預防性抗生素的使用分析調查

Survey of Prophylactic Antibiotics Usage in a Local Hospital

台北市某地區醫院97年第三季清淨手術抗生素小於1日使用率低於健保稽核目標 值，乃由醫院業管單位介入調查。取得研究醫院97年7月至9月所有清淨手術之名單， 共計樣本67件，採回溯性病歷資料分析調查；樣本定義依據健保指標VPN代號：36， 案件分類為2，且DRG碼為0163A、0163B、0209A、0209B、0290A、0471A。發現合 乎定義科別為骨科、泌尿外科及一般外科，資料收集後以描述性統計、卡方檢定及單 因子變異數分析進行統計分析，統計軟體為SPSS15.0。研究結果發現：影響醫師使用 預防性抗生素天數的因素為：住院科別、用藥方式及醫師別。經由行政措施制定標 準化流程後，健保審查品質監測指標依規定目標值≧35%需達權重16分，本次達成18 分。

The frequency of usage Prophylactic antibiotics in a local hospital in Taipei was noted to be lower than the standards set by the Bureau of National Health Insurance (BNHI). This has resulted in alteration in the payment point system given to the involved hospital. Because of this, a retrospective study was done. The medical records of 67 patients who had undergone elective surgery and were given pre-operative antibiotics from July to September of 2008 were reviewed. The cases involved are within the BNHI VPN code no.36 and DRG numbers 0163A, 0163B, 0209A, 0209B, and 0471A. The hospital services involved were urology, orthopedic surgery and general surgery. Data analyses were subjected to Chi-square and one-way ANOVA method. SPSS15.0 software was used for analysis. There were significant differences in the number of days of antibiotic used and admission department, level of deepness of anesthesia, and physician specialty. There were no wound infection seen in all the cases and was not related to the duration of use of antibiotics and medical specialty. The results will be submitted to the administrators and hopefully the BNHI will raise the points to 41% in the fourth quarter.