某醫學中心外科手術預防性抗生素非計畫性使用原因分析及改善

An Analysis of Unscheduled Prophylactic Antibiotic Administration in Surgical Procedure and Improvement in a Medical Center

本研究目的在於探討外科手術預防性抗生素非計畫性使用情形，分析其發生原因，並研擬改善對策，經實施後統計其改善情形。研究設計以醫院2006年7至12月健保規範六大類清淨手術項目為措施介入前組，凡未正確使用之手術（抗生素使用天數大於一天者），蒐集與整理，各科的不同醫師其使用抗生素不正確率是有所不同，也就是在同樣多項手術、同樣傷□等級，不同醫師其使用情形亦有所不同。再經由直接教育介入及訪談等改善措施，進行追蹤。研究先排除非預防性抗生素使用情形，並以2007年1至6月為措施介入後組做比較。研究發現措施介入前1,424例中，不正確使用為146例，不正確使用率為10.396，改善後之實驗組1,151例中不正確使用為60例，不正確使用率為5.2%，措施介入後之不正確使用率顯著較措施介入前低。故研究建議，分析非計畫性抗生素原因，除應廣泛性宣導外，並應依個別差異進行分析，尋找不正確使用理由，並研擬對策，積極性教育介入方式，方可有效改善不正確使用預防性抗生素情形。

The purpose of this study was to evaluate the appropriateness of prophylactic use of antibiotic and to identify the factors associated with unscheduled administration of prophylactic antibiotics in the surgical procedures organized by the health insurance company from July to December 2006. The data revealed that unscheduled administration of prophylactic antibiotics was a frequent occurrence in surgeries with high wound grade and in multiple surgeries. However, physicians had different rates of unscheduled administration for the treatment of the same wound grade and multiple surgeries. We conducted an educational intervention for the physicians who had high rates of unscheduled administration and collected the data for administration after the intervention. The rate of unscheduled administration of prophylactic antibiotics declined from 10.3% to 5.2% after the intervention. The reasons for unscheduled administration of prophylactic antibiotics were also listed. The most common reason was that the surgeon was concerned about the possibility of postoperative wound infection. The other reasons included inappropriate use of antibiotics by residents etc. The results of the study suggest that physicians who have high rates of unscheduled administration of prophylactic antibiotics must undergo educational intervention.