Analysis On The Status And Implementation Effect Of The Antimicrobial Drug Clinical Application Management In Hospital Of Shanxi Province

Objective:1.To know the latest distribution of clinical application of antibacterial drugs and of its management status in public hospitals above grade II in our province.2.Identify the management priorities that need to be strengthened by analyzing the differences in the implementation of antimicrobial management and the distribution of antimicrobial use results.3.In order to promote the rational and standardized clinical use of antibacterial drugs in our province,to further curb the bacterial drug resistance and to ensure the quality and safety of medical treatment,this paper tries to put forward some reasonable suggestions.Method:1.Literature researchBy retrieving the databases such as CNKI,NCBI,PubMed,etc.,reading the periodical articles,academic dissertations,degree papers,theories,reviews and other related literatures on related topics,to understand the latest research results and research trends on the rational application of antimicrobial agents at home and abroad.2.Site investigationHospital selection:through simple random sampling,1 tertiary hospital and 1county-level?level II?hospital were selected from 11 prefectures and cities in the province separately,and 9 provincial direct hospitals?excluding traditional Chinese medicine hospitals?were selected by cluster sampling.A total of 31 hospitals were selected.Access to management status:management of the 31 hospitals were take on-site investigation.Semi-structured interview were conducted to the person in charge of antibacterial drug management in hospitals based on the Guiding Principles for Clinical Application of Antimicrobial Drugs?2015 Edition?and 2017 Antibacterial Drugs Clinical Rational Application Management Implementation Survey Form?Annex I?.And filled in the final score of the management survey?Annex I?,which was prepared on the basis of the national document,under the guidance of the accompanying expert group,by reviewing the documents,work records,meeting minutes,emergency drill records and other supporting materials and listening to the report and debriefing.Clinical data selection:systematic sampling?isometric sampling?was used to extract100 out-patient prescriptions?person-times?from hospitals in July,100 emergency prescriptions?person-times?,100 in-patient medical records?copies?,and 30 cases of class I incision surgery records?excluding if not counted?.A total of 3100 out-patient and emergency prescriptions respectively,3100 cases of inpatients and 731 cases of class I incision surgery were selected from all hospitals.3.Statistical methodThe data were analyzed retrospectively.The statistical description of the counting data is showed with n?%?,and it of the measurement data is showed with±s or P₅₀(P₂₅,P₇₅).The comparison of two groups of the counting data is analyzed by Chi-square test or Fisher exact probability method.The measurement data is first tested for normality.T test was used to analyze the mean of the two groups of data subject to normal distribution under the condition of homogeneity of variance.For data that did not comply with normal distribution or condition of homogeneity of variance,rank sum test was used to compare the mean values of the two groups.=0.05 is taken as the above test standard.Result:1.Implementation of Clinical Application Management of Antibacterial Drugs?1?The management implementation of most of the tertiary hospitals is better than that of the second level hospitals,but there is also a very few level II hospitals?1 hospital?with a better management implementation,while several tertiary hospitals?2 hospitals?with poor management implementation.According to the distribution characteristics of the management implementation and combined with the expert evaluation opinions,the score passing line of management implementation was drawn.84.21%of the investigated level III hospitals?16 hospitals?scored exceeding the pass line and 91.67%of the level 2hospitals were lower than it.The difference was statistically significant?P<0.001?.?2?There were 24 items in the management survey,12 of which showed statistical difference in the comparison between the passing group and the failing group?P<0.05?.The 12 items'centralized management points were as follows:?1?antibacterial drug supply catalogue;?2?the construction of related disciplines and the training of relevant personnel;?3?the participation or construction of antibacterial drug monitoring networks/centres and bacterial resistance monitoring networks/centres?abbreviated as“two networks”?and their routine monitoring and early warning;?4?the management of special grade antibiotics.Therefore,the failing group should pay attention to the above management points.?3?The construction and equipment of the core departments of clinical application and management of antibacterial drugs are insufficient.The number of beds in infection department,the number of microbe employees and the number of anti-infective clinical pharmacists were better in the tertiary hospital than in the second class hospital?P<0.05?.The average number of above of the secondary hospitals was 5.18,1.55 and 0.55respectively.The number of anti-infective clinical pharmacists in the province was slightly insufficient,with an average of only 1.16 people.2.Clinical Application of Antibacterial drugs?1?In the failure group,the usage rate of antibacterial drugs and the antibiotics use density?AUD?was higher.The proportion of antibiotics prescription in outpatients,the usage rate of antibiotics and AUD in inpatients,and the proportion of prophylactic use of antibiotics in Class I incision surgery were higher in the failing group than in the passing group?P<0.05?.There was no significant difference in the proportion of antibiotics prescription in emergency