急诊病房抗生素应用的临床审查(英文教学)Clinical Audit of the Use of Antibiotics in Acute Medical Wards方案说明.ppt

Clinical Audit of the Use of Antibiotics in Acute Medical Wards Dr. Chan Kai Ming Microbiology / Infectious Disease Team Department of Pathology / Department of Medicine Geriatrics Tuen Mun Hospital Background Appropriateness in use of antibiotics directly affect the quality of care of patients. Patient care Morbidity Mortality Restriction in use Minimization of emergence of resistant strains Objectives Audit the use of antibiotics in the following aspects Initiation of the use of antibiotics Choice of initial subsequent antibiotics Duration of antibiotics Dose of antibiotics Route of administration Standards No international set criteria available for reference. Ideal situation 100% appropriateness in the antibiotic use for all patients Set standard 80% Criteria for appropriate choice of antibiotics Prescription of antibiotics in accordance to available guidelines Depends on diagnosis made Good guess of possible pathogen Change of antibiotics according to microbiological results Culture result Serological test etc. Criteria for appropriate choice of antibiotics Change of antibiotics according to clinical progress Suboptimal response to current antibiotics therapy Individual Allergy to antibiotics Criteria for appropriate duration/ dosage/ route of administration of antibiotics According to guidelines According to clinical progress According to pharmacokinetic/ pharmacodynamic properties Data collection and analysis Objective observation on the management of patients. Period – 7th July 2004 to 12th July 2004 All acute admission to one male ward and one female ward Daily assessment done on the management of individual patient till discharge, transferred out or a maximum duration of seven days Three steps Initiation of antibiotics Choice of antibiotics Duration/ dosage/ route of administration of antibiotics 106 admissions, 4 missing 102 59 given antibiotics I 5 (8.5%) Not appropriate 54 C 7 (14.8%) Not appropriate 47 R,D,D 8 (15.2%) Not appropriate I: Indica