Effects of Clinical Pharmacist Intervention on the Use of Antibacterials During Perioperative Period of Cesarean Section

doi:10.3877/cma.j.issn.1673-5250.2014.04.014

Objective

To evaluate the effects of clinical pharmacist intervention on the use of antibacterials during perioperative period of cesarean section.

Methods

The patients with cesarean section who were not receive clinical pharmacist intervention on the use of antibacterials during perioperative period from July to September 2012 in Shaanxi Martenal and Child Hospital were chosen into non-intervention group(n= 136). The patients with cesarean section who received clinical pharmacist intervention on the use of antibacterials during perioperative period from July to September 2013 in the same hospital were chosen into intervention group(n= 145). The rationality of prophylactic use of antibacterials during perioperative period and effects of hospitalization were compared, retrospectively. The study protocol was approved by the Ethical Review Board of Investigation in Human Beings of Shaanxi Marternal and Child Hospital. Informed consent was obtained from each participating patient. The average age, operation duration and the amount of bleeding had no significant differences between two groups (P> 0.05).

Results

After the intervention of clinical pharmacist, the rationality of choice of medicine and medication time of the preventive application of antibacterials during perioperative period were statistically improved compared with those of non-intervention(χ² = 6.30,221.38; P = 0.01,0.00). While the time points of prophylaxis use of antibacterials and mean hospital days had no significant differences between two groups(χ²/t= 1.36, 1.60; P=0.24,0.11). The per capita antibacterial expense, per capita total medicine expense and per capita total hospitalization expense were statistically lower after intervention (t = 28.99,5.10, 4.23; P = 0.00, 0.00, 0.00).

Conclusions

The rationality of use of antibacterials during perioperative period of cesarean section were significantly improved after clinical pharmacist intervention, which could reduce hospitalization expense. The clinical pharmacist intervention on the preventative application of antibacterials is feasible and effective.

Key words: Perioperative period, Anti-bacterial agents, Pharmacists

表1 围手术期预防应用抗菌药物合理性评价标准

Table 1 The reasonable criterion of prophylactic use of antibacterials during perioperative period

给药方案	合理	不合理
有预防用药指征	使用抗菌药物	未使用抗菌药物
抗菌药物种类	第一代或第二代头孢菌素，可加用甲硝唑	使用除第一代或第二代头孢菌素以外的抗菌药物（第一代或第二代头孢菌素过敏者除外）
初次给药时机	钳夹脐带后使用	术前或术后
术中追加抗菌药物	手术时间≥3 h或术中出血量>1 500 mL即追加	手术时间≥3 h或术中出血量>1 500 mL未追加
术后用药时间	≤48 h	>48 h
联合用药	未联合或有联合用药指征时使用	无联合用药指征仍使用

表1 围手术期预防应用抗菌药物合理性评价标准

Table 1 The reasonable criterion of prophylactic use of antibacterials during perioperative period

给药方案	合理	不合理
有预防用药指征	使用抗菌药物	未使用抗菌药物
抗菌药物种类	第一代或第二代头孢菌素，可加用甲硝唑	使用除第一代或第二代头孢菌素以外的抗菌药物（第一代或第二代头孢菌素过敏者除外）
初次给药时机	钳夹脐带后使用	术前或术后
术中追加抗菌药物	手术时间≥3 h或术中出血量>1 500 mL即追加	手术时间≥3 h或术中出血量>1 500 mL未追加
术后用药时间	≤48 h	>48 h
联合用药	未联合或有联合用药指征时使用	无联合用药指征仍使用

表2 两组抗菌药物使用种类及构成比[n(%)]

Table 2 The types of antibacterials and their constituent ratio of two groups[n(%)]

组别	n	青霉素类	第一代头孢菌素		第二代头孢菌素		第三代头孢菌素
组别	n	磺苄西林	头孢唑林	头孢西酮	头孢孟多	头孢呋辛	头孢曲松
未干预组	136	62(45.6)	1 (0.7)	0(0.0)	68(50.0)	4(3.0)	1(0.7)
干预组	145	0 (0.0)	131(90.3)	10(6.9)	0 (0.0)	4(2.8)	0(0.0)

