PDCA循环在规范Ⅰ类切口手术预防用抗菌药物中的应用

目的探讨某院应用PDCA循环管理在规范医院Ⅰ类切口手术围手术期合理预防使用抗菌药物的效果。方法选取2011年1-6月Ⅰ类切口手术患者，为实施PDCA循环前组；根据PDCA实施的3个循环过程，将2011年7月-2012年12月全院Ⅰ类切口手术患者分为3组。按照PDCA循环管理法的计划、实施、检查、处理程序，对Ⅰ类切口手术预防用抗菌药物进行管理和控制，对实施PDCA循环管理前后用药合理性进行对照研究。结果实施PDCA前，Ⅰ类切口手术预防使用抗菌药物率为100.00%（101/101），实施3个PDCA循环后，降至36.09%（61/169）,差异有统计学意义(χ2=135.66,P＜0.001）；合理用药率由实施PDCA前的62.38%（63/101）提高至81.97%（50/61），差异有统计学意义(χ2=8.29,P=0.04)。实施PDCA前，51.49%（52/101）的患者术后用药时间＞3 d；实施3个PDCA循环后，术后用药时间>3 d的患者降至7.69%，术后预防用药时间较前规范，无联合用药。结论实施PDCA循环管理在规范Ⅰ类切口手术预防用抗菌药物中成效显著。

Application of PDCA cycle in standardizing antimicrobial application in type I incision operation

Objective To evaluate the efficacy of plan-do-check-act（PDCA）cycle management in standardizing antimicrobial application in typeⅠincision operation.Methods Patients with typeⅠincision operation between January and June 2011 were selected as pre-PDCA group;according to three cycles of PDCA,all patients with typeⅠincision operation between July 2011 and December 2012 were divided into three groups.According to plan,do,check and act procedure of PDCA cycle,antimicrobial use in typeⅠincision were managed and controlled,case control study on the rationality of antimicrobial use before and after the implementation of PDCA were performed.Results Antimicrobial use in typeⅠincision operation decreased from100.00%（101/101）before implementing PDCA to 36.09%（61/169）after implementing three cycles of PDCA,the difference was significant（χ2=135.66,P0.001）;antimicrobial rational usage increased from62.38%（63/101）to 81.97%（50/61）,the difference was significant（χ2=8.29,P=0.04）.Before implementing PDCA,51.49%（52/101）of patients used antimicrobial agents3days;after implementing three cycles of PDCA,7.69% of patients used antimicrobial agents3 days,postoperative antimicrobial use was more rational than before,there was no combination use of antimicrobial agents.Conclusion PDCA cycle is obviously effective in standardization the rational use of antimicrobial agents in typeⅠincision operation.