临床药师参与特殊使用级抗菌药物评估工作模式的实践与探讨

目的：建立临床药师参与特殊使用级抗菌药物评估工作模式，探讨新模式的运行对于促进特殊使用级抗菌药物合理使用的效果。方法：某院自2011年9月起开始运行特殊使用级抗菌药物临床申请与评估工作模式。回顾性抽取该院2011年1—3月（新模式运行前，A2组）、2012年1—3月（新模式运行后3个月，A1组）、2012年10-12月（新模式运行后1年，A2组）使用特殊使用级抗菌药物的全部出院病历，对抗菌药物的用药频度（DDDs）、微生物送检及用药合理性等多个指标进行综合评价及分析，并将结果进行对比研究。结果：该院特殊使用级抗菌药物包括3个品种，即注射用盐酸头孢吡肟、注射用盐酸万古霉素、注射用亚胺培南／西司他丁钠。新模式运行后3个月、运行后1年分别与运行前相比，特殊使用级抗菌药物的DDDs由新模式运行前的987．25分别降至579．75、401．50；微生物送检及按药敏试验结果选择用药比例显著提高（P〈0．01），由新模式运行前的64．2％、49．1％升至运行后3个月的97．1％、82．6％和运行后1年的98．O％、84．3％；不合理用药病历比例由新模式运行前的55．7％分别降至运行后3个月的7．2％和运行后1年的3．9％（P〈0．01）。结论：临床药师参与特殊使用级抗菌药物评估工作模式的运行可以更好地发挥临床药师的作用，对于促进医院特殊使用级抗菌药物合理使用的效果显著。

Practice and Exploration of the Evaluation Mode of Antibacterial Agents in Special Needs with the Participation of Clinical Pharmacists

OBJECTIVE： To establish the evaluation mode of antibacterial agents in special needs with the participation of clinical pharmacists and investigate the effect of the new mode on the rational use of the antibacterial agents in special needs. METHODS： Approval and evaluation mode of antibacterial agents in special needs had been performed on Sept. 2011. All medical records which used the antibacterial agents in special needs in the first quarter of 2011 （before the new mode operated, group A0）, the first quarter of 2012 （3 months after operation of new mode, group A1） and the fourth quarter of 2012 （1 year after operation of new mode, group A2） were retrospectively selected in order to analyze and evaluate the DDDs, microbiological examination and the rationality of drug use; and their results were compared. RESULTS： Antibacterial agents in special needs contained Cefepime hydrochloride for injection, Vancomycin hydrochloride for injection and Imipenem/Cilastatin sodium for injection. Compared with group A0, the DDDs of antibacterial agents in special needs in group A1 and A2 reduced from 987.25 to 579.75 and 401.50 respectively; the rate of microbiological examination and the proportion of drug selection according to results of susceptibility test were both increased significantly （P〈0.01）, increasing form 64.2% and 49.1% to 97.1% and 82.6% in group A1 and 98.0% and 84.3% in group A2; the rate of irrational drug use decreased from 55.7% to 7.2% and 3.9%, respectively （P〈0.01）. CONCLUSIONS： Clinical pharmacists can better play their roles in clinical therapy through practicing the evaluation mode of antibacterial agents in special needs. Meanwhile, the new mode can significantly improve rational use of the antibacterial agents in special needs.