使用国家审计工具评估英国一家医院外科患者抗生素处方的适宜性以确定干预机会:一项单中心回顾性审计
Identification of Intervention Opportunities through Assessment of the Appropriateness of Antibiotic Prescribing in Surgical Patients in a UK Hospital Using a National Audit Tool: A Single Centre Retrospective Audit.
作者信息
Hearsey Daniel John, Bamford Kathleen B, Hutton Michael, Wade Liam, Coates Henry, Ramsay Elizabeth, Alberts Barbara, Powell Neil
机构信息
Pharmacy Department, Royal Cornwall Hospital, Truro TR1 3LJ, UK.
Medical Microbiology, Royal Cornwall Hospital, Truro TR1 3LJ, UK.
出版信息
Antibiotics (Basel). 2022 Nov 8;11(11):1575. doi: 10.3390/antibiotics11111575.
Identifying opportunities to safely reduce antibiotic prescribing is necessary for prescribers and antibiotic stewardship teams to minimise unwarranted antibiotic use. We aimed to quantify excess antibiotic use in General Surgery. We retrospectively audited the antibiotic prescribing for patients discharged from the General Surgery specialty in an acute hospital in the south-west of England for one month using an audit tool developed by Public Health England. The appropriateness of prescribing was determined for each patient at three antibiotic decision time-points: at initiation, the pre-72-hour antibiotic review, and treatment duration. Two infection specialists and a general surgeon reviewed each patient. Indication and excess days of therapy (DOTs) were calculated at each decision time-point and expressed as a proportion of total DOTs. Eighty-six patients were prescribed 1162 DOTs; 192 (16.5%) excess DOTs were prescribed in 38 patients (44%), with zero excess days identified in the remaining 48 patients (56%). Seventy-five of 192 (39%) excess DOTs occurred at initiation; 55/192 (29%) after the pre-72-hour antibiotic review; and 62/192 (32%) due to protracted antibiotic courses. There was concordance between the general surgeon and infection specialist for most apportioned excess DOTs. However, the surgeon apportioned fewer excess DOTs 160/1162 (13.8%). Overall IV antibiotics accounted for 53.4% of total DOTs. Seventy-two of 86 (83.7%) patients received 620 intravenous DOTs; of these, 79 (12.7%) IV DOTS were unnecessary. We have identified excess antibiotic prescribing in General surgery with comparable excess DOTs at all three time-points.
对于开处方者和抗生素管理团队而言,识别安全减少抗生素处方的机会对于尽量减少不必要的抗生素使用至关重要。我们旨在量化普通外科中过量使用抗生素的情况。我们使用英国公共卫生部门开发的审核工具,对英格兰西南部一家急症医院普通外科专科出院患者的抗生素处方进行了为期一个月的回顾性审核。在三个抗生素决策时间点确定每位患者处方的适宜性:开始时、72小时前的抗生素复查时以及治疗期间。两名感染专科医生和一名普通外科医生对每位患者进行了评估。在每个决策时间点计算用药指征和额外治疗天数(DOTs),并表示为总DOTs的比例。86名患者共开具了1162个DOTs;38名患者(44%)开具了192个(16.5%)额外的DOTs,其余48名患者(56%)未发现额外天数。192个额外DOTs中的75个(39%)发生在开始时;55/192(29%)发生在72小时前的抗生素复查后;62/192(32%)是由于抗生素疗程延长。对于大多数分摊的额外DOTs,普通外科医生和感染专科医生的意见一致。然而,外科医生分摊的额外DOTs较少,为160/1162(13.8%)。总体而言,静脉用抗生素占总DOTs的53.4%。86名患者中的72名(83.7%)接受了620个静脉DOTs;其中,79个(12.7%)静脉DOTs是不必要的。我们发现在普通外科中存在过量使用抗生素的情况,在所有三个时间点都有相当数量的额外DOTs。