信息化临床决策支持系统对住院患者抗菌药物合理使用的影响
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摘要
目的通过临床住院信息系统抗菌药物医嘱管控模块的应用,来研究信息化临床决策支持系统对住院患者抗菌药物合理使用的影响。方法 2018年4月在临床住院信息系统增设七方面的抗菌药物信息化决策(抗菌药物预停、抗菌药物权限、用药目的选择、特殊使用级抗菌药物会诊、围术期预防用药限制、联合用药监控、微生物标本送检),比较干预前后住院患者抗菌药物使用率和使用强度(AUD)变化情况。结果住院患者抗菌药物使用率从干预前的39.51%下降到干预后的36.93%(P=0.002),下降了6.53%。住院患者AUD从干预前的(53.54±2.39) DDDs/100住院日下降到干预后的(46.85±3.11) DDDs/100住院日(P<0.001);其中非限制使用级AUD下降最明显,下降了20.68%(P<0.001)。接受抗菌药物治疗患者微生物标本送检率从干预前的53.88%提高到65.16%(P<0.001)。结论信息化临床决策支持系统可以有效控制住院患者抗菌药物使用率和AUD,在一定程度上促进抗菌药物临床合理应用。
OBJECTIVE To study the effect of clinical decision support systems on promoting the rational use of antimicrobial agents of hospitalized patients with the application of clinical hospitalization information system and doctors' advice for antibiotics management modules. METHODS In April 2018, seven new modules were added to the clinical information system, including pre-discontinuation of antimicrobial agents, authority of antimicrobial agents, selection of medication purposes, consultation of special-use antimicrobial agents, perioperative restrictions on preventive use of antimicrobial agents, monitoring of combined use of antimicrobial agents, and submission of microbial specimens. The utilization rate of antimicrobial agents and antimicrobial use density(AUD) were observed and compared among the hospitalized patients before and after the intervention. RESULTS The utilization rate of antibiotics of the hospitalized patients was decreased from 39.51% before the intervention to 36.93% after the intervention(P=0.002), with an decrease 6.53%. The AUD of the hospitalized patients was decreased from(53.54±2.39) DDDs/100 hospitalization days before the intervention to(46.85±3.11) DDDs/100 hospitalization days after the intervention(P<0.001); the AUD of non-restrictive use grade antibiotics was decreased significantly, with a decrease 20.68%(P<0.001). The submission rate of microbial specimens of the patients who were treated with antibiotics was increased significantly from 53.88% before the intervention to 65.16%(P<0.001). CONCLUSION The clinical decision support systems can effectively control the utilization rate of antimicrobial agents and AUD of the hospitalized patients and to some extent promote the reasonable clinical use of antibiotics.
OBJECTIVE To study the effect of clinical decision support systems on promoting the rational use of antimicrobial agents of hospitalized patients with the application of clinical hospitalization information system and doctors' advice for antibiotics management modules. METHODS In April 2018, seven new modules were added to the clinical information system, including pre-discontinuation of antimicrobial agents, authority of antimicrobial agents, selection of medication purposes, consultation of special-use antimicrobial agents, perioperative restrictions on preventive use of antimicrobial agents, monitoring of combined use of antimicrobial agents, and submission of microbial specimens. The utilization rate of antimicrobial agents and antimicrobial use density(AUD) were observed and compared among the hospitalized patients before and after the intervention. RESULTS The utilization rate of antibiotics of the hospitalized patients was decreased from 39.51% before the intervention to 36.93% after the intervention(P=0.002), with an decrease 6.53%. The AUD of the hospitalized patients was decreased from(53.54±2.39) DDDs/100 hospitalization days before the intervention to(46.85±3.11) DDDs/100 hospitalization days after the intervention(P<0.001); the AUD of non-restrictive use grade antibiotics was decreased significantly, with a decrease 20.68%(P<0.001). The submission rate of microbial specimens of the patients who were treated with antibiotics was increased significantly from 53.88% before the intervention to 65.16%(P<0.001). CONCLUSION The clinical decision support systems can effectively control the utilization rate of antimicrobial agents and AUD of the hospitalized patients and to some extent promote the reasonable clinical use of antibiotics.
引文
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[20] Lemmen SW,Lewalter K.Antibiotic stewardship and horizontal infection control are more effective than screening,isolation and eradication[J].Infection,2018,46(5):581-590.