patients between the two groups?P>0.05?.The rate of reaching the national standard was also higher in the passing group than in the non-pass group?P<0.05?.The usage rate of antibiotics in outpatients and emergency patients were controlled well,all of them reached the national standard,and there was no difference between the two groups?P>0.05?.Inpatients'antibacterial use rate?45.35±0.03?and AUD?32.84±4.50?were 77.42%and 70.97%of the surveyed hospitals met the national standards.The rate of reaching the national standard of the proportion of prophylactic use of antibiotics in Class I incision surgery?49.32±0.06?was only 38.71%?12 hospitals?.There was no use of special-grade antibacterial drugs both in outpatient and emergency through the investigation.?2?In the failure group,the rate of etiological examination,and the timing and course of treatment for prophylactic use of antibiotics were lower than those of the passing group.The rate of pathogenic microorganisms in hospitalized patients receiving antimicrobial therapy,the reasonable rate of antibacterial treatment time and course of prophylactic use of antibiotics in Class I incision operation,were lower in the failure group?P=0.002,P=0.008 and P=0.001?.The total send-over rate of pathogenic microorganisms in the whole province was?38.88±0.06?,58.06%of the hospitals surveyed met the national standards.The rational rate of type selection?58.97±0.07?,timing?60.07±0.06?and course of treatment?52.30±0.06?for the prophylactic use of antibacterial drugs in class I incision operation were 67.74%,54.84%and 32.26%respectively of the investigated hospitals met the national standards.The rate of reaching the national standard in the passing group was higher than that in the passing group?P<0.05?.3.Rationality of prophylactic use of antibiotics?1?Non-restricted grade antibiotics such as cefuroxime,cefazolin,ceftriaxone and so on were mainly selected for the prophylaxis of class I incision operation?62.17%?.Single use?41.18%?was on the top of combined use and dual use?7.66%?took the second place.There were some irrational drug use cases,and some non-indications unreasonable drug use accounting for a large proportion was found in pass group?83.33%?,inferior group?54.37%?and general group?60.90%?.?2?The timing of prophylactic use of antibiotics in class I incision surgery was mainly fastened on 0.5¹h before operation?35.00%?,1²h before operation?29.57%?and postoperative?21.30%?.The failure group tended to 1²h before operation?44.04%?.The postoperative drug delivery rate was high,the pass group and the failing group were 25.68%and 18.41%respectively.The medication course was mostly 5¹0d?30.65%?,and the failing group was significantly?35.74%?.There were unexpectedly prophylactic medications for more than 15 days?2.17%?,and other types of irrational medications were all represented by the failing group.?3?The three reasonable rates of prophylactic use of antibiotics in class I incision operation were higher in pass group than in non-pass group?P<0.001?.The rational rate of drug selection,the timing of drug delivery,and the course of treatment,were higher in the passing group?67.21%,54.10%and 61.75%?,and the unreasonable condition were obvious in the failure group?74.37%,74.37%and 81.23%?.Conclution:1.Generally speaking,the secondary hospitals have a poor implementation of the antimicrobial drugs clinical application management,and the management and implementation of the tertiary hospitals is better than the secondary hospitals.The management of the second-level hospital needs to be strengthened.2.Management work has a positive effect on the standardization and rationality of clinical application of antibacterial drugs.The better the management implementation,the smaller the clinical use of antibacterial drugs and the higher the rationality of use.Conversely,the more ineffective the management is,the more antibiotics use and the lower the rationality of antibiotics use.This proves that scientific and effective management has a positive effect on improving the rationality of clinical application of antibacterial drugs.Organizational management against weak points could promote the rational clinical application of antibacterial drugs.3.The development of clinical application management of antimicrobial drugs needs to be supported by strengthening the construction of core departments.The number of beds,the actual number of clinical microorganisms'employees and the number of anti-infective clinical pharmacists in the third-level hospitals were better than those in the secondary hospital,and the clinical application results of antibacterial drugs were also superior to those of the secondary hospitals.At the same time,the pathogenic microorganisms which in poor management hospitals was poor,while the use rate of antibiotics was high and the rational use rate was low.It is characterized by“low-high-low”in the clinical application of antibacterial drugs.Therefore,in order to ensure good results in clinical application of antibacterial drugs,the management work should be supported by strengthening the construction of core departments,coordinating relevant departments to form organic synergy,using information technology to help management,improving the management mechanism for management weaknesses,standardizing the classification management supply catalogue of antibacterial drugs to provide a clear reference for clinical use,carrying out training and education to achieve long-term intervention,and doing well in monitoring and perfecting the early warning mechanism of the“two nets”.In the following work,secondary hospitals should be regarded as the key management targets,consolidating their infrastructure construction and improving their health service capabilities.Through a number of measures,efforts have been made to curb bacterial resistance to further development.