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Objective:To explore the effect of comprehensive accusation intervention on the use of antibacterial drugs and the writing of medical records in elderly patients with closed fracture.Methods:A total of 120 elderly patients (aged ≥60 years) with fracture were enrolled from January 2017 to June 2019 in the department of orthopaedics and traumatology of the Second Hospital of Tangshan University and the Affiliated Hospital of North China University of Technology. According to random number table method, 120 patients were divided into intervention group (61 cases) and non intervention group (59 cases) by computer random number method. The patients in the intervention group received pharmaceutical care and quality control management intervention during the perioperative period; The patients in the non intervention group were routinely treated with antibiotics and wrote medical records. The use effect of antibiotics, the cost of antibiotics and the effect of standardized writing of medical documents were compared between the two groups. Independent sample t-test was used for comparison between measurement data groups with normal distribution, and χ 2 test was used for comparison between counting data groups. Results:Compared with the non-intervention group, the rate of perioperative use of antibiotics (49.2% (30/61)), the rate of drug use without indication (4.9% (3/61)), the rate of irrational drug selection (6.6% (4/61)), the rate of irrational drug use (6.6% (4/61)), and the proportion of irrational combined use of antibiotics (3.3% (2/61)) were significantly lower than that in the non-intervention group (81.4% (48/59), 16.9%(10/59), 22.0% (13/59), 20.3% (12/59), 18.6% (11/59)), the difference was statistically significant (χ 2 values were 13.65, 4.49, 5.91, 4.93 and 7.33, respectively; P values were <0.001, 0.034, 0.015, 0.026 and 0.007,respectively). The cost of antibiotics in the intervention group ((283.86±59.86) yuan) was lower than that in the non intervention group ((820.45±136.27) yuan), and the difference was statistically significant ( t=27.478, P<0.001). The eligible rate of the pre-operative informed consent document signing was 100% (61/61) in the intervention group, and the eligible rate of the operative record completion time was 100% (61/61) higher than that in the non-intervention group (84.7% (50/59), 79.7% (47/59)), the difference was statistically significant (χ 2 values were 7.98 and 13.79; P values were 0.005 and <0.001). The loss rate of preoperative alternative therapy (0) and postoperative communication (0) were significantly lower than those of non-intervention group (11.9% (7/59), 10.2% (6/59)) (χ 2 values were 5.68 and 4.56; P values were 0.017 and 0.033). Conclusion:The implementation of comprehensive quality control intervention mode reduced the application of unreasonable antibiotics and standardized the writing of inpatient medical records. It is of great significance for the rational use of antibiotics and the standardization of medical record writing in the elderly patients with closed fracture.
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OBJECTIVE：To establish quantitative e valuation system of the prophylactic use of antibiotics in orthopedic type Ⅰ incision surgery ，and to provide reference for evaluating the rational prevention use of antibiotics in this type surgery scientifically. METHODS：Based on the Guidelines of Clinical Use of Antimicrobial Agents （2015 edition），drug instructions ，related guidelines and references ，experts from relevant departments jointly discussed and formulated the evaluation criteria for the rationality of the use of antibiotics in type Ⅰ incision in orthopedic surgery. AHP method was used to assign the weights for various indexes of evaluation criteria ；TOPSIS method was used to retrospectively analyze and evaluate the rationality of 120 cases of type Ⅰ incision surgery from 3 orthopedic departments in Peking University People ’s Hospital during Sept. 1st-30th，2019. RESULTS ：Established evaluation system included 4 primary indicators （medication indication ，usage and dosage ，medication timing ，other factors ）and 12 secondary indicators. Among the secondary indicators ，indications，drug selection and timing of preoperative administration were the most important （weights were 0.209，0.140，0.117）. Among 120 cases，30.83％ of drug use were reasonable ，47.50％ were basically reasonable and 21.67％ were unreasonable. Evaluation results obtained by AHP-TOPSIS were consistent with the actual situation. CONCLUSIONS ：The rationality evaluation method of prophylactic use of antibiotics in type Ⅰ incision surgery based on AHP-TOPSIS method can quantitatively evaluate the rationality of drug use by combining multiple indicators. The method is feasible ，operable，and the evaluation results can be quantified ，which has a wide range of application.
