手術前注射預防性抗生素之改善方案

Interventions to Improve the Timely Administration of Preoperative Antibiotics

本專案目的乃評估介入措施是否能改善手術前注射預防性抗生素時間之正確率，建立持續監測品管指標，進而提升預防性抗生素的使用效益。本院於2004年針對TQIP之監測項目，調查闌尾切除術、全髖關節置換術、全膝關節置換術、經腹部全子宮切除術及經陰道全子宮切除術五項術式，發現於劃刀前30~60分鐘預防性抗生素注射的正確率只有19.2%。分析原因為送出單位完成注射、流動護士太早叫入下一位手術病患及病患在進入急診即注射抗生素，經手術前準備到劃刀時已超過60分鐘(注射時間太早)，其次為外科醫師認為不需要注射(未執行預防性抗生素)，最後則為送出單位之護理人員忘記執行醫囑，轉由手術室護理人員注射(注射時間太晚)。2005年10月執行改善措施：1.修正手術前預防性抗生素注射流程；2.感染管控專科舉辦全院性在職教育；3.制定預防性抗生素使用規範；4.建立『預防性抗生素使用管理系統』後，調查75例病患之注射時間，未符合僅12例，顯示本專案能有效將手術前預防性抗生素注射時間之正確率由19.2%升為84%。

The aim of this study is to evaluate if our interventions can improve the timely administration ofpreoperative antibiotics thereby maximize the benefits of prophylactic antibiotics. Assessing thecompliance with current recommendation for surgical antibiotic prophylaxis from the database ofthe TQIP (Total Quality Improvement Plan) surveillance system of KMHK in 2004, we found thatthe timely administration of antibiotics, which should be given within 60 minutes prior to surgicalincision among patients undergoing appendectomy, total knee or hip replacement, and hysterectomywas only 19.2%. The leading cause of failure to administer antibiotics in a timely fashion waspatients'receiving antibiotics too early in the inpatient ward. Surgeons'reluctance to use preoperativeantibiotics, operating room nurses sending the patients to preoperative waiting area too early orgiving therapeutic antibiotics in emergency department resulting in omission of a prophylactic doseprior to surgery were among others. To address these problems, the following interventions included1) setup of an antibiotic administration protocol, 2) education program by subspecialists ofinfection disease, 3) establishment of a guideline, and 4) use of computerized monitoring systemwere implemented from October 2005. ThroughDecember 2005, 75 patients underwent the abovementionedsurgeries, with 12 without appropriate preoperative antibiotics. Timely administration ofpreoperative antibiotics improved from 19.2% to 84%. The study shows that our interventionsfacilitate appropriate preoperative antibiotics use.