广西某三甲医院取消头孢菌素类药物皮试实践

目的: 探索推进取消头孢皮试政策落地的实践和成效。方法: 抗菌药物科学化管理(AMS)小组发挥牵头作用,制定院内头孢菌素类抗菌药物皮肤过敏试验指导意见。通过信息系统维护,多维度、多途径地宣传和培训促进政策落地。通过回顾性分析头孢菌素取消皮试后相关数据以及药品不良反应发生上报情况,分析政策实施前后相关数据的变化。结果: 取消头孢菌素皮试后,抗菌药物使用结构更加合理,三代头孢及酶抑制剂复合制剂的用量明显增加,从28 704 DDDs上升至39 591 DDDs,同比增加40%;皮试人次显著下降,与2020年同期相比,2021年5-11月皮试减少37 165人次;住院患者减少近60%,急诊患者减少近70%,共节省护理工作时间18 582.5 h;皮试药品单独打包环节减少,静脉药物配置中心(PIVAS)药师工作效率大大提高;成本降低,取消皮试期间共减少皮试费用128.09万元;头孢类药物不良反应上报数量无明显变化。结论: 取消头孢菌素皮试,可以优化抗菌药物的使用结构、减少护理和药学人员的工作量,同时可降低医院成本,为患者造福。此外在具体实施过程中,AMS小组的牵头作用,信息系统的支持,多维度、多途径的宣传和培训均必不可少。

Practice of canceling the skin test of cephalosporins in a tertiary hospital in Guangxi

OBJECTIVE To explore the practice and results of promoting the policy implementation of abolishing cephalosporin skin tests.METHODS The antimicrobial stewardship (AMS) team played a leadership role in formulating the guideline for skin allergy testing of cephalosporin antibiotics. A variety of measures including HIS system optimization, multi-dimensional and multi-channel publicity and training were adopted to promote the implementation of policies. Furthermore, a retrospective analysis was conducted on the clinical data of cephalosporin skin tests and adverse drug reactions. The changes in the relevant data before and after the policy implementation were analyzed as well.RESULTS After the skin test of cephalosporins was canceled, the use structure of antibacterial drugs was further reasonable. The combination use of the third-generation cephalosporin and β-lactamase inhibitor increased significantly from 28 704 DDDs to 39 591 DDDs, which was up 40% year-on-year. The number of skin tests dropped significantly, and as compared with the same period in 2020, the number of cephalosporin skin tests reduced by 37 165 persons from May to November in 2021. The number of cephalosporin tests for inpatients was reduced by nearly 60%, and by nearly 70% for emergency patients. In addition, a total of 18 582.5 hours of nursing work time was saved. Meanwhile, the abolition of skin test also reduced the separate packaging process of skin test drugs, which greatly improved the work efficiency of PIVAS. In terms of cost savings, the cost of the skin test was reduced by 1 280 900 yuan during the cancellation of the skin test. Finally, the number of reported adverse reactions of cephalosporins did not change after the skin test was canceled.CONCLUSION The abolition of cephalosporin skin test can optimize the use structure of antibacterial drugs, reduce the workload of nurses and pharmacists, and benefit both hospitals and patients. In the implementation process, the leading role of AMS team, the support of information system, and multi-dimensional and multi-channel publicity and training are all indispensable.