广西中医药大学抗菌药物临床应用的原则与策略课件.ppt

* Passive education of healthcare personnel is probably the least effective strategy for improving antimicrobial use, but does have some impact. Strategies designed to limit use, including antimicrobial order forms, formulary restrictions, and approval systems, can be successful, but only if resources are applied to ensure oversight and response. Automatic pharmacy substitution of one similar drug for another or from one route of administration to another (e.g. IV to oral) can be highly successful in reducing costs, but is not always acceptable to clinicians. Multidisciplinary drug utilization evaluation is an approach favored in institutions that have successfully engaged the appropriate professionals in the process, but does require up-front personnel resources to have maximum cost-effectiveness. Interactive provider education is also a successful approach that is gaining acceptance as experience evolves. Performance feedback can be a powerful tool for improving antimicrobial prescribing patterns. This method is more likely to be acceptable when utilization in a unit is compared over time or to a benchmark; provider-specific performance feedback can be successfully implemented if initial resistance is overcome. Computerized decision support is likely to be the best long-term approach for improving antimicrobial use. * In this study of patients admitted to a community hospital in Salt Lake City, Utah, computer-assisted decision support was successfully employed to guide antimicrobial treatment. Over a 7-year period of time after the system was implemented, the acuity of patients admitted to the hospital increased. However, hospital mortality, antimicrobial treatment costs per patient, and adverse drug events declined. The proportion of patients who received a properly-timed preoperative prophylactic antimicrobial increased dramatically. Overall, patterns of antimicrobial resistance were stable over the 7-year study period. * * (七)外科手术预防用药常见错误 1.未掌握外科手术预防用药指