【摘要】 目的 验证临床药师对外科预防使用抗菌药物进行干预的效果。 方法 以临床药师督查记录数据为基础，将2010年1-3月238份病历设为非干预组，2010年10—12月240份病历设为干预组，建立评价标准，进行回顾性汇总、分析。 结果 通过干预，抗菌药物使用率从干预前的100%下降为77.08%（χ2=63.633，P=0.000），抗菌药物联用情况减少（χ2=53.712，P=0.000），用药时机和用药疗程有了较大改善，抗菌药物费用下降（t=-5.235，P=0.000），住院医疗费用降低（t’=-12.280，P=0.000），住院天数减少（t=-5.071，P=0.000）。 结论 临床药师通过实施合理用药干预对促进医院安全、有效、经济使用抗菌药物起到了积极作用。【Abstract】 Objective To verify the effect of clinical pharmacists’ intervention in antibiotics used for Type I incision surgical prevention. Methods Based on the supervision and inspection recording data of clinical pharmacists, we arranged 238 medical records in the first quarter of 2010 as non-intervened group and 240 medical records in the fourth quarter of 2010 as intervened group, and then established evaluation criteria and conducted a retrospective study for analysis. Results Through intervention, the rate of using antibiotics decreased from the previous 100% to 77.08% (χ2=63.633, P=0.000), the use of combined antibiotics also decreased (χ2=53.712, P=0.000), the time of course of using antibiotics improved, medical expenses of the antibiotics were reduced (t=-5.235, P=0.000), hospitalization cost decreased (t=-12.280, P=0.000), and hospital stay was shortened (t=-5.071, P=0.000). Conclusion Clinical pharmacists’ intervention in rational use of drugs play a positive role in contribution to a safe, effective and economical application of antibiotics.
Objective To explore the application methods and values of using health failure mode and effect analysis (HFMEA) to prevent surgical site infection (SSI) in patients undergoing bone fracture and craniotomy surgery with class Ⅰ incision. Methods Patients undergoing bone fracture and craniotomy surgery with class Ⅰ incision at the Chengdu Pidu District People’s Hospital between January 2020 to December 2021 were selected. Based on whether receiving HFMEA-based risk management or not, the patients were divided into conventional group and intervention group. The compliance rates with infection control measures, changes in risk priority numbers (RPN) at various stages (1 month and 10 months after intervention) of HFMEA implementation, and the incidence of SSI between the conventional group and the intervention group were compared. Results A total of 884 surgeries were included. Among them, there were 399 cases in the conventional group and 485 cases in the intervention group; 16 cases SSI occurred. A total of 7 SSI prevention and control measures had been formulated. Except for proper surgical attire (P＞0.05), there were statistically significant differences in the compliance rate of the other prevention and control measures between the two groups of patients (P＜0.05). In the intervention group, the RPN values of pre-operative, intra-operative, and post-operative risk factors at the 10th month after intervention were all lower than those at the 1st month after intervention (P<0.05). Except for the incidence of SSI during craniotomy surgery (6.1% vs. 1.8%, P=0.375), there were statistically significant differences in the total SSI incidence (3.3% vs. 0.6%) and bone fracture surgery SSI incidence (2.7% vs. 0.5%) between the conventional group and the intervention group (P>0.05). Conclusion Applying HFMEA-based risk management techniques to prospectively identify, assess, analyze, manage and track the risk of SSI in bone fracture and craniotomy surgery with class Ⅰ incision can effectively enhance the adherence of preventive measures and reduce the incidence rate of SSI.