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OBJECTIVE： To establish antibiotics use rationality evaluation model in type Ⅰ incision surgery patients， and to provide reference for prescription review of clinical pharmacists. METHODS： Totally 432 inpatients underwent type Ⅰ surgical incision in a hospital from Jan. 1st- Dec. 31st， 2017 were selected as the research objects. The information of diagnosis and treatment including age， nosocomial infection， the number of kinds of antibiotics used were extracted. Based on the results of clinical pharmacists’ comments on the antibiotics use rationality in patients’ prevention and treatment， non-conditional Logistic regression and support vector machine （SVM） in machine learning method were used to convert clinical pharmacists’ comments into objective index that can be recognized by the machine learning model， using categories of antibiotics （preventive or therapeutic use） as dependent variables and the patient’s diagnosis and treatment information as independent variables. Classification and identification model was established for antibiotics use rationality in type Ⅰ incision surgery patients. Using sensitivity， specificity and Youden index as indexes， established mode was validated on the other 61 samples of type Ⅰ incision surgery patients. The rationality of antibiotics prescriptions in type Ⅰ incision surgery patients before （by manual review， Jan.-Dec. 2017） and after （Jan.-Oct. 2018） using the model were collected， and the effects of the model were evaluated. RESULTS： The sensitivity， specificity and Youden index of non-conditional Logistic regression model were 65.63％， 75.00％ and 40.63％， respectively. Main parameters of the model established by SVM included gamma 0.01， cost 10， sensitivity 92.19％， specificity 87.50％， Youden index 79.69％. The model established by SVM was better than non-conditional Logistic regression. SVM was used to validate established mode， and sensitivity， specificity and Youden index were 100％， 88.57％ and 88.57％， respectively. Compared with before using the model， the evaluation ratio increased from 69.44％ to 100％， the rate of prophylactic use of antibiotics decreased from 23.84％ to 16.43％， the rate of rational drug type selection increased from 37.86％ to 54.39％， and treatment course shortened from 5.01 days to 3.26 days after using the model. CONCLUSIONS： Established antibiotics use rationality evaluation model in typeⅠincision surgery patients by SVM in machine learning method fully covers all the patients， promotes rational use of antibiotics in typeⅠincision surgery patients， and provides a new idea for pharmacist prescription comment.
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OBJECTIVE:To provide reference for improving the rationality of perioperative prophylactic application of antibiotics in typeⅠincision operation of neurosurgery. METHODS:Medical records of 794 patients with typeⅠincision operation of neurosurgery were collected from our hospital during Jan.-Dec. 2016 in order to retrospectively investigate the perioperative prophylactic application of antibiotics and evaluate the rationality of drug use. RESULTS:Among all the 794 cases,433 used antibiotics for prophylaxis (single type was used in all cases),with utilization rate of 54.53％. Cefazolin(51.73％)and cefuroxime(21.48％)were the most frequently used antibiotics. The prophylactic application rate of 30 min-1 h before surgery was 85.45％ in 433 patients. Patients with prophylactic medication course≤24 h accounted for 68.36％. The main irrational drug use manifestations were long medication time(31.64％)and improper antibiotics selection(26.10％);other manifestations included improper medication timing(14.55％),etc. CONCLUSIONS:Unreasonable perioperative prophylactic application of antibiotics in typeⅠincision operation of neurosurgery exists in our hospital,such as improper drug selection,improper medication timing,long medication course. It is necessary to further strengthen the comprehensive interventions,so as to promote the rational use of antibiotics.
