采用PDCA循环管理方法规范我院神经外科质子泵抑制剂合理用药的实践
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摘要
目的:促进质子泵抑制剂(PPIs)在围手术期中的合理用药。方法:采用PDCA(Plan、Do、Check、Action)循环管理方法,收集我院神经外科围手术期PPIs使用的300份病历的不合理情况,分析原因、制订相应的管理目标及措施并实施,再与管理后神经外科围手术期PPIs 300份病历中的不合理使用率及不合理类型占比进行比较来评价管理效果。结果:通过采取收集相关资料确定应激性溃疡风险因素、建立围手术期预防使用PPIs的合理性评判标准、对医务人员开展合理用药培训、拟定各种管理制度、加强监督管理等措施,我院PPIs不合理使用率明显降低,不合理用药病历数由管理前的240例减少为156例,其中无指征预防用药率由37.33%降至29.00%(P<0.05);给药剂量不合理率由11.33%降至6.33%(P<0.05);给药频次不合理率由12.67%降至5.00%(P<0.01)。结论:我院采取的PDCA循环管理措施可规范神经外科围手术期PPIs的预防性使用,促进PPIs的合理使用。
OBJECTIVE:To promote rational use of proton pump inhibitors(PPIs)during perioperative period. METHODS:PDCA(Plan,Do,Check,Action)cycle management was used,the irrational use of PPIs of 300 medical records in neurosurgery department of our hospital were collected. The reasons were analyzed,management target was formulated and measures were implemented. The effects of management were evaluated through comparing the rate of irrational drug use and ratio of irrational type of PPIs in 300 medical records of neurosurgery department during perioperative period after management. RESULTS:Through collecting related data to confirm risk factors of stress ulcer,establishing rationality evaluation criteria for perioperative prophylactic use of PPIs,conducting rational drug use training among medical staff,drawing up various management systems and strengthening supervision and management,the rate of irrational use of PPIs was decreased significantly in our hospital;the number of irrational drug use cases decreased from 240 before management to 156 after management,among which the rate of prophylactic drug use without indication decreased from 37.33% to 29.00%(P<0.05);the irrational dosage rate decreased from 11.33% to 6.33%(P<0.05);the rate of irrational dosing frequency dropped from 12.67% to 5.00%(P<0.01). CONCLUSIONS:PDCA cycle management of our hospital can standardize the prophylactic use of PPIs in neurosurgery department during perioperative period and promote rational use of PPIs.
OBJECTIVE:To promote rational use of proton pump inhibitors(PPIs)during perioperative period. METHODS:PDCA(Plan,Do,Check,Action)cycle management was used,the irrational use of PPIs of 300 medical records in neurosurgery department of our hospital were collected. The reasons were analyzed,management target was formulated and measures were implemented. The effects of management were evaluated through comparing the rate of irrational drug use and ratio of irrational type of PPIs in 300 medical records of neurosurgery department during perioperative period after management. RESULTS:Through collecting related data to confirm risk factors of stress ulcer,establishing rationality evaluation criteria for perioperative prophylactic use of PPIs,conducting rational drug use training among medical staff,drawing up various management systems and strengthening supervision and management,the rate of irrational use of PPIs was decreased significantly in our hospital;the number of irrational drug use cases decreased from 240 before management to 156 after management,among which the rate of prophylactic drug use without indication decreased from 37.33% to 29.00%(P<0.05);the irrational dosage rate decreased from 11.33% to 6.33%(P<0.05);the rate of irrational dosing frequency dropped from 12.67% to 5.00%(P<0.01). CONCLUSIONS:PDCA cycle management of our hospital can standardize the prophylactic use of PPIs in neurosurgery department during perioperative period and promote rational use of PPIs.
引文
[1]赵玉沛.应激性黏膜病变预防与治疗:中国普通外科专家共识(2015)[J].中国实用外科杂志,2015,35(7):728-730.
[2]柏愚,李延青,任旭,等.应激性溃疡防治专家建议(2015)[J].中华医学杂志,2015,95(20):1555-1557.
[3]REEVE E,ANDREWS JM,WIESE MD,et al.Feasibility of a patient centered deprescribing process to reduce inappropriate use of proton pump inhibitors[J].Ann Pharmacother,2015,49(1):29-38.
[4]ALQUDAH MA,AL-AZZAM S,ALZOUBI K,et al.Overuse of proton pump inhibitors for stress ulcer prophylaxis in Jordan[J].Int J Clin Pharmacol Ther,2016,54(8):597-602.
[5]WALKER NM,MCDONALD J.An evaluation of the use of proton pump inhibitors[J].Pharm World Sci,2001,23(3):116-117.
[6]NAUNTON M,PETERSON GM,BLETERSON GM.Overuse of proton pump inhibitors[J].J Clin Pharm Ther,2000,25(5):330-340.
[7]ASHP Therapeutic Guidelines on Stress Ulcer Prophylaxis.ASHP commission on therapeutics and approved by the ASHP board of directors on November 14,1998[J].Am JHealth Syst Pharm,1999,56(4):347-379.
