임상적 의사결정시스템 도입 후 수술 시 예방적 항생제 사용 평가
Medication Use Evaluation for Prophylactic Antibiotics in Surgery - Effects of Establishing Clinical Decision Support System
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Prophylactic antibiotics for surgical patients are used to prevent surgical site infections(SSIs). If they are not used appropriately, in addition to the risk of SSIs, emergence of antibiotics-resistant bacteria and demands on healthcare resource probably increase. In Seoul St. Mary’s hospital, we set up Prophylactic Antibiotics(PA) practice guidelines for surgery in 2007 and established Clinical Decision Support System(CDSS) which recommend kinds and dosage of antibiotics in October 2008. The objects of our study are to evaluate the usefulness of CDSS program and to find methods of its improvements. We reviewed the electronic medical record charts of patients who underwent gastric surgery,colon surgery, cholecystectomy, hip replacement, knee replacement, hysterectomy, hysterotokotomy or cardiac surgery. The primary outcomes are average duration of PA use(PAU), prescription rate of recommended PA and prescription rate of inappropriate PA. The secondary outcomes are administration rate of first PA within 60 minutes before incision and average duration of hospitalization. We compared historical group(before introduction of CDSS, January~February 2008) and intervention group(after introduction of CDSS, January~February 2009)As a result, patients are 283 person in historical group, 328 in intervention group and 611 intotal. Average duration of PAU is decreased from 6.6days to 4.8days(p<0.0001), Prescription rate of recommended PA is increased from 69.3% to 76.2%(p=0.053) as marginal value and prescription rate of inappropriate PA is a little improved but not significantly(15.9% vs 13.7%, p=0.39). Administration rate of first PA within 60 minutes before incision(89.8 % vs 92.4%, p=0.25) and average duration of hospitalization(8.4days vs 8.6days, p=0.73) are not statistically significant, too. Furthermore, there are many differences between operations in improvements outcomes. Therefore, it is necessary to encourage appropriate use of PA by being forced into using CDSS and giving feedback actively.
Abstract
Prophylactic antibiotics for surgical patients are used to prevent surgical site infections(SSIs). If they are not used appropriately, in addition to the risk of SSIs, emergence of antibiotics-resistant bacteria and demands on healthcare resource probably increase. In Seoul St. Mary’s hospital, we set up Prophylactic Antibiotics(PA) practice guidelines for surgery in 2007 and established Clinical Decision Support System(CDSS) which recommend kinds and dosage of antibiotics in October 2008. The objects of our study are to evaluate the usefulness of CDSS program and to find methods of its improvements. We reviewed the electronic medical record charts of patients who underwent gastric surgery,colon surgery, cholecystectomy, hip replacement, knee replacement, hysterectomy, hysterotokotomy or cardiac surgery. The primary outcomes are average duration of PA use(PAU), prescription rate of recommended PA and prescription rate of inappropriate PA. The secondary outcomes are administration rate of first PA within 60 minutes before incision and average duration of hospitalization. We compared historical group(before introduction of CDSS, January~February 2008) and intervention group(after introduction of CDSS, January~February 2009)As a result, patients are 283 person in historical group, 328 in intervention group and 611 intotal. Average duration of PAU is decreased from 6.6days to 4.8days(p<0.0001), Prescription rate of recommended PA is increased from 69.3% to 76.2%(p=0.053) as marginal value and prescription rate of inappropriate PA is a little improved but not significantly(15.9% vs 13.7%, p=0.39). Administration rate of first PA within 60 minutes before incision(89.8 % vs 92.4%, p=0.25) and average duration of hospitalization(8.4days vs 8.6days, p=0.73) are not statistically significant, too. Furthermore, there are many differences between operations in improvements outcomes. Therefore, it is necessary to encourage appropriate use of PA by being forced into using CDSS and giving feedback actively.
참고문헌 (10)
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