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Objective To analyze the use of antibiotics in perioperative period of type 1 incision in our hospital from 2014 to 2016.Methods The type Ⅰ incision of clean operation cases in our hospital from January 2014 to December 2016 were selected as the research subjects.Among them,201 cases were assigned as the control group from January 2014 to July 2015,while 202 cases were set as observation group from August 2015 to December 2016.General intervention in the using status of antibiotics was adopted for the controls,meanwhile,intensive intervention was given to observation groups.At the same time,the types of antibiotics,the beginning time and duration of antibiotics use were compared between the two groups.Results Before operation,the antibiotics use proportion of 0.5-1 h in the observation group was significantly higher than that in the control group (89.11％ vs.54.73％).The antibiotics use proportion of preoperative 1-24h (1.9％ vs.24.4％) and postoperative drug use ratio (8.91％ vs.20.9％)were significantly lower than those in the control group,the differences were statistically significant (x2 =59.027,44.251,11.420,all P ＜ 0.05).The ratio of treatment duration ≤ 1 d in the observation group (89.6％ vs.62.7％)was significantly higher than the control group,the proportions of 1 ＜ T ≤ 2d (9.9％ vs.22.4％) and ＞ 2d (0.5 ％ vs.14.9％) in the observation group were significantly lower than those in the control group,the differences were statistically significant (x2 =40.226,11.613,29.546,all P ＜ 0.05).In the observation group,the ratios of the first generation cephalosporin (79.7％ vs.48.2％) and the second generation cephalosporin (12.8％ vs.5.4％) were significantly higher than those of the control group (all P ＜ 0.05).The proportions of the third generation cephalosporin and fluoroquinolones were significantly lower than those of the control group,the differences were statistically significant (x2 =43.246,6.614,47.960,8.203,all P＜0.05).Conclusion After the intensive intervention,the duration of prophylaxis and drug selection in the perioperative period of type 1 incision is more reasonable.
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Objective To investigate and analyze the surgical site infection rate,clinical characteristics,risk factors and pathogens in patients after type Ⅰ incision orthopedic foot and ankle surgery,which may provide a basis for preventing surgical site infection in foot and ankle surgery.Methods Patients undergoing type Ⅰ incision orthopedic foot and ankle surgery from Jun.2011 to Jun.2015 were investigated retrospectively.Clinical data of cases with surgical site infection were collected and analyzed.Incidence of surgical site infection,clinical features,risk factors and pathogen distribution were studied.Results Seven hundred and sixty-one patients were undergoing type Ⅰ incision orthopedic foot and ankle surgery,surgical site infection occurred in 42 patients with an infection rate of 5.5％.In terms of age,gender,anesthesia,smoking,drinking,rheumatoid arthritis,gout,number of incisions and recovery after open injuries,no significant difference of surgical site infection rate were found.Diabetes mellitus complicated with peripheral neuropathy increased the risk of surgical site infection compared with nondiabetic patients.Patients who had an operative time more than 3 hours had a greater risk of surgical site infection compared with those less than 1 hours.The presence of intra-operative implants increases the risk of surgical site infection compared with patients with external fixations or without implants.Conclusions Surgical site infection is a common complication for the patients after type Ⅰ incision orthopedic foot and ankle surgery.Diabetes mellitus complicated with peripheral neuropathy,long operation time and intra-operative implants may be the high risk factors for surgical site infection.
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OBJECTIVE:To evaluate the effects of PDCA cycle management on perioperative prophylactic application of antibiotics in typeⅠincision surgery of orthopedics department. METHODS:In retrospective analysis,512 discharge medical records, 861 ones and 1 070 ones were selected from our hospital before PDCA cycle management(Jan.-Dec. 2013,before intervention group), after first cycle of PDCA cycle management (Jan.-Dec. 2014,first intervention group) and after second cycle of PDCA cycle management(Jan.-Dec. 2015,second intervention group),respectively. The perioperative prophylactic application of antibiotics was analyzed comparatively before and after continuous intervention. RESULTS:After 2 cycles of PDCA cycle management intervention, the constituent ratio of internal fixation in orthopedics department increased significantly;utilization ratio of antibiotics,the rate of rational type,medication ratio 0.5-1 h before surgery,the rate of rational treatment course,the proportion of antibiotics use in accordance with indications increased from 50.20%,98.08%,93.77%,6.61%,82.10% to 58.41%,100%,99.04%,52.00%, 99.04%,respectively. The number of antibiotics type decreased from 4 to 2;the proportion of cephazolin increased significantly while that of clindamycin decreased significantly compared to before intervention. Postoperative prophylactic medication course decreased from(4.63 ± 2.42)d to(1.61 ± 0.75)d;the proportion of patients with medication course 72 h decreased significantly, with statistical significance (P<0.05). CONCLUSIONS:PDCA cycle management improves the rational rate of perioperative prophylactic application of antibiotics in typeⅠincision surgery of orthopedics department in our hospital. The prophylactic medication course of our hospital is not yet fully controlled within 24 h so it should be further intervened.
