探讨临床药师在动静脉内瘘术中规范化使用抗菌药物的作用

目的 探讨临床药师在实施单病种动静脉内瘘术临床路径中的作用,摸索在有限的卫生资源条件下,通过规范化诊疗过程、标准化用药行为,来降低抗菌药物的使用率,减少耐药菌的产生,降低医疗费用,最终达到改善医疗质量,使患者的临床用药能够做到安全、有效、经济.方法 根据研究项目的需要自行设计点评表,对实施临床路径前后应用抗菌药物情况进行对比分析研究.结果 实施临床路径后,抗菌药物的不合理使用率由路径前的98.51％下降至路径后的5.3％ （P ＜0.001）,预防用抗菌药物的平均金额由443元降至5.01元（P ＜0.001）,预防用抗菌药物总费用占总住院费用比例由4.1％降至0.093％（P＜0.001）,平均用药天数由4d降至0.06 d（P ＜0.001）.西药总费用占总住院费用比例由36.57％降至15.89％（P＜0.001）.结论 临床药师在肾内科动静脉内瘘术临床路径实施中对抗菌药物使用的干预是行之有效的,应进一步在该院推广.

Role of clinical pharmacist in rational use of antibiotic in arteriovenous fistula

Abstract：Objective To save the medical resources reasonably and to obtain significant social benefits and economic benefits, the clinical pathway of single disease of arteriovenous fistula is implemented. Methods A retrospective study was conducted, both the case files of patients using prophylactic antibacterials. Uses of antibacterials before and after the implementation of clinical pathway were contrasted, analyzed and studied. Results After the implementation of clinical pathway, the rate of unreasonable use of antibiotics decreased from 98.51% before the clinical pathway to 5.3% after the clinical pathway （P 〈 0. 001 ）. Average prophylactic antibiotic cost decreased from 443 yuan to 5.01 yuan（P 〈 0. 001 ）. The proportion of the prophylactic antibiotic cost in total drugs cost decreased from 4.1% to 0. 093% （P 〈 0.001 ） ,and the proportion of the western drugs cost in the total drugs cost decreased from 36.57% to 15.89% （ P 〈 0.001 ）. The average using time of prophylactic antibacterials decreased from 4 d to 0.06 d （ P 〈 0. 001 ）. Conclusions The role of clinical pharmacists in arteriovenous fistula is imperative whose intervention of antibiotic use is effective, which is worthy of promotion.