以「突破系列模式」改善人工膝關節置換術預防性抗生素投與

Application of Breakthrough Series Model to Improve Prophylactic Antibiotics Administration for Total Knee Replacement

本研究目的包括：利用「突破系列模式」（Breakthrough Series Model, BTS）改善人工膝關節置換手術預防性抗生素投與之標準程序，並比較分析使用預防性抗生素投與者之給藥時間與住院日數、抗生素使用費用、手術傷口感染之關係。研究期間「改善前」自2006年7月1日至年9月30日止，「改善後」自2006年12月1日至2007年2月28日止。介入措施包括1.預防性抗生素投與標準程序之訂定2.教育訓練與宣導及工作人員間之溝通協調3.量測指標資料結果的即時回饋與分享等；結果顯示，「改善前」收案24人，平均給藥時間為劃刀前14.4±6.9分，「改善後」收案11人，平均給藥時間為劃刀前25.6±11.9分，呈現統計上差異。手術時間超過2-3小時追加第二劑者「改善前」為0%、「改善後」為63.6%。住院天數8.2±2.7 vs. 8.8±3.7天、抗生素總金額471.6±497.0 vs. 290.9±188.5元、術後使用≦24小時23（95.8%）vs. 11人（100.0%）、術後一個月傷口感染率改善前組為4.2%，改善後組為9.1%，但未達統計上差異。本研究利用「突破系列模式」進一步改善人工膝關節置換手術病人預防性抗生素投與的標準程序，使手術室醫護團隊人員在參與醫療處置工作的程序上有據可循，以確保手術病人的安全，並提供日後醫療品質改進參考依據。

This project used “Breakthrough series model (BTS)” to establish the standard of procedure (SOP) in antibiotics prophylaxis for total knee replacement (TKR). The objectives of this study are to compare the timing for antibiotics injection, length of hospital stay, antibiotics fee, and wound infection rates before (BEFORE Group) and after (AFTER Group) the implementation of quality improvement. The period of BEFORE group (N=24) spanned from July 1 to September 30, 2006; the period of AFTER group (N=11) spanned from December 1, 2006 to February 28, 2007. The interventions implemented were (1) the establishment of SOP in prophylactic antibiotics administration, (2) the education, promotion, and communication among healthcare workers, and (3) the real-time feedback and sharing of the data indicators. There was significant difference in the average antibiotics injection time before the start of operation (14.4±6.9 minutes for BEFORE group and 25.6±11.9 minutes for AFTER group). Supplementary doses for operations longer than 2-3 hrs were given to 63.6% of the AFTER group cases. There was no statistic difference in length of hospital stay (BEFORE vs. AFTER, 8.2±2.7 vs. 8.8±3.7 days), antibiotics fees (BEFORE vs. AFTER, 471.6±497.0 vs. 290.9±188.5 NT Dollars), and the case percentages of antibiotics used within 24 hrs after operations (BEFORE vs. AFTER, 95.8% vs. 100.0%). Short-term (within one month after operations) post-operative wound infection for BEFORE group was 4.2%, and AFTER group 9.1%, which also showed no statistic difference (p>0.05). This project successfully improves the SOP in antibiotics prophylaxis for TKR and also for the staff of operation room to follow through. We believe this provides guidelines for quality improvement and can further improve the safety of surgical patients.