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OBJECTIVE:To provide reference for perioperative rational prophylactic application of antibacterials in type Ⅰ in-cision operation. METHODS:4 201 patients underwent type Ⅰ incision operation were collected from a class A grade three hospi-tal during Mar. 2013-Feb. 2015. The perioperative prophylactic application of antibacterials in type Ⅰ incision operation were ana-lyzed statistically. RESULTS:Of 4 201 patients underwent type Ⅰ incision operation,there were 2 399 cases of prophylactic appli-cation of antibiotics(accounting for 57.10%). Cephalosporins andβ-lactam/β-lactamase inhibitor were the main classes of antibacte-rials for preventive use,accounting for 45.60%and 19.76%,respectively. The frequency of using cefazolin,ceftriaxone and amoxi-cillin-clavulanic acid ranked the top 3 places, among which there was 823 cases of unsuitable prophylactic medication time (34.31%),and 855 cases of prophylactic medication time >48 h(accounting for 35.64%). CONCLUSIONS:There still is unrea-sonable perioperative prophylactic application of antibacterials in type Ⅰ incision operation in this hospital. It is necessary to strengthen the supervision of antibacterials and conduct regular rational antibacterials use seminars in order to promote rational use of antibacterials.
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Objective To analyze the situation and trend of the application of antibacterial drugs in the case of typeⅠincision operation in our hospital.Methods A total of 1 964 patients in our hospital from 2010 to 2014 were randomly selected,and the changes of antimicrobi-al drugs during the treatment period were analyzed.The surgical site infection probability and antimicrobial application rules in typeⅠincision surgery in 3 years,including probability,category,first time and duration of drug use,and the relationship between antibacterial drugs and typeⅠincision infection were analyzed.Results Application of antibacterial drugs in typeⅠincision operation probability decreased significant-ly,and the surgical infection probability decreased year by year,with statistically significant difference(P<0.05).The first application of an-tibacterial drug time was more reasonable,the choice of antimicrobial drugs were mainly one generation or two generation of Cephalosporin. There was a significant increase in the probability of stopping medication within 2 days after surgery,and the difference was statistically signif-icant(P<0.05).Conclusion The application of antibiotics should be strictly applied to the application of the indications for the use of anti-biotics.To understand the scope of application of antimicrobial drugs,and should try to shorten the use of time,control of infection during peri-operative period,reduce drug resistance.
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Objective To evaluate the effect of multiple intervention measures on perioperative antimicrobial use in pa-tients undergoing typeⅠincision operation in a hospital,and provide basis for rational use of antimicrobial agents. Methods 9 823 patients with type I incision operation in April and October of 2005-2012 were surveyed retrospectively, data of 2005 was as baseline,from 2006 to 2012,multiple measures,including training,examination,supervision,feed-back,and cooperation of relevant departments were conducted,antimicrobial use before and after intervention was com-pared.Results The qualified rate of perioperative antimicrobial use in patients undergoing typeⅠ incision operation in-creased from 14.20% in 2006 to 92.30% in 2012;the rate of combined use of antimicrobial agents was relatively higher (7.00%-9.00%)in 2006-2009,had a downward trend in 2010- 2012,and decreased to 3.20% in 2012.Types of an-timicrobial agents for prophylactic use in typeⅠincision operation in 2006 and 2007 were similar to that of 2005,the main used antimicrobial agents were cephalosporins,penicillin and it’s compounds,and aminoglycosides;the major antimicrobial prophylaxis in 2008-2012 were the first and second generation cephalosporins,penicillin and it’s compounds.Multivariate non-conditional logistic regression analysis showed that age (40 - 59 years old),departments (orthopedics,general surgery,and ophthalmology),and years (2011 and 2012)were the main influencing factors for the qualified use of antimicrobial agents(all P<0.05).Conclusion Implementation of multiple intervention measures can improve the qualified rate of perioperative antimicrobial use in typeⅠ incision operation,reduce types of antimicrobial use and rate of combined antimicrobial use.
