中国临床药学杂志

目的 探讨骨科抗菌药物一体化闭环药学服务模式改善骨科抗菌药物合理使用情况的效果。方法 建立事前、事中和事后的骨科抗菌药物一体化闭环药学服务模式，收集该模式实施前（2020年）和实施后（2021至2023年）的骨科抗菌药物使用数据和医嘱等信息，比较实施前后骨科合理用药相关指标（不合理医嘱、抗菌药物用药频度、抗菌药物使用前送检率、抗菌药物使用率、药品费用）和干预建议接受情况。结果 2021至2023年药师共审核医嘱109 756条，干预医嘱24 472条，减少抗菌药物使用4 520次，药师提出干预建议的医嘱数量呈逐年上升趋势。骨科抗菌药物用药频度基本呈逐年下降趋势，从2020年的每百人每日33.8下降到2023年每百人每日32.0。合理用药相关各项指标持续改善，Ⅰ类切口手术抗菌药物预防性使用率从2020年的65.1%下降到2023年的22.4%。结论 骨科抗菌药物一体化闭环药学服务模式能够降低骨科抗菌药物使用强度，提高骨科抗菌药物合理用药水平。

AIM To explore the impact of the integrated closed-loop pharmacy service model for antimicrobial drugs on improving rational drug use in orthopedics. METHODS A closed-loop pharmacy service model for orthopedic antibacterial drugs was established, integrating the pre-event, in-event, and post-event stages. Data on the usage of orthopedic antimicrobial drugs and physician orders were collected both before(2020) and after(January 2021-December2023) the implementation. Indicators such as drug use intensity and rational drug use metrics, including irrational orders, antimicrobial drug use frequency, pre-use testing rates, usage rates, average costs, and acceptance of intervention suggestions, were compared before and after the implementation. RESULTS From 2021 to 2023, pharmacists reviewed a total of 109 756 medical prescriptions, and retorted 24 472 medical prescriptions, reducing 4 520 instances of antimicrobial drug use. The number of prescriptions for which intervention suggestions were proposed by pharmacists showed an increasing trend over the years. The defined daily doses of antimicrobial drug in the orthopedic department of the hospital had been decreasing, from 33.8 per hundred people per day in 2020 to 32.0 per 100 people per day in 2023. The indicators of rational drug usage were continuously improved, specifically the percentage of prophylactic use of antimicrobial drugs for Class I incisions from 65.1% in 2020 to 22.4% in 2023. CONCLUSION The integrated closed-loop pharmacy service has been promoted to decrease the use of antibiotics practices and rationalize the use of orthopedic antimicrobial drugs.