背景:符合中国关于改进麻醉学药物管理的国家指令,青岛大学附属医院启动了质量改进项目,旨在解决药物管理效率低下的普遍挑战,不断上涨的药物成本,以及药剂师和麻醉师之间明显的沟通差距。
方法:我们采用了Plan-Do-Study-Act方法来建立药学团队并执行多维药学干预。干预措施包括制定标准程序,指导方针和法规,信息系统(包括自动配药柜和前瞻性处方审查系统)的帮助,沟通反馈(通过微信群),和麻醉人员的教育。这项干预措施从2023年4月到9月,重点是优化药物管理,实现成本节约,提高麻醉小组成员的满意度,从2023年10月到12月的额外观察。
结果:在干预之后,观察到药物管理实践有所改善.这些改进包括加强对会计程序的遵守,更严格的管制物质登记,更有效地处理液体残留物。没有与高度警惕的药物或外观相似的药物使用错误相关的不良事件。自动配药柜和前瞻性处方审查系统的引入显着提高了工作效率。微信群的使用促进了关于不合理处方和药物相关问题的有效沟通。在干预前后接受手术的29,061名患者中,药物比例和人均药物成本均显著下降(P=0.03,P=0.014).人均药品费用下降20.82%,从723.43日元到572.78日元,在整个9个月的观察期内一直保持在600日元以下。监测包括地佐辛在内的药物的人均成本,布托啡诺,血凝酶agkistrodon,戊乙奎醚,和乌司他丁经历了显著降低(P<0.05)。此外,在返回的满意度问卷中,94.44%的麻醉人员对全面的药物干预措施表示高度满意。
结论:质量改进项目取得了显著的积极成果,作为一个值得在类似的医疗保健环境中参考和复制的模型。
BACKGROUND: In alignment with China\'s national directive for improved drug management in anesthesiology, the Affiliated Hospital of Qingdao University initiated a quality improvement project, aiming to tackle the prevailing challenges of inefficiencies in drug administration, escalating drug costs, and the notable communication gap between pharmacists and anesthesiologists.
METHODS: We employed a Plan-Do-Study-Act methodology to establish a pharmacy team and execute a multidimensional pharmaceutical intervention. The interventions included the formulation of standard procedures, guidelines and regulations, assistance from an information system (including automatic dispensing cabinets and prospective prescription review system), communication feedback (via WeChat groups), and education for anesthesiology staff. The intervention spanned from April to September 2023, focusing on optimizing medication management, achieving cost savings, and enhancing the satisfaction of anesthesia team members, with an additional observation from October to December 2023.
RESULTS: Following the interventions, improvements were observed in drug management practices. These enhancements included increased compliance with accounting procedures, more rigorous registration of controlled substances, and more effective disposal of liquid residues. There was no adverse events related to high-alert medications or look-alike drug usage errors. The introduction of automatic dispensing cabinets and a prospective prescription review system markedly improved work efficiency. The utilization of a WeChat group facilitated effective communication about unreasonable prescriptions and drug-related issues. Among the 29,061 patients who underwent surgery both before and after the interventions, significant reductions were observed both in the drug proportion and the per capita drug costs (P = 0.03, P = 0.014, respectively). The per capita drug cost decreased by 20.82%, from ¥723.43 to ¥572.78, consistently remaining below ¥600 throughout the 9-month observation period. The per capita cost of monitoring drugs including dezocine, butorphanol, haemocoagulase agkistrodon, penehyclidine, and ulinastatin experienced a significant reduction (P < 0.05). Additionally, in the satisfaction questionnaires returned, a remarkable 94.44% of anesthesiology staff expressed high satisfaction with the comprehensive pharmaceutical interventions.
CONCLUSIONS: The quality improvement project has yielded remarkable positive outcomes, serving as a model worthy of reference and replication in similar healthcare settings.