Quality Management Tools Combined With Evidence-based Evaluation In Prophylactic Antibiotics Management On Type Land ? Incision Operation During Perioperative Period

Objective:1.The purpose of this study is to explore the application of the integration of PDCA cycle combined with Root Cause Analysis(RCA)in prophylactic antibiotics management in type ? and ? incision operation throughout perioperative period,so that unreasonable use of antimicrobial drugs can be avoided,patients' pain and the economic burden can be relieved,ease the growth of drug-resistant bacteria,and then provide rationale for making policy of prophylactic antibiotic during perioperative period for the management.2.This study is significant in that it discusses an evidence-based evaluation of the rationality of cefoxitin use for perioperative prevention on cesarean delivery through relevant literature review.The most effective evidence is selected in order to develop scientific and rational drug use for patients.Methods:1.This research using RCA to locate the main reason for the problem,strictly follows the eight steps of the four-stage PDCA cycle to implement intervention on type? and ? incision with prophylactic antibiotics application.The intervention object of type ? incisionin cludes generalsurgery,orthopedics,urology,brainsurgery,s operation,while the one of type ? incision includes obstetrics and gynecology's operation.Sixmonths as a phase since August 2013,the research applies a four-phase cyclemanagement model collecting 1020 cases in pre-intervention period(Feb.to Jul.2013),4266 cases in post-intervention periods(Aug.2013 to Jan.2014,Feb.to Jul.2014,Aug.2014 to Jan.2015,Feb.to Jul.2015)through HIS system.Self-designed questionnaire isadopted to collect information on patients' basic situlation,operations information anddrug use information,medical cost,et al.Comparisons were made with the rate of therationality of prophylactic antibiotics application,the incidence of adverse drugreactions,operation incision infection respectively on pre-intervention andpost-intervention on type ? and ? incision.Besides,the usage rate of prophylacticantibiotics,the dose of antimicrobial drug,the rational rate of antibacterial drug costsaccounting for the proportion of the total drug cost,the average antibacterial drug costsandantimicrobial drug use percapita number of days on pre-intervention andpost-intervention on type ? incision were analyzed.2.We retrieve the latest edition of medicine instruction,?Martindale:The CompleteDrug Reference?,the authority of the drug guide and rules of diagnosis and treatment soas tocollect all the indications of cefoxitin.PubMed,Epistemonikos,Cochrane Library,CBM,CNKI and Wanfang database were used to collect the articles focusing oncefoxitin use for perioperative prevention about cesarean delivery.And then we evaluatethe methodological quality and quality of evidence of theses tudies using AGREE tooland GRADE system to provide evidence-based basis for its reasonable use.Eventually aconsensus is reached by the vote recommendations from members of the hospitalpharmaceutical affairs committee of management and drug therapy according toevidence-based evidence provided.Results:1.The results indicate that after a four-phase cycle intervention management on the integrated use of PDCA cycle and RCA in prophylactic antibiotics on type I and IIincision operation druing the perioperative period,compared with pre-intervention,exista decreased incidence rate in the post-intervention(P<0.05).Concerning the incidenceof irrational choice of antibacterial drugs,the combined use without indication,unreasonable given time,unreasonable medication time,replacement of antimicrobialagents without indication and the inaptitude of usage and dosage.The rate of therationality of prophylactic antibiotics application was significant increased(P<0.05).However,the incidence of adverse drug reactions and operation incision infectionbetween the two groups have no significant difference(P>0.05).The rate of theantibacterial drug usage on type I incision operation conforms to the?2013 TheNational Special Clinical Aapplication of Antibacterial Drugs Programme?,the dose ofantimicrobial drug,the average antibacterial drug costs,antimicrobial drug use percapita number of day were significantly reduced(P<0.05).But the rational rate ofantibacterial drug costs accounting for the proportion of the total drug cost has nosignificant difference(P>0.05).2.Evidence-based study shows that the latest edition of medicine instructions and?Martindale:The Complete Drug Reference?of cefoxitin,both of which indicate thatthe cefoxitin can be used for perioperative prevention on cesarean delivery.Althoughthe clinical guidelines and systematic review have not been formulated,through arandomised controlled trial(RCT)which compared for cefoxitin and the placebo forantibiotic prophylaxis in elective caesarean delivery,a systematic evaluation of theefficacy and safety of the drug for perioperative prevention on cesarean delivery showsthat perioperative prophylactic antibiotics can not reduce the incidence of postoperativefever,wound infection,endometritis,urinary tract infection and pneumonia.Due to thehigh level of evidence on the medicine instructions,the obtained RCT studies were onlyfor the selective cesarean section.Members of management in the hospitalpharmaceutical affairs committee and drug therapy voted based on evidence provided,and finally reached an agreement that cefoxitin can.be used for cesarean delivery on perioperative as preventive use.Conclusion:1.The analysis of reasons resulted in the irrational use of antimicrobial agents on perioperative period through RCA is associated with many factors including lack of knowledge about antimicrobial agents,operation process and the traditional habit about the antimicrobial agents use,etc.And intervention by PDCA cycle can not only promote more effective utilization of perioperative antimicrobial prophylaxis but also reduce the rate of the rationality of prophylactic antibiotics application,the dose of antimicrobial drug,the average antibacterial drug costs,antimicrobial drug use per capita number of day,the intervention methods were proved practicable.The intervention methods will provide a theoretical basis and feasible model for normalization of perioperative antimicrobial prophylaxis on other operations.At the same time the management also promotes the beilun medical institution's quality and safety of medical work of continuous improvement.2.Evidence-based evaluation is a combination of the research results of many clinical medicine practice,guidelines,standards and RCT.Thus it is concluded that multiple quality levels of resources,using scientific evaluation method to provide the most valuable reference information for clinical will assist to reduce the unreasonable use of antibiotics.It is an inevitable trend to apply evidence-based methods to promote clinical rational drug use in the development of future pharmacy.