Gardiner Sharon J, Basevi Ari B, Hamilton Niall L, Metcalf Sarah Cl, Chambers Stephen T, Withington Stephen G, Chin Paul K, Freeman Joshua T, Dalton Simon C
Antimicrobial Stewardship Pharmacist, Infectious Diseases, Clinical Pharmacology and Pharmacy Departments, Christchurch Hospital, Canterbury District Health Board, Christchurch.
Medical Student, Infectious Diseases, Christchurch Hospital, Canterbury District Health Board, Christchurch.
N Z Med J. 2020 Nov 20;133(1525):18-33.
To determine the nature and appropriateness of antimicrobial prescribing in adult inpatients at Canterbury District Health Board (CDHB).
Multidisciplinary teams collected clinical details for all adult inpatients on antimicrobial therapy at three CDHB facilities (~1,100 beds) and made standardised assessments based on the Australian National Antimicrobial Prescribing Survey (http://naps.org.au) against local guidelines and national funding criteria.
Antimicrobial therapy was prescribed to 42% of inpatients (322/760), usually to treat infections [377/480 prescriptions (79%)], with amoxicillin+clavulanic acid the agent most commonly prescribed [72/480 prescriptions (15%)]. Of assessable prescriptions, 74% (205/278) were guideline compliant, 98% (469/480) were funding criteria compliant, and 83% (375/451) were appropriate clinically. Prescriptions for the most common indications-surgical prophylaxis [66/480 (14%)] and community-acquired pneumonia [56/480 (12%)]-were often non-compliant with guidelines (32% and 41%, respectively) and inappropriate (18% and 21%, respectively). Overall, the indication was documented in 353/480 (74%) prescriptions, the review/stop date documented in 145/480 (30%) prescriptions, and surgical prophylaxis stopped within 24 hours in 53/66 (80%) prescriptions.
Most antimicrobial prescriptions were appropriate and complied with guidelines. Compliance with key quality indicators (indication documented, review/stop date documented, and surgical prophylaxis ceased within 24 hours) were well below target (>95%) and needs improvement.
确定坎特伯雷地区卫生委员会（CDHB）成年住院患者抗菌药物处方的性质及合理性。
多学科团队收集了CDHB三个机构（约1100张床位）所有接受抗菌治疗的成年住院患者的临床细节，并根据澳大利亚国家抗菌药物处方调查（http://naps.org.au）针对当地指南和国家资助标准进行标准化评估。
42%的住院患者（322/760）接受了抗菌治疗，通常用于治疗感染[480份处方中的377份（79%）]，阿莫西林+克拉维酸是最常用的药物[480份处方中的72份（15%）]。在可评估的处方中，74%（205/278）符合指南，98%（469/480）符合资助标准，83%（375/451）临床合理。最常见适应症的处方——外科手术预防[480份中的66份（14%）]和社区获得性肺炎[480份中的56份（12%）]——往往不符合指南（分别为32%和41%）且不合理（分别为18%和21%）。总体而言，353/480（74%）的处方记录了适应症，145/480（30%）的处方记录了复查/停药日期，53/66（80%）的外科手术预防处方在24小时内停药。
大多数抗菌药物处方合理且符合指南。关键质量指标（记录适应症、记录复查/停药日期以及外科手术预防在24小时内停药）的合规率远低于目标（>95%），需要改进。
