某三甲医院头孢菌素取消常规皮试后的使用情况及影响因素分析

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摘要目的：确定“取消头孢菌素常规皮试”政策对住院头孢菌素使用的影响,探讨影响其使用的因素,为该项工作的的可持续推进提供参考依据。方法：统计并分析2020年6―9月和2021年6―9月头孢菌素使用情况。通过临床药学部向院内各临床科室发出调查问卷,调查医生、护士、药师对取消头孢菌素常规皮试政策的态度与落实。结果：取消皮试后,头孢菌素的使用数量较前显著下降,且总抗菌药物使用强度（DDDs）占比减少（25.24%vs 24.41%）。被调研的医务工作者总计328人,医师、护士和药师分别占26.83%、63.72%、9.45%。知晓医院实施“取消头孢菌素常规皮试”的政策仅占41.46%,51.23%调查对象支持“取消头孢菌素常规皮试”。不支持的原因主要（53.96%）是“皮试是评估患者对头孢菌素是否过敏的有效筛选手段”。单因素卡方检验显示对于“取消常规皮试后,是否仍会给患者进行皮试?”,各因素（包括性别、年龄、最高学历、科室、工作年限）均无显著差异。81.71%认为头孢菌素过敏史最常见的描述是皮试阳性,会因既往头孢菌素皮试阳性而规避使用的占80.49%。护士对于头孢菌素皮试液的配置、操作方法及结果的判读正确率占比分别为35.58%、3.37%、75.00%,且单因素卡方检验显示科室有显著差异,职称为正确“配置头孢菌素皮试液的方法”的主要影响因素。结论：该院取消常规头孢菌素皮试后,仍会常规皮试或减少使用头孢菌素。考虑与医务工作者对于头孢菌素皮试的相关知识仍存在较多误区等原因密切相关。临床药师应积极与临床加强沟通、培训,消除医务工作者的顾虑。在临床医护、信息系统的协助下,共同促进政策的落实与推广。

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	彭敏
	潘勇
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	李威
	邓银华

关键词：头孢菌素,皮试,使用情况,影响因素

Abstract：ObjectiveA questionnaire survey was used to evaluate the knowledge of medical staff in a certain hospital on cephalosporin skin test, to determine the impact of the policy of “phasing out cephalosporin skin test “ on the use of inpatient cephalosporins, and to provide reference for the sustainable advancement of this work.MethodsStatistics and analysis of cephalosporin use in June-September 2020 and June-September 2021. A quesionnaire was distributed to each clinical department by the clinical pharmacy department in the hospital to investigate the attitudes of doctors, nurses and pharmacists to cancel the routine skin test of cephalosporin and the corresponding countermeasures.ResultsAfter the skin test was cancelled, the amount of cephalosporins was significantly decreased, and the proportion of total defined daily doses (DDDs) decreased (25.24%vs 24.41%). A total of 328 medical workers were surveyed, and doctors, nurses and pharmacists accounted for 26.83%, 63.72%, and 9.45%, respectively. Only 41.46% knew that the hospital implemented the policy of “phasing out cephalosporin skin test”, and 51.23% of the respondents supported “phasing out cephalosporin skin test”. The main reason for disapproval (53.96%) is that “skin test is an effective screening method to assess whether patients are allergic to cephalosporins”. The univariate chi-square test showed that there was no significant difference in each factor (including gender, age, highest education, department, and working years) for “after canceling the routine skin test, will the patient still be given a skin test?”.81.71% thought that the most common description of the history of cephalosporin allergy was a positive skin test, and 80.49% would avoid the use of cephalosporin because of a positive skin test in the past. Nurses' correct interpretation of the configuration, operation method and results of the cephalosporin skin test solution accounted for 35.58%, 3.37%, and 75.00%, respectively, and the univariate chi-square test showed that there were significant differences between departments. The main influencing factors for the correct “method of preparing cephalosporin skin test solution”.ConclusionThere are still many misunderstandings about the knowledge of cephalosporin skin test among medical workers in this hospital, and after the cancellation of routine cephalosporin skin test, routine skin test is still performed or the use of cephalosporin antibiotics is reduced. Clinical pharmacists should actively respond to national policies, strengthen communication and training with clinical clinics, and eliminate the concerns of medical workers. With the assistance of clinical medical care and information systems, we will jointly promote the implementation and promotion of policies.

Key words：cephalosporins skin test usage analysis influencing factors

收稿日期:2023-06-12

中图分类号:

R978.1

基金资助:湖南省自然科学基金资助项目（2020JJ4420）; 湖南省自然科学基金资助项目（2023JJ60462）

通讯作者:邓银华,E-mail：dengyinhua@sina.com

引用本文:

彭敏, 潘勇, 戴迎春, 陈丽, 颜笑, 李威, 邓银华. 某三甲医院头孢菌素取消常规皮试后的使用情况及影响因素分析[J]. 金宝搏官方188学报(医学版), 2023, 20(5): 132-138. PENG Min, PAN Yong, DAI Yingchun, CHEN Li, YAN Xiao, LI Wei, Deng Yinhua. Analysis of the use and influencing factors of cephalosporins after the routine skin test was cancelled in a tertiary hospital. HuNan ShiFan DaXue XueBao(YiXueBan), 2023, 20(5): 132-138.

链接本文:

http://yxb.hunnu.edu.cn/CN/或http://yxb.hunnu.edu.cn/CN/Y2023/V20/I5/132

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