表2 两组抗菌药物使用种类及构成比[n(%)]

Table 2 The types of antibacterials and their constituent ratio of two groups[n(%)]

组别	n	青霉素类	第一代头孢菌素		第二代头孢菌素		第三代头孢菌素
组别	n	磺苄西林	头孢唑林	头孢西酮	头孢孟多	头孢呋辛	头孢曲松
未干预组	136	62(45.6)	1 (0.7)	0(0.0)	68(50.0)	4(3.0)	1(0.7)
干预组	145	0 (0.0)	131(90.3)	10(6.9)	0 (0.0)	4(2.8)	0(0.0)

表3 两组抗菌药物用药时机、术后用药时间及其构成比[n(%)]

Table 3 The antibacterials use time and postoperative medication time and their constituent ratio of two groups[n(%)]

组别	n	用药时机				术后用药时间(h)
组别	n	大于术前2 h	术前0.5～2 h	钳夹脐带后用药	术后用药	≤24	>24～48	>48～72	>72
未干预组	136	1(0.7)	3(2.2)	130(95.6)	2(1.5)	7 (5.2)	5 (3.7)	19(14.0)	105(77.2)
干预组	145	0(0.0)	0(0.0)	143(98.6)	2(1.4)	65(44.8)	77(53.1)	3 (2.1)	0 (0.0)

表3 两组抗菌药物用药时机、术后用药时间及其构成比[n(%)]

Table 3 The antibacterials use time and postoperative medication time and their constituent ratio of two groups[n(%)]

组别	n	用药时机				术后用药时间(h)
组别	n	大于术前2 h	术前0.5～2 h	钳夹脐带后用药	术后用药	≤24	>24～48	>48～72	>72
未干预组	136	1(0.7)	3(2.2)	130(95.6)	2(1.5)	7 (5.2)	5 (3.7)	19(14.0)	105(77.2)
干预组	145	0(0.0)	0(0.0)	143(98.6)	2(1.4)	65(44.8)	77(53.1)	3 (2.1)	0 (0.0)

表4 两组抗菌药物合理使用率比较[n(%)]

Table 4 Comparison of reasonable use rate of antibacterials of two groups[n(%)]

组别	n	抗菌药物选择合理率	术后使用时间合理率	用药时机合理率
未干预组	136	73 (53.7)	12 (8.8)	130(95.6)
干预组	145	145(100.0)	142(97.9)	143(98.6)
χ²		6.30	221.38	1.36
P		0.01	0.00	0.24

表4 两组抗菌药物合理使用率比较[n(%)]

Table 4 Comparison of reasonable use rate of antibacterials of two groups[n(%)]

组别	n	抗菌药物选择合理率	术后使用时间合理率	用药时机合理率
未干预组	136	73 (53.7)	12 (8.8)	130(95.6)
干预组	145	145(100.0)	142(97.9)	143(98.6)
χ²		6.30	221.38	1.36
P		0.01	0.00	0.24

表5 两组患者平均住院时间及各项费用比较(±s)

Table 5 Comparison of mean hospital days and all the expenses of patients of two groups (±s)

组别	n	住院时间(d)	抗菌药物费用（元）	药品总费用（元）	住院总费用（元）
未干预组	136	4.88±1.02	2 478.81±23.26	4 961.17±29.35	10 574.59±78.32
干预组	145	5.08±1.01	135.71±5.39	2 955.22±20.06	8 627.09±48.85
t		1.60	28.99	5.10	4.23
P		0.11	0.00	0.00	0.00

表5 两组患者平均住院时间及各项费用比较(±s)

Table 5 Comparison of mean hospital days and all the expenses of patients of two groups (±s)

组别	n	住院时间(d)	抗菌药物费用（元）	药品总费用（元）	住院总费用（元）
未干预组	136	4.88±1.02	2 478.81±23.26	4 961.17±29.35	10 574.59±78.32
干预组	145	5.08±1.01	135.71±5.39	2 955.22±20.06	8 627.09±48.85
t		1.60	28.99	5.10	4.23
P		0.11	0.00	0.00	0.00

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