Domestic should improve antimicrobial drug management

The three-year national special campaign for the clinical application of antibacterial drugs has entered a consolidation phase.

Over the past year or so since the rectification activities were carried out, health administrative departments and medical institutions at all levels have attached great importance, and medical institutions have now established relatively complete systems for the clinical application and management of antibacterial drugs.

In conjunction with its own reality, targeted implementation programs have emerged in various places. For example, the Shanghai Municipal Health Bureau has formulated the “Guidelines for the Guiding Principles of Clinical Application of Antibacterial Drugs in Shanghai” and the Catalogue of Classified Management of Antimicrobial Drugs, and details the special remediation of antibacterial drugs. The work plan strengthens the clinical application of antibacterial drugs and the monitoring of bacterial drug resistance; in another example, Jiangsu Province, in conjunction with the actual situation of the province, formulated the “Guidelines for the selection and classification of 50 antibacterial drugs in tertiary hospitals in Jiangsu Province” and “Antibacterial drugs for hospitals in Jiangsu Province. "Guidelines for the Guiding Opinions on the Construction of Clinical Application Management System" and other documents specifically guide the medical institutions to do a good job in the clinical remediation of antibacterial drugs.

At this critical time, the hospital's internal control requirements became more prominent.

From the feedback of the recently completed 2012 special rectification activities, the improvement effect will be continuously improved as an important indicator for the promotion of deans and department directors. In the future, the antibacterial activities should be further implemented and promoted. Reasonable use of drugs, information construction, without delay.

Information construction is lagging behind

The “2012 National Special Program for Clinical Application of Antimicrobial Remediation Program” (hereinafter referred to as “the Program”) was reissued in March of this year and emphasized again that it is necessary to “strictly implement the classification management system for antibiotics”.

The "plan" requires medical institutions to clarify the directory of antibacterial drug grade management of this institution, strictly limit the right to prescribe antibacterial drugs at different management levels, clarify the prescription authority for the use of antibacterial drugs at all levels of doctors, and take effective measures to ensure the implementation of a hierarchical management system. To eliminate the phenomenon of doctors violating regulations.

In accordance with the Guiding Principles for the Clinical Application of Antibacterial Drugs and related regulations, all antibacterial drugs are classified into “non-restricted use class,” “restricted use class,” and “special use class,” and limited access to different classes of antimicrobial agents. After the clinical application of antibacterial drugs training and qualified qualified doctors prescribe the right to prescribe.

The supervision results in Shandong, Henan, and Ningxia show that at present, most hospitals can set the authority of antibacterial prescriptions for different doctors through the Hospital Information System (hereinafter referred to as the “HIS system”). Through the HIS system, the hospital records the ID number and password, and doctors need to check and confirm promptly, limit and monitor the doctor's permission. The pharmacist of the drugstore can maintain the dynamic changes of the types of antimicrobial drugs that can be used in actual procurement.

At the same time, the implementation of antibacterial drug prescription review system is also the main content of this year's rectification work.

The "Proposal" proposes that every month, the organization will review 25% of the prescriptions and doctor's orders issued by doctors with prescribing rights to antibacterial drugs. Each physician shall have no less than 50 prescriptions and orders, and focus on spotting infections, surgery, and respiratory diseases. Clinical departments such as intensive medicine and cases of type I incision surgery and interventional treatment.

"Because of the enormous workload of prescription reviews, many hospitals will find it difficult to implement without an information system," said Tong Rongsheng, director of the pharmacy department at Sichuan Provincial People's Hospital.

Coincidentally. Yang Yuehui, director of the pharmacy department of China Medical University's affiliated Shengji Hospital, who has participated in special rectification activities for two consecutive years, also stated: “These requests for prescription comments may not be possible without a reasonable information system. I participated in the inspection this year. In nearly 20 hospitals, only about 1 hospital can do it."

It is understood that in this year's special rectification supervision work, the "information construction system" has a score of 15 points, including "to achieve the electronic management of physicians antibacterial drug prescription rights and pharmacist antibiotic prescription adjustment qualification", "to achieve electronic "Antibacterial drug prescription reviews", "statistics of the use of antibiotics in hospitalized patients", "statistics and ranking of antibacterial drug use intensity in hospitalized patients" and other 15 items.

However, the survey results show that the information construction of many hospitals is lagging behind.

Linked with assessment

In addition, the rational appraisal results of clinical application of antibacterial drugs will serve as an important content for promotion of professional titles, appraisal, periodic assessment, income distribution, and performance appraisal, and serve as an examination of “basic status of clinical application of antimicrobial drugs”. Content, a score of 1 point.

The supervision team will review the documents, the system, and the work records of the working group or other related records of the hospital. "And, the key is to have specific implementation methods." Tong Rongsheng stressed.

According to Tong Rongsheng, specific implementation measures and measures are mainly reflected in the promotion of professional titles, appraisals, annual assessments, bonus distribution, performance appraisal, prescription authority, hospital recognition, and economic penalties. There must be at least two of these.

The Second Hospital of Shandong University is one of the resolute practitioners of this policy.

It is understood that in 2011, the hospital incorporated antibacterial drug use into the program for regular physician assessments. The rational use of antibiotics was used as a regular assessment by physicians and quantified. This was linked to promotion of professional titles and evaluation .

At the same time, the hospital also has a relatively clear method of performance assessment: For example, according to the index of antibacterial drug use rate of hospitalized patients in clinical departments, the clinical utilization rate of antibacterial drugs in hospitalized patients is reduced by 1%, and the awarding department or medical team will receive 500 yuan. If the use rate of antibiotics in hospitalized patients exceeds 1%, 500 yuan will be deducted from the department or medical team. Other relevant indicators are clearly defined.

In addition, the supervision plan also requires that doctors who have apparently irrational use of drugs be criticized and educated, talked about, or punished accordingly.

In this regard, Tong Rongsheng said: "Hospitals need to use effective methods or measures, such as prescription reviews or dynamic monitoring, to find unreasonable physicians. Interventions are necessary for doctors who are obviously irrational in drug use. It can be seen that this inspection requires more Finer."

Take Xi'an Fourth Hospital Disciplinary Committee as an example.

The hospital monthly ranked the top 10 antibacterial drugs sold by the hospital and various departments in the statistical ranking, analysis of antibacterial drug use trends, and together with the pharmacy department to evaluate it, the abnormal increase in the use of antibacterial drugs, the amount of use For the first three months in a row for three consecutive months and there are irrational clinical applications, the purchase or withdrawal will be halved in the next month. For those who have failed to meet the standard for three consecutive months or have not significantly improved, and three consecutive visits Physicians who use antibiotics unreasonably at the hospital’s weekly briefings conducted talks and conducted strict rewards and punishments for departments and individuals.

In the future, it is imperative to further implement and promote the rational use of antibacterials and information construction.