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Objective:To analyze the effects of rational intervention on prophylactic antibiotics use in typeⅠIncision. Methods:A retrospective investigation method was used. Totally 170 cases with typeⅠIncision undergone in the hospital from April to Decem-ber 2013 were selected as the non-intervention group, and 173 cases with typeⅠIncision undergone in the hospital from April to De-cember 2014 were selected as the intervention group. The prophylactic antibiotics use, medication time, drug selection and duration of drug treatment were analyzed. Results:After intervention, the use rate of antibiotics was decreased from 67. 65% to 26. 59%, the ir-rational rate of use time was decreased from 15. 88% to 4. 63%, the irrational rate of treatment course was decreased from 30. 58% to 8. 09%, and the combination rate was declined from 10. 59% to 5. 20%. Conclusion:The rational prophylactic use of antimicrobial in type Ⅰ incision is improved through the intervention, and further efforts are still needed to improve the reasonable use.
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OBJECTIVE:To evaluate the effect of clinical antibiotics use special rectification in our hospital. METHODS:100 discharged medical records of typeⅠincision surgery were randomly sampled from our hospital during May in 2010 to Apr. in 2011,May in 2011 to Apr. in 2012,May in 2012 to Apr. in 2013,May in 2013 to Apr. in 2014,totaling 400 records. And then evaluation indicators were analyzed statistically,such as antibiotics use intensity,perioperative DDDs of antibiotics in typeⅠinci-sion surgery,DUI,types of antibiotics during perioperative period,medication time,etc. RESULTS:Since the implementation of clinical antibiotics use special rectification in May 2011,the utilization ratio of antibiotics in typeⅠincision surgery of our hospital decreased from 96% to 33%;DUI decreased from 1.44 to 0.79;while reasonable rate of drug selection increased from 19.8% to 100%,and that of medication time increased from 43.8% to 100%. CONCLUSIONS:Rational medication evaluation indicators in typeⅠincision surgery of our hospital have been improved after the implementation of clinical antibiotics use special rectification.
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OBJECTIVE:to provide reference for the continuous improvement of surgical site infection (SSI). METHODS:There were totally 7 472 patients with typeⅠand typeⅡincision surgeries in a hospital after the targeted monitoring and special recti-fication(Jul. 2012 to Jun. 2013,monitoring group)and 5 958 patients with surgeries during the same period before special rectifi-cation(Jul. 2010 to Jun. 2011,control group). The clinic data of typeⅠand typeⅡincision surgical was compared,including infec-tion,the perioperative antibiotics use and hospitalization time after surgery,etc. RESULTS:The infection rate of typeⅠand typeⅡstandardized incision in monitoring group was respectively 0.35% and 0.43% and control group was respectively 0.60% and 1.36%(P<0.05). The rate of typeⅠincision perioperative antibiotics use in monitoring group was 10.72% and control group was 86.88%(P<0.05). The post-operative non-medication rate of patients was increased from the 6.98%(control group)to 49.20%(monitor-ing group)(P<0.05),the discontinuance rate within 48 h was increased from the 32.09%(control group)to 44.11%(monitoring group),and the ratio of patients who took antibiotics after the surgery for more than 3 d was decreased from the 42.82%(control group)to 3.05%(monitoring group)(P<0.05). The inguinal hernia repair time in monitoring group was 3.90 d,shorter than con-trol group(4.22 d)(P=0.018). The patient with gallbladder surgery in monitoring group was 6.47 d,compared with control group (6.38 d),there was no significant difference (P=0.619). CONCLUSIONS:The special rectification can obviously promote the standardized of perioperative antibiotics use,reduce the incidence of SSI and shorten the hospitalization time after operation.
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Objective To investigate the rationality of prophylactic use of anti‐bacterial in 251 type Ⅰ incision opera‐tions .Methods The anti‐bacterial use of 251 type Ⅰ incision operations sampled randomly from May 2012 to May 2013 were retrospectively analyzed .Results The prophylactic antibiotics rate was 98 .41% in the 251 cases of the type Ⅰ incision;among the 247 cases used anti‐bacterial ,the utility rate of first generation cephalosporin antibiotic was 28 .57% after surgery and the rate of prophylactic antibiotic use within 0 .5‐2 h before operation was 61 .94% .14 .17% of antibiotic treatment was finished within 48 h after surgical operation .Conclusion There was the unreasonable situation in the prophylactic use of anti‐bacterial , w hich need to be improved .
