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Gæðaeftirlit með sýklalyfjaávísunum á Landspítalanum

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Authors
Gunnar Gunnarsson
Rannveig Einarsdóttir
Sigurður Guðmundsson
Sigurður B. Þorsteinsson
Issue Date
1998-04-01

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Other Titles
Analysis of antibiotic utilization review at Landspitalinn, the University Hospital in Iceland
Citation
Læknablaðið 1998, 84(4):277-81
Abstract
Objective: To describe the application of and analyze the cost effects of antibiotic utilization review at Landspitalinn, the National University Hospital in Iceland, and review the use of prophylactic antibiotics in a general surgical ward. Material and methods: The study was undertaken during a two month period in 1996. Patients in wards 11-A and 11-B (general medical floors), ward 12-G (general surgery service) and 11-E (hematology service) were enrolled. A specialist in infectious diseases and a clinical pharmacist reviewed the antibiotic treatment daily. If felt appropriate a recommendation to change treatment was forwarded. The number of patients treated with antibiotics, recommendations, recommendations accepted, and types of suggestions were recorded. Minimal savings per day were calculated by subtracting the cost of the antibiotic treatment after recommended modifications from the cost of the previous treatment. Prophylactic surgical treatment was examined in ward 12-G during an additional month. Results: One hundred and fifty patients were treated with antibiotics during January and February 1996. The percentage of cases where changes in antibiotic treatment was recommended was 74% in 12-G, 65% in 11-E but 33% and 32% in 11-A and 11-B respectively. In ward 11-E, 80% of the recommendations were accepted and appropriate changes made, corresponding figures for the other wards were 93-100%. The most frequently recommended changes were stopping antibiotics (33%), reducing doses (31%) and switching to oral agents (19%). The minimum savings were estimated at ISK 210 000 per month if the effects of recommendations that were accepted were presumed to have lasted three days. Four percent of prescribed prophylactic surgical treatment was according to approved standards. Conclusions: The results confirm the need to optimize the use of antibiotics at The National University Hospital. The antibiotic utilization review was well received and acceptance of recommendations was high. The application of antibiotic utilization review to the entire hospital could reduce antibiotic cost by as much as 30-36%.
Markmið: Að gera grein fyrir framkvæmd og kanna kostnaðaráhrif sýklalyfjaeftirlits á Landspítalanum. Einnig var könnuð notkun sýklalyfja í varnandi skyni á skurðdeild. Efniviður og aðferðir: Rannsóknin var framkvæmd í janúar til mars 1996. Fylgst var með sýklalyfjameðferð hjá sjúklingum á deild-um 11-A og 11-B (almennar lyflækningadeildir), 12-G (almenn handlækningadeild) og 11-E (blóðfræðideild). Sérfræðingur í smitsjúkdómum og klínískur lyfjafræðingur fóru yfir sýklalyfjameðferðina daglega. Ef ástæða þótti til var lögð fram ráðlegging um breytingu á sýklalyfjameðferð. Læknar sjúklings ákváðu hvort ráðleggingum var fylgt. Skráður var fjöldi sjúklinga á sýklalyfjum, fjöldi ráðlegginga, eðli þeirra og hlutfall sem var fylgt. Lágmarkssparnaður var fundinn með því að draga kostnað við sýklalyfjameðferð eftir breytingu frá kostnaði fyrir breytingu. Skráð var varnandi sýklalyfjameðferð sem beitt var á deild 12-G í mars 1996 og hún borin saman við samþykktar leiðbeiningar um slíka meðferð í lyfjalista Landspítalans.Niðurstöður: Eitthundrað og fimmtíu sjúklingar voru meðhöndlaðir með sýklalyfjum í janúar og febrúar 1996. Hlutfall ráðlegginga um breytingu á meðferð var 74% á deild 12-G, 65% á 11-E en 33% og 32% á 11-A og 11-B. Fylgt var 80% ráðlegginga á deild 11-E en 93-100% á öðrum deildum. Algengustu ástæður ráðlegginga um breytingar á sýklalyfjameðferð voru: stöðvun meðferðar (33%), lækkun skammta (31%) og breytingar á meðferð úr stungulyfi í meðferð um munn (19%). Lágmarkssparnaður var metinn 70-210.000 krónur á mánuði ef reiknað var með að ráðleggingar hefðu áhrif í einn til þrjá daga. í mars voru 4% varnandi meðferðar fyrir skurðaðgerðir á deild 12-G í samræmi við samþykktar leiðbeiningar. Ályktanir: Niðurstöður okkar styðja nauðsyn þess að bæta sýklalyfjameðferð á Landspítalanum. Sýklalyfjaeftirliti var vel tekið og ráðleggingum fylgt í 80-100% tilvika. Eftirlit með sýklalyfjanotkun á Landspítalanum öllum gæti leitt til sparnaðar sem næmi allt að 30-36% sýklalyfjakostnaðar.
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