Clinical audit on the use of expensive systemic antifungals in the Besancon University Hospital
Clinical audit on the use of expensive systemic antifungals in the Besancon University Hospital
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DOI：
10.1016/j.medmal.2008.09.028
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发表时间：
2009-02-01
影响因子：
5
通讯作者：
Leroy, J.
中科院分区：
文献类型：
--
作者：
Raymond, S.;Henon, T.;Leroy, J.
医疗质量的持续改进政策需要实践评估。临床审计的原则是将实践与指南进行比较。自2003年以来，我院已制定了抗真菌药物使用处方指南。它于2005年和2006年更新。- 本研究的目的是评估对指南的依从性，并对处方进行审核：阿替西霉素B脂质制剂、伏立康唑和卡泊芬净，这些昂贵的抗真菌药与活动相关的预算津贴有关。受补充报销的编码同质类疾病。- 评估标准为：适应症的相关性、没有更好的替代品、符合推荐剂量、负荷剂量和时间。本次回顾性研究涉及所有科室的所有处方。2007年1月至5月，成绩。- 对81例患者的118张处方进行回顾性分析。总体符合率为54%。抗真菌治疗是合理的113处方（96%）。在30%的情况下，建议使用更有效、更便宜或毒性更小的替代品。剂量正确率为92%，电荷闭合正确率为80%。- 这次审计有助于评估抗真菌药的良好使用情况。我们发现卡泊芬净处方过量，有时伏立康唑剂量不足的儿童方案。报告这些审计结果和制定新的国际准则强调需要定期更新地方建议。(C)2008年，Elsevier Masson SAS。图斯所有权保留。
The continuous improvement policy for healthcare quality requires practice evaluation. The principle of a clinical audit is to compare practice to guidelines. Prescription guidelines on antifungal agent use has been available in our hospital since 2003. It Was updated in 2005 and 2006.Objective. - The aim of this study was to assess compliance to guidelines, with an audit of prescriptions: amphotericin B lipid formulation, voriconazole and caspofungin, expensive antifungals concerned by the budget allowance correlated to