一种优化术前抗生素给药与管理的质量管理方法。

Welch L, Teague A C, Knight B A, Kenney A, Hernandez J E

Department of Medicine, West Virginia University, USA.

Clin Perform Qual Health Care. 1998 Oct-Dec;6(4):168-71.

OBJECTIVE

To optimize the process for delivering and administering preoperative antibiotics in order to prevent potential adverse patient outcomes.

DESIGN

Using a multidisciplinary quality-improvement team, an evaluation of the preoperative medication order and delivery process was conducted. Charts were reviewed by selected time periods, with winter 1994 discharges for orthopedic surgeries (n = 97) and spring 1995 discharges for open heart procedures (n = 50) being used to arrive at baseline data (n = 147). A plan was devised to mainstream the medication-use process so that it would be standardized hospitalwide. A goal of administering preoperative antibiotics within 30 to 60 minutes prior to cut time was established. Following redesign and education, a repeat chart review of orthopedic surgeries (n = 33) and open heart procedures (n = 168) was conducted during April 1997 for discharges from the same diagnosis-related groups to total (n = 201).

SETTING

A nearly 1,000-bed tertiary referral center and teaching hospital with three separate campuses.

RESULTS

We identified multiple ordering mechanisms, multiple medication sources and delivery sites, multiple administration sites and administering personnel, and other logistical conflicts. Thirty-one percent of cases received antibiotics less than 30 minutes prior to start time, 39% between 30 to 60 minutes, and 30% greater than 60 minutes before start time. Following the multidisciplinary redesign and education, an increase from 39% to 61% receiving preoperative antibiotics between 30 to 60 minutes prior to surgery start time and a decrease from 31% to 18% receiving them in less than 30 minutes was documented. The percentage of patients receiving preoperative antibiotics in 60 minutes or less increased from 70% to 80%.

CONCLUSION

A continuous quality-improvement approach that engages all departments involved in patient care is necessary to achieve meaningful change in complicated hospital processes.

目的

优化术前抗生素的给药和管理流程，以防止患者出现潜在不良后果。

设计

利用多学科质量改进团队，对术前用药医嘱和给药流程进行评估。按选定时间段审查病历，以1994年冬季骨科手术出院患者（n = 97）和1995年春季心脏直视手术出院患者（n = 50）作为基线数据（n = 147）。制定了一项计划，使用药流程标准化，以便在全院范围内统一。确立了在切开时间前30至60分钟内给予术前抗生素的目标。经过重新设计和培训后，于1997年4月对来自相同诊断相关组的骨科手术出院患者（n = 33）和心脏直视手术出院患者（n = 168）进行了病历复查，总数为（n = 201）。

地点

一家拥有近1000张床位的三级转诊中心和教学医院，有三个独立校区。

结果

我们发现了多种医嘱机制、多种药物来源和给药地点、多种给药部位和给药人员以及其他后勤冲突。31%的病例在开始时间前不到30分钟接受抗生素治疗，39%在30至60分钟之间，30%在开始时间前超过60分钟。经过多学科重新设计和培训后记录显示，在手术开始时间前30至60分钟接受术前抗生素治疗的比例从39%增至61%，在不到30分钟内接受治疗的比例从31%降至18%。在60分钟或更短时间内接受术前抗生素治疗的患者比例从70%增至80%。