the highest antibiotics usage rate was oral surgery of 2014 in these three years and the monthly rate was 61%. According to the standard of outpatient antibiotics usage rates for grade III, class A hospital, the monthly percentages of outpatient sections those exceeded the standard were from 10.3% to 23.5% and there was a decreasing tendency of every corresponding month in these three years.2. The application status of wards:There were 72 or 73 wards every year from 2013 to 2015. In these three years, wards ranking the top three antibiotics usage rates and AUD were as follows:14ARICU, ICU (medicine), and respiration medicine 14A. The sequences of wards ranking the top ten antibiotics usage rates in these three years were almost constant.3. The prescription qualified rates of selective examination:There were totally 103,784 prescriptions and 101,333 were qualified. The totally prescription qualified rate was 97.64%. There were no statistically significant differences of prescription qualified rates between every quarter of 2013 (P=0.257). There were statistically significant differences of prescription qualified rates between every quarter per year from 2014 to 2015 (P<0.001). There were statistically significant differences of prescription qualified rates between every corresponding quarter from 2013 to 2015 (P<0.001).4. The main problems existing in inappropriate prescriptions in every quarter from 2013 to 2015 were as follows:lacking of standardization in prescription writing, lacking of signature as modification, usage and dosage being inappropriate. There were statistically significant differences of constituent ratios of main problems existing in inappropriate prescriptions of every quarter (P<0.001). There was a decreasing trend of lacking of signature as modification and usage and dosage being inappropriate, and an increasing trend of lacking of standardization in prescription writing.ConclusionAccording to the standard of outpatient antibiotics usage rates for grade III, class A hospital, the monthly percentages of outpatient sections those exceeded the standard of this hospital were from 10.3% to 23.5%, but there was a decreasing tendency of every corresponding month in these three years. Wards ranking the top three antibiotics usage rates and AUD were as follows:RICU, ICU (medicine), and respiration medicine. Furhter investigation and analysis are suggested to explore the reasons of antibiotics usage rates exceeding the standard, especially in key sections, to provide reliable basis for using antibiotics reasonably in clinic, and control the abuse of antibiotics strictly.2. The totally outpatient prescription qualified rate was 97.64% in these three years. The main problems existing in inappropriate prescriptions were as follows: lacking of standardization in prescription writing, lacking of signature as modification, usage and dosage being inappropriate. Further review of prescriptions and regularizing the behaviour of medical establishments and workers are suggested to promote medicine reasonably usage in clinic. |
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