Herawati Fauna, Irawati Adinda Dessi, Viani Ella, Sugianto Nully Andaretha, Rahmatin Nur Laili, Artika Made Prita, Sahputri Sukmawati Eka Bima, Kantono Kevin, Yulia Rika, Andrajati Retnosari, Soemantri Diantha
Department of Clinical and Community Pharmacy, Faculty of Pharmacy, Universitas Surabaya, Surabaya 60293, Indonesia.
Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Indonesia, Depok 16424, Indonesia.
Antibiotics (Basel). 2022 Mar 16;11(3):399. doi: 10.3390/antibiotics11030399.
Clinical pathways can improve the quality of health services. The effectiveness and impact of implementing clinical pathways are controversial. The preparation of clinical pathways not only enacts therapeutic guidelines but requires mutual agreement in accordance with the roles, duties, and contributions of each profession in the team. This study aimed to investigate the perception of interprofessional collaboration practices and the impact of clinical pathway implementation on collaborative and Defined Daily Dose (DDD) prophylactic antibiotics per 100 bed-days in orthopedic surgery. The Collaborative Practice Assessment Tool (CPAT) questionnaire was used as a tool to measure healthcare' perceptions of collaborative practice. The clinical pathway (CP) in this study was adapted from existing CPs published by the Indonesian Orthopaedic Association (Perhimpunan Dokter Spesialis Orthopaedi dan Traumatologi Indonesia, PABOI) and was commended by local domestic surgeons and orthopedic bodies. We then compared post-implementation results with pre-implementation clinical pathway data using ANCOVA to explore our categorical data and its influence towards CPAT response. ANOVA was then employed for aggregated DDD per 100 bed-days to compare pre and post intervention. The results showed that the relationships among members were associated with the working length. Six to ten years of working had a significantly better relationship among members than those who have worked one to five years. Interestingly, pharmacists' leadership score was significantly lower than other professions. The clinical pathway implementation reduced barriers in team collaboration, improved team coordination and organization, and reduced third-generation cephalosporin use for prophylaxis in surgery (pre: 59 DDD per 100 bed-days; post: 28 DDD per 100 bed-days). This shows that the clinical pathway could benefit antibiotic stewardship in improving antibiotic prescription, therefore reducing the incidence of resistant bacteria.
临床路径可以提高医疗服务质量。实施临床路径的有效性和影响存在争议。临床路径的制定不仅要制定治疗指南，还需要根据团队中每个专业的角色、职责和贡献达成相互一致。本研究旨在调查跨专业协作实践的认知，以及临床路径实施对骨科手术中协作和每100床日限定日剂量（DDD）预防性抗生素使用的影响。协作实践评估工具（CPAT）问卷被用作衡量医疗保健人员对协作实践认知的工具。本研究中的临床路径（CP）改编自印度尼西亚骨科协会（印度尼西亚骨科与创伤外科专家协会，PABOI）发布的现有临床路径，并得到了当地国内外科医生和骨科机构的认可。然后，我们使用协方差分析（ANCOVA）将实施后的结果与实施前的临床路径数据进行比较，以探索我们的分类数据及其对CPAT反应的影响。然后采用方差分析（ANOVA）对每100床日的汇总DDD进行分析，以比较干预前后的情况。结果表明，成员之间的关系与工作年限有关。工作6至10年成员之间的关系明显比工作1至5年的成员更好。有趣的是，药剂师的领导得分明显低于其他专业。临床路径的实施减少了团队协作中的障碍，改善了团队协调和组织，并减少了手术中第三代头孢菌素用于预防的使用量（实施前：每100床日59 DDD；实施后：每100床日28 DDD）。这表明临床路径有助于抗生素管理，改善抗生素处方，从而降低耐药菌的发生率。
