Effects of PDCA Cycles on Implementation of Antimicrobial Stewardship Program Led by Clinical Pharmacists

MA Yingjie; MA Liping

doi:10.14009/j.issn.1672-2124.2020.06.022

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Effects of PDCA Cycles on Implementation of Antimicrobial Stewardship Program Led by Clinical Pharmacists

更新时间：2022-10-08

- Effects of PDCA Cycles on Implementation of Antimicrobial Stewardship Program Led by Clinical Pharmacists
- Vol. 20, Issue 6, Pages: 723-726(2020)
- 作者机构：
  
  1. 首都医科大学附属北京世纪坛医院药剂科
  2. 临床合理用药评价北京市重点实验室
  3. 临床合理用药评价国际合作联合实验室
  4. 北京大学首钢医院临床试验机构办
- 作者简介：
- 基金信息：
- DOI：10.14009/j.issn.1672-2124.2020.06.022
  CLC： R95
- Published：2020，
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[1]马英杰,马丽萍.PDCA循环法对临床药师主导的抗菌药物管理项目实施效果的影响[J].中国医院用药评价与分析,2020,20(06):723-726+728.

MA Yingjie, MA Liping. Effects of PDCA Cycles on Implementation of Antimicrobial Stewardship Program Led by Clinical Pharmacists. [J]. 20(6):723-726(2020)
[1]马英杰,马丽萍.PDCA循环法对临床药师主导的抗菌药物管理项目实施效果的影响[J].中国医院用药评价与分析,2020,20(06):723-726+728. DOI： 10.14009/j.issn.1672-2124.2020.06.022.

MA Yingjie, MA Liping. Effects of PDCA Cycles on Implementation of Antimicrobial Stewardship Program Led by Clinical Pharmacists. [J]. 20(6):723-726(2020) DOI： 10.14009/j.issn.1672-2124.2020.06.022.

摘要

目的:探讨某三级甲等综合医院（以下简称"该院"）应用PDCA循环管理优化临床药师主导抗菌药物管理项目（antimicrobial stewardship program

ASP）对抗菌药物合理应用的影响。方法:基于ASP策略

在该院干部综合科病区实施综合干预措施

包括抗菌药物首次用药医嘱前置审核;带有干预和反馈的用药审核;针对抗菌药物治疗持续时间>10 d的患者予以干预管理。对医师进行培训

对患者开展用药教育。并采用PDCA循环管理优化ASP

将实施PDCA循环前（2018年7—10月）、实施PDCA循环后（2018年11月至2019年10月）的抗菌药物使用金额占药品总收入的比例、住院患者抗菌药物使用率、住院患者抗菌药物使用强度、住院患者特殊使用级抗菌药物使用强度以及接受抗菌药物治疗患者微生物检验标本送检率进行比较。结果:采取ASP并通过PDCA循环不断优化干预措施后

住院患者抗菌药物使用金额占药品总收入的比例由25. 71%降至17. 87%

住院患者抗菌药物使用率由50. 46%降至40. 53%

均呈显著降低趋势

与干预前的差异均有统计学意义（P<0. 05）;住院患者抗菌药物使用强度由37. 34 DDDs/（100人·d）降至27. 68 DDDs/（100人·d）

住院患者特殊使用级抗菌药物使用强度由10. 94 DDDs/（100人·d）降至6. 00 DDDs/（100人·d）;接受抗菌药物治疗患者微生物检验标本送检率由48. 19%升至66. 36%

呈升高趋势

与干预前的差异有统计学意义（P<0. 05）。结论:本研究由临床药师主导ASP

采取PDCA循环管理不断对ASP干预措施进行优化

提高了该院干部综合科病区抗菌药物合理应用水平。但是还存在一些问题

在今后的工作中需要进一步完善。

Abstract

OBJECTIVE: To probe into the effects of PDCA cycles on implementation of antimicrobial stewardship program（ ASP） led by clinical pharmacists in a grade Ⅲ

class A general hospital（ hereinafter referred to as "the hospital"）. METHODS: Based on the strategy of ASP

comprehensive intervention measures were implemented in the comprehensive department ward of the hospital

including first-time premedication review

medication review with intervention and feedback

patients with >10 d duration of antibiotics. Training for clinicians and education for patients on medication were performed. The ASP was optimized by using PDCA cycles management

the proportion of consumption sum of antibiotics to the total drugs

application rate of antibiotics in inpatients

use intensity of antibiotics in inpatients and special application grade antibiotics in inpatients

and microbiological test specimen submission rates for patients receiving antimicrobial therapy were compared before PDCA cycle（ from Jul. to Oct.2018） and after PDCA cycle（ from Nov. 2018 to Oct. 2019）. RESULTS: After the adoption of ASP and continuous optimization of intervention measures through PDCA cycles

the proportion of consumption sum of antibiotics to the total drugs in inpatients decreased from 25. 71% to 17. 87%

and the application rate of antibiotics in inpatients decreased from 50. 46% to 40. 53%

both of which showed the significant decrease trend

with statistically significant differences compared with before PDCA cycle（ P<0. 05）. The use intensity of antibiotics in inpatients decreased from37. 34 DDDs/（ 100 people·d） to 27. 68 DDDs/（ 100 people·d）

and the use intensity of special application grade antibiotics in inpatients decreased from 10. 94 DDDs/（ 100 people·d） to 6. 00 DDDs/（ 100 people·d）. The rate of microbiological test specimen submission rates for patients receiving antimicrobial therapy increased from 48. 19% to66. 36%

showing the increasing trend

and the difference was statistically significant compared with before PDCA cycle（ P< 0. 05）. CONCLUSIONS: In this study

the clinical pharmacists lead the ASP and adopt PDCA cycles to continuously optimize the ASP intervention measures and improve the rational application level of antibiotics in the comprehensive ward of the hospital’s cadre comprehensive department. However

there are still some problems

which need to be further improved in the future.

关键词

抗菌药物抗菌药物管理项目合理用药临床药师PDCA循环

Keywords

AntibioticsAntimicrobial stewardship programRational drug applicationClinical pharmacistsPDCA cycles

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