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Objective:To analyze the prophylactic use of antibiotics during the perioperative period of typeⅠincision operation in a cancer hospital in order to promote the safe, effective and rational use of antibiotics. Methods:The rationality of 480 cases of typeⅠincision operation from January to December in 2013 and from January to December in 2014 was evaluated respectively, and the analy-sis and comparison were performed on the prophylactic use of antibiotics. Results: Through the pharmaceutical intervention including the special evaluation carried out by clinical pharmacists, the use of antibiotics gradually reached the rational level. Conclusion: The participation of clinical pharmacists in the use management of antibiotics in typeⅠincision operation can improve the rationality of the drugs used in clinic.
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OBJECTIVE:To standardize periooperative prophylactic application of antibiotics. METHODS:According to the characteristics of orthopaedic and parenchyma surgery,classifying evaluation table of typeⅠincision infection risk was designed sci-entifically and rationally. The individual application of antibiotics in surgery patients had been achieved through infection risk evalua-tion. High risk typeⅠincision patients used antibiotics rationally and low risk patients seldom used or didn’t use at all. RESULTS:Through using infection risks classifying table,the rate of antibiotics prophylactic application in typeⅠincision drops from 74.10%to 28.68%,and and the per capita duration of antibiotics prophylactic application shortened from 4.23 d to 2.21 d. The postopera-tive infection rate remained the same. CONCLUSIONS:Through infection risk classifying evaluation,individual application of anti-biotics can be achieved in surgery patients,so as to promote rational use of antibiotics for prophylactic use,reduce antibiotics dos-age and antibiotics abuse under the condition of controllable surgery infection.
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Objective To survey the usage of prophylactic antimicrobial agents for the patients in type Ⅰ incision operation and provide reference for rational use of antibiotics clinically. Methods 456 surgical ca-ses of type Ⅰ incision operation were selected among the surgical patients discharged from department of gen-eral surgery, department of orthopaedics, department of neurosurgery, department of chest surgery, depart-ment of ophthalmology, department of stomatology, department of urology and department of otology from 2007 to 2008,excluding the cases of remedial antimicrobial agents before the operation. 331 cases used prophylac-tic antimicrobial agents were analyzed. Results There are problems in prophylactic antimicrobial usage in patients with type Ⅰ incision operation in this hospital, including antimicrobial agents not chosen properly, the indications not stringent, the timing of usage not appropriate. These problems can induce medical costs to go up and drug-resistance bacteria to increase. Conclusions Clinicians should learn the guiding principles for clinical application of antibacterial agent according to the features of different surgical departments, take essen-tial administrative actions for surveillance, and promote rational use of antibiotics in infection prevention of surgical intervention.
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OBJECTIVE:To investigate the feasibility of defined individual treatment course as evaluation index of rational use of drugs.METHODS:The doses of antibiotics and treatment course in 63 patients with type Ⅰ incision operation of our hospital in Jan.2010 were taken as examples.Case analysis,DUI evaluation and defined individual treatment course evaluation were adopted.Similar results were obtained by 3 kinds of methods.RESULTS&CONCLUSION:Results of 3 kinds of methods are consistent.DUI evaluation isn't closely associated with treatment course.Defined individual treatment course is more sensitive and available than DUI based on the introduction of dose and treatment course.
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OBJECTIVE:To compare the reasonability of antimicrobials in 6 kinds of typeⅠ incision operations before and after intervention and to survey the effect of intervention measures. METHODS: Discharge records of typeⅠ incision operations from Jan. to Jun. in 2009 (before intervention) and that from Sep. to Dec. in 2009 (after intervention) were collected. The reasonability of antimicrobials application before and after intervention was compared. RESULTS: The reasonabilities of medication time and medication duration of antimicrobials were improved significantly after intervention. There were still some problems, such as high utilization rate, high-grade drug used at the beginning and irrational drug combination. CONCLUSION: The intervention measures are effective and feasible but should be strengthened to standardize management.
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OBJECTIVE To investigate whether it is essential to utilize prophylactic antibiotics in patients with gynecologic surgery type Ⅰincision.METHODS Antibiotics were applied prophylactically to 112 patients in the study group,while 101 cases in the control group were treated without antibiotics.The postoperative infection rate,the hemogram,the incision healing rate,the duration in hospital,hospital fees and so on were analyzed.RESULTS The postoperative infection rate,the incision healing rate and other items were compared in the two groups.No significant difference was found ststistically.CONCLUSIONS Prophylactic antibiotics are not necessery in patients with gynecologic operation type Ⅰ incision during perioperative periods.