某醫學中心手術病患術前預防性抗生素正確投藥與改善研究

Improvement in Prophylactic Antibiotics Administration in Surgical Operations: Experiences in a Medical Center

古雪鈴(Shei-Ling Ku) ； 張月霞(Yueh-Hsia Chang) ； 張清鋒(Chin-Fong Chang) ； 王拔群(Pa-Chun Wang) ； 陳雅惠(Ya-Hui Chen)

《輔仁醫學期刊》 3卷2期 (2005/06) Pp. 57-62

摘要

手術部位感染會延長病人的住院天數、增加醫療費用，甚至造成病人的死亡。研究證明；正確使用手術前預防性抗生素，對於降低手術部位的感染具有正面的效果。本改善專案旨在提升手術病患預防性抗生素於劃刀前15至30分正確投與比率，以降低手術傷口感染機會。自2002年10月17日至11月20日止，利用手術室設計查檢表，查檢手術病患預防性抗生素投與情形，結果顯示預防性抗生素使用總共566件，其中只有124件於劃刀前15~30分投與，佔21.9%。分析其原因為1.工作人員認知不一（佔42.1%）2.術前準備時間不一（佔25.3%）；3.麻醉護士忘記給藥（佔17.6%）。經實施三個月之品質改善對策包括：加強工作人員在職教育訓練、訂定各科手術給藥時間標準流程、釐清給藥流程之責任歸屬、人員間重複再確認等後，劃刀前15-30分投與率已明顯改善，實施一年後持續追蹤評值，此比率提升至92.0%(523/571)，對於手術病患降低手術感染應有實質助益。

關鍵字

預防性抗生素 ； 正確投與 ； 品質改善

並列摘要

Surgical wound infection prolongs hospitalization, increases medical expenses, and even leads to patients' death. Many studies have proven the efficacy of using preventive antibiotics to control surgical wound infection. The objective of this project was to improve the timeliness of the preventive antibiotics administration rate (within 15~30 min prior to surgery) in our institute. From October 17 to November 20, 2002, we used a checklist to investigate improvements in the effectiveness of the timeliness of the preventive antibiotics administration rate. The preventive antibiotics administration rate was 21.9% (124/566) before implementation of the quality control method. The major underlying causes included a poor employee consensus (42.1%), inconsistent preoperative preparation times (25.3%), and negligence by anesthesia nurses (17.6%). Three months after implementation of the quality control measures (including education, standard procedural development, and process reengineering), the timeliness of the preventive antibiotics administration rate had attained a level of 92% (523/571) at 1 year after implementation of the quality control method.

並列關鍵字

prophylactic antibiotics ； administration ； quality improvement