[21] Cosgrove SE,Hermsen ED,Rybak MJ,et al.Guidance for the knowledge and skills required for antimicrobial stewardship leaders[J].Infect Control Hosp Epidemiol,2014,35(12):1444-1451.
[2] Bell BG,Schellevis F,Stobberingh E,et al.A systematic review and meta-analysis of the effects of antibiotic consumption on antibiotic resistance[J].BMC Infect Dis,2014,14:13.
[3] Zhu E,Fors U,Smedberg A.Understanding how to improve physicians' paradigms for prescribing antibiotics by using a conceptual design framework:a qualitative study[J].BMC Health Serv Res,2018,18(1):860.
[4] Knight GM,Costelloe C,Deeny SR,et al.Quantifying where human acquisition of antibiotic resistance occurs:a mathematical modellingstudy[J].BMC Med,2018,16(1):137.
[5] Cox JA,Vlieghe E,Mendelson M,et al.Antibiotic stewardship in low- and middle-income countries:the same but different[J].Clin Microbiol Infect,2017,23(11):812-818.
[6] Gutema G,Hakonsen H,Engidawork E,et al.Multiple challenges of antibiotic use in a large hospital in Ethiopia - a ward-specific studyshowing high rates of hospital-acquired infections and ineffective prophylaxis[J].BMC Health Serv Res,2018,18(1):326.
[7] Schuts EC,Hulscher MEJL,Mouton JW,et al.Current evidence on hospital antimicrobial stewardship objectives:a systematic review and meta-analysis[J].Lancet Infect Dis,2016,16(7):847-856.
[8] 杨晓娟,林海,王海银.国外抗菌药物管理项目实施经验及启示[J].中国药师,2014,17(3):484-487.
[9] Evans RS,Olson JA,Stenehjem E,et al.Use of computer decision support in an antimicrobial stewardship program (ASP)[J].Appl Clin Inform,2015,6(1):120-135.
[10] Barlam TF,Cosgrove SE,Abbo LM,et al.Implementing an antibiotic stewardship program:guidelines by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America[J].Clin Infect Dis,2016,62(10):e51-77.
[11] 王莹,田佳,谈宜斌,等.国内外医院抗菌药物管理项目的对比分析及对我国抗菌药物的管理启示[J].中华医院感染学杂志,2018,28(18):2829-2833.
[12] 国家卫生计生委医院管理研究所药师管理研究部.全国抗菌药物临床应用监测网工作手册[M].2018:158-173.
[13] 关于进一步加强抗菌药物临床应用管理工作的通知.国卫办医发[2015]42号,附件《抗菌药物临床应用管理评价指标及要求》.
[14] Simoes AS,Maia MR,Gregorio J,et al.Participatory implementation of an antibiotic stewardship programme supported by an innovative surveillance and clinical decision-support system[J].J Hosp Infect,2018,100(3):257-264.
[15] Curtis CE,Al Bahar F,Marriott JF.The effectiveness of computerised decision support on antibiotic use in hospitals:a systematic review[J].PLoS One,2017,12(8):e0183062.
[16] Holstiege J,Mathes T,Pieper D.Effects of computer-aided clinical decision support systems in improving antibiotic prescribingby primary care providers:a systematic review[J].J Am Med Inform Assoc,2015,22(1):236-342.
[17] 孙丽媛,金丁萍,严继承,等.166所综合医院医院感染管理监控指标调查[J].中华医院感染学杂志,2017,27(17):4034-4037.
[18] Zhen L,Jin C,Xu HN.The impact of prescriptions audit and feedback for antibiotic use in rural clinics:interrupted time series with segmented regression analysis[J].BMC Health Serv Res,2018,18(1):777.
[19] Chow AL,Lye DC,Arah OA.Patient and physician predictors of patient receipt of therapies recommended by a computerizeddecision support system when initially prescribed broad-spectrum antibiotics:a cohort study[J].J Am Med Inform Assoc,2016,23(e1):e58-70.
[20] Lemmen SW,Lewalter K.Antibiotic stewardship and horizontal infection control are more effective than screening,isolation and eradication[J].Infection,2018,46(5):581-590.
[21] Cosgrove SE,Hermsen ED,Rybak MJ,et al.Guidance for the knowledge and skills required for antimicrobial stewardship leaders[J].Infect Control Hosp Epidemiol,2014,35(12):1444-1451.