Pharamcy Service, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
Department of Internal Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
Braz J Infect Dis. 2022 Jan-Feb;26(1):102333. doi: 10.1016/j.bjid.2022.102333. Epub 2022 Feb 16.
Stewardship programs have been developed to optimize the use of antibiotics, but programs focusing on antifungal agents are less frequent.
To evaluate the quality of antifungal prescriptions in a tertiary care hospital, and to test if a simple educational activity could improve the quality of prescriptions.
The study comprised three phases: 1) Retrospective audit of all antifungal prescriptions in a 6-month period, applying a score based on six parameters: indication, drug, dosage, route of administration, microbiologic adequacy after results of cultures, switching to an oral agent, and duration of treatment; 2) Creation of text boxes in the electronic medical records with information about antifungal agents, shown during prescription; 3) Retrospective audit of all antifungal prescriptions in a 6-month period, applying the same 6-parameters score, and comparison between the two periods.
Among 333 prescriptions, fluconazole was the most frequently (80.5%) prescribed agent. Hematology (26.7%), Infectious Diseases Department (22.8%), Internal Medicine (15.9%) and Intensive Care Unit (14.4%) were the units with most antifungal prescriptions. The median score for the 333 prescriptions was 8.0 (range 0 - 10), and 72.7% of prescriptions were considered inappropriate. The median and mean scores in the first and second audit were 8.0 and 6.9, and 8.0 and 7.9, respectively (p<0.001). All items that comprised the score improved from the first to the second audit. Likewise, there was a reduction of inappropriate prescriptions (80.2% in the first audit vs. 64.6% in the second audit, p=0.001).
A large proportion of inappropriate prescriptions was observed, which improved with the implementation of simple educational activities.
已开发管理方案以优化抗生素的使用，但针对抗真菌药物的方案则较少。
评估一家三级保健医院的抗真菌药物处方质量，并检验一项简单的教育活动是否能提高处方质量。
该研究包括三个阶段：1）回顾性审核 6 个月期间的所有抗真菌药物处方，应用基于以下 6 个参数的评分：适应证、药物、剂量、给药途径、培养结果得出后微生物学的充分性、转为口服药物、以及治疗持续时间；2）在电子病历中创建包含抗真菌药物信息的文本框，在开具处方时显示；3）回顾性审核 6 个月期间的所有抗真菌药物处方，应用相同的 6 个参数评分，并比较两个时期。
在 333 张处方中，氟康唑是最常开的药物（80.5%）。血液科（26.7%）、传染病科（22.8%）、内科（15.9%）和重症监护病房（14.4%）是开抗真菌药物处方最多的科室。333 张处方的中位数评分为 8.0（范围 0-10），72.7%的处方被认为不恰当。第一次和第二次审核的中位数和平均值评分分别为 8.0 和 6.9，8.0 和 7.9（p<0.001）。评分所包含的所有项目均从第一次审核提高到了第二次审核。同样，不恰当处方的比例也从第一次审核的 80.2%下降到了第二次审核的 64.6%（p=0.001）。
观察到大量不恰当的处方，实施简单的教育活动后得到改善。
