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减少地区肿瘤中心围手术期抗生素处方的不当及遗漏情况

Reducing Improper and Missed Peri-Procedure Antibiotics Prescriptions in a Regional Oncology Centre.

作者信息

Marwat Muhammad Khursheed Ullah Khan, Laila Laila

机构信息

Oncology, Hull University Teaching Hospitals NHS Trust, Hull, GBR.

Oncology, Hull University Teaching Hospitals NHS Trust, Cottingham, GBR.

出版信息

Cureus. 2024 May 2;16(5):e59527. doi: 10.7759/cureus.59527. eCollection 2024 May.

Abstract

Background In the realm of oncology care, patients undergoing invasive procedures are particularly vulnerable to infections due to their compromised immune systems. Antibiotics play a pivotal role in preventing such infections. However, inappropriate or missed administration of peri-procedure antibiotics poses a significant risk in the form of treatment complications, contributing to antibiotic resistance and increased healthcare costs. Methods The study was a two-cycle, closed-loop quality improvement project utilizing both retrospective and prospective data analysis of peri-procedure antibiotics prescription in a regional oncology centre. Two audit cycles were carried out in total; the first cycle was carried out in November 2023 where six-week data were collected retrospectively. As a result, formal and informal teaching sessions about the importance of correct peri-procedure antibiotics and the availability of complete institutional peri-procedure antibiotics guidelines in clinical areas were ensured. The second cycle was carried out prospectively for two weeks in January 2024. Patients were included if they underwent selected procedures performed by interventional radiology or gastroenterology while the patients operated on by the general surgeons and any day case procedures were excluded. Results We identified a total of 82 interventional procedures during the first cycle that fulfilled the inclusion criteria. Six out of 82 patients (7.3%) did not receive the correct peri-procedural antibiotics as per hospital antibiotics guidelines. A prospective two-week data after implementing the change revealed that 25 patients had documented interventional procedures done during this period using electronic patient records. Out of 25 patients, only one patient (4%) did not receive the peri-procedural antibiotics as per guidelines. We were able to demonstrate increased adherence to the peri-procedural guidelines (from 93% to 96%) during the two cycles. However, this change was not statistically significant (p = 0.50). Conclusion By educating and engaging healthcare professionals in adhering to evidence-based guidelines and best practices, we have observed notable, although statistically significant improvement in peri-procedure antibiotics prescription practices. Continued educational efforts and reinforcement strategies will be vital in further improvements over time. By providing ongoing support and resources, healthcare providers can be empowered to consistently make informed decisions regarding peri-procedure antibiotic administration. This commitment to maintaining high standards of antibiotic prescribing practices is expected to result in improved patient outcomes, including reduced rates of surgical site infections and antibiotic resistance. It is imperative to recognize the critical role that accurate peri-procedure antibiotic prescriptions play in patient safety and overall healthcare quality. By fostering a culture of continuous improvement and adherence to established guidelines, we can ensure that patients receive optimal care while minimizing the risks associated with antibiotic overuse or misuse.

摘要

背景 在肿瘤护理领域,接受侵入性手术的患者由于免疫系统受损,特别容易受到感染。抗生素在预防此类感染方面发挥着关键作用。然而,围手术期抗生素的不当使用或漏用会以治疗并发症的形式带来重大风险,导致抗生素耐药性增加和医疗成本上升。方法 本研究是一个两周期的闭环质量改进项目,利用区域肿瘤中心围手术期抗生素处方的回顾性和前瞻性数据分析。总共进行了两个审核周期;第一个周期于2023年11月进行,回顾性收集了六周的数据。结果,确保了在临床区域就正确的围手术期抗生素的重要性以及完整的机构围手术期抗生素指南的可用性开展正式和非正式的教学课程。第二个周期于2024年1月前瞻性地进行了两周。纳入的患者为接受介入放射学或胃肠病学进行的特定手术的患者,而普通外科医生进行手术的患者和任何日间手术患者被排除在外。结果 在第一个周期中,我们共确定了82例符合纳入标准的介入手术。82例患者中有6例(7.3%)未按照医院抗生素指南接受正确的围手术期抗生素治疗。实施变更后的前瞻性两周数据显示,在此期间有25例患者使用电子病历记录了介入手术。在这25例患者中,只有1例(4%)未按照指南接受围手术期抗生素治疗。我们能够证明在两个周期中围手术期指南的依从性有所提高(从93%提高到96%)。然而,这种变化在统计学上并不显著(p = 0.50)。结论 通过教育和促使医疗保健专业人员遵守循证指南和最佳实践,我们观察到围手术期抗生素处方实践有显著改善,尽管在统计学上并不显著。随着时间的推移,持续的教育努力和强化策略对于进一步改进至关重要。通过提供持续的支持和资源,可以使医疗保健提供者有能力始终就围手术期抗生素给药做出明智的决定。致力于维持高标准的抗生素处方实践有望改善患者预后,包括降低手术部位感染率和抗生素耐药性。必须认识到准确的围手术期抗生素处方在患者安全和整体医疗质量中所起的关键作用。通过营造持续改进和遵守既定指南的文化,我们可以确保患者获得最佳护理,同时将与抗生素过度使用或滥用相关的风险降至最低。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cf1b/11144021/868c6cf5f043/cureus-0016-00000059527-i01.jpg

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