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題 名 | 推行抗生素管理計畫之成效分析=Antibiotics Stewardship Program on the Use of Antibiotics at a District Hospital |
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作 者 | 王惠蓉; 黃郁茜; 侯瑞良; 陳圭; 黃婉翠; | 書刊名 | 藥學雜誌 |
卷 期 | 31:4=125 2015.12[民104.12] |
頁 次 | 頁100-105 |
分類號 | 418.281 |
關鍵詞 | 抗生素管理計畫; 每千人日使用DDD數; 敏感性; 抗藥性; DID; |
語 文 | 中文(Chinese) |
中文摘要 | 背景:世界衛生組織 (WHO) 於2011年4月7日將「Combat drug resistance」訂為世 界衛生日主題,強調「No action today, no cure tomorrow」,呼籲各國重視抗藥性議 題。抗生素不合理使用、多重抗藥性細菌的衍生及新藥的研發趨緩,已使抗藥性成為 全球公共衛生的重要疑慮,為減緩國內抗藥性的問題,疾病管制署以抗生素合理使 用及感染管制為主要措施,自2013年起推動抗生素管理計畫 (Antibiotics Stewardship Program, ASP)。 目的:本院於2014年由院長帶領加入 ASP,希望透過資訊系統的輔助及醫師、感 染管制護理師、護理科、檢驗科、藥劑科等團隊合作、進行相關管理和監測,提升抗 生素使用的合理性,以減少抗藥性細菌發生,降低病人醫療照護相關感染風險,促進 病人安全並提升醫療品質。 對策:一、院長於全院業務性會議宣示目標與對策;二、成立抗生素管理小組, 負責跨單位協調與監測指標、追蹤成效;三、從 HIS 系統建置處方管理機制;四、建 立管制性抗生素事前 HIS 系統填寫申請使用之條件、事後由兼任感控醫師抽審病歷的 制度;五、建立藥師介入評估與回饋機制;六、提供醫療人員教育訓練。 結果:與2013年同期相比,2014年整體抗生素藥費成長率、門、急、住診處方佔 率及特殊管制性抗生素耗用密度 DID 均為負成長,抗藥性未見成長,顯示管制性抗 生素使用合理、並趨於謹慎,推行 ASP 成效良好。 |
英文摘要 | Background: The misuse of antibiotics has contributed to the growing problem of antibiotic resistance, which has become one of the most serious and growing threats to public health. "Antibiotic Stewardship Programs (ASPs)" was a hospital based programs dedicated to improving antibiotic use, can optimize the treatment of infections and help clinicians improve the quality of patient care and safety through increased infection cure rates, reduced treatment failures. We reported here the policy and outcomes of Antibiotics Stewardship Program (ASP) at a district hospital without full-time infectious diseases (ID) physicians. Methods: A district hospital with 343 beds, including an ICU of 10 beds. Broadspectrum antibiotics (BSA) prescription was essentially based on antibiotic susceptibility reports without ID consultation. An ASP was implemented to reduce heavy use of BSA in which, among others, pharmacists gave prompt feedback within 24 hours and monthly reports of inappropriate BSA use. Inappropriate BAS prescriptions evaluated by pharmacists, and change of BSA prescription according to pharmacist feedback were analyzed at the end of study period. BSAs in this study included carbapenems, glycopeptides, fluoroquinolones and 3rd cephalosporins, which were compared on DIDs (total acute inpatient antibiotic consumption in Defined Daily Doses per 1,000 Patient-Days ) between two study periods of 12 months before and after the implementation of the ASP.Results: BSA DIDs reduced by 34.3% after ASP took effect. 67.5% (253/375). BSA were evaluated within 24 hours by pharmacists. 6.7% (17/253) inappropriate BSA prescription, among which 47.1% (8/17) were changed in prescription according to pharmacist recommendation. Conclusions: In 2013, Taiwan CDC recommended that all acute care hospitals implement Antibiotic Stewardship Programs. The core elements of hospital antibiotic stewardship programs included: leadership commitment, accountability and drug expertise, implement policies and interventions to improve antibiotic use, and tracking antibiotic use and outcomes. In this study, ASP with pharmacists' timely intervention and feedback on BSA use effectively reduced inappropriate prescription of BSA, especially for hospitals without ID consultation service. |
本系統中英文摘要資訊取自各篇刊載內容。