[8]ALLEN ME,KOPP BJ,ERSTAD BL.Stress ulcer prophylaxis in the postoperative period[J].Am J Health Syst Pharm,2004,61(6):588-596.
[9]GRUBE RR,MAY DB.Stress ulcer prophylaxis in hospitalized patients not in intensive care units[J].Am J Health Syst Pharm,2007,64(13):1396-1400.
[10]EAST practice management guidelines committee.Practice management guidelines for stress ulcer prophylaxis[EB/OL].[2018-05-01].https://www.east.org/education/practice-management-guidelines/stress-ulcer-prophylaxis.
[11]中华医学杂志编辑委员会.应激性溃疡防治建议[J].中华医学杂志,2002,82(14):1000-1001.
[12]《普通外科应激性黏膜病变的预防与治疗:中国普通外科专家建议》编审委员会.普通外科应激性黏膜病变的预防与治疗:中国普通外科专家建议[J].中国实用外科杂志,2009,29(11):881-882.
[13]维基百科.戴明循环[EB/OL].[2018-11-01].https://wiki.mbalib.com/wiki/PDCA.
[14]秦艳娥,钟慧,陈彪,等.PDCA循环管理干预骨科Ⅰ类切口手术围术期抗菌药物预防应用的效果评价[J].中国药房,2017,28(5):690-694.
[15]袁洪.湖南省质子泵抑制剂的临床应用指导原则(试行)[J].中南药学,2016,14(7):673-683.
[16]张勤,姜云平,郑咏池,等.医疗机构药师干预促进合理用药管理的系统评价[J].中国医院药学杂志,2015,35(14):1327-1332.
[17]刘晓玲,李静燕,张鹏,等.围手术期质子泵抑制剂预防应激性溃疡用药分析[J].药物与临床,2015,18(4):496-499.
[18]文爱东,王婧雯,石小鹏,等.临床药师培训创新模式的构建与探索[J].中国高等医学教育,2015(11):62-63.
[2]柏愚,李延青,任旭,等.应激性溃疡防治专家建议(2015)[J].中华医学杂志,2015,95(20):1555-1557.
[3]REEVE E,ANDREWS JM,WIESE MD,et al.Feasibility of a patient centered deprescribing process to reduce inappropriate use of proton pump inhibitors[J].Ann Pharmacother,2015,49(1):29-38.
[4]ALQUDAH MA,AL-AZZAM S,ALZOUBI K,et al.Overuse of proton pump inhibitors for stress ulcer prophylaxis in Jordan[J].Int J Clin Pharmacol Ther,2016,54(8):597-602.
[5]WALKER NM,MCDONALD J.An evaluation of the use of proton pump inhibitors[J].Pharm World Sci,2001,23(3):116-117.
[6]NAUNTON M,PETERSON GM,BLETERSON GM.Overuse of proton pump inhibitors[J].J Clin Pharm Ther,2000,25(5):330-340.
[7]ASHP Therapeutic Guidelines on Stress Ulcer Prophylaxis.ASHP commission on therapeutics and approved by the ASHP board of directors on November 14,1998[J].Am JHealth Syst Pharm,1999,56(4):347-379.
[8]ALLEN ME,KOPP BJ,ERSTAD BL.Stress ulcer prophylaxis in the postoperative period[J].Am J Health Syst Pharm,2004,61(6):588-596.
[9]GRUBE RR,MAY DB.Stress ulcer prophylaxis in hospitalized patients not in intensive care units[J].Am J Health Syst Pharm,2007,64(13):1396-1400.
[10]EAST practice management guidelines committee.Practice management guidelines for stress ulcer prophylaxis[EB/OL].[2018-05-01].https://www.east.org/education/practice-management-guidelines/stress-ulcer-prophylaxis.
[11]中华医学杂志编辑委员会.应激性溃疡防治建议[J].中华医学杂志,2002,82(14):1000-1001.
[12]《普通外科应激性黏膜病变的预防与治疗:中国普通外科专家建议》编审委员会.普通外科应激性黏膜病变的预防与治疗:中国普通外科专家建议[J].中国实用外科杂志,2009,29(11):881-882.
[13]维基百科.戴明循环[EB/OL].[2018-11-01].https://wiki.mbalib.com/wiki/PDCA.
[14]秦艳娥,钟慧,陈彪,等.PDCA循环管理干预骨科Ⅰ类切口手术围术期抗菌药物预防应用的效果评价[J].中国药房,2017,28(5):690-694.
[15]袁洪.湖南省质子泵抑制剂的临床应用指导原则(试行)[J].中南药学,2016,14(7):673-683.
[16]张勤,姜云平,郑咏池,等.医疗机构药师干预促进合理用药管理的系统评价[J].中国医院药学杂志,2015,35(14):1327-1332.
[17]刘晓玲,李静燕,张鹏,等.围手术期质子泵抑制剂预防应激性溃疡用药分析[J].药物与临床,2015,18(4):496-499.
[18]文爱东,王婧雯,石小鹏,等.临床药师培训创新模式的构建与探索[J].中国高等医学教育,2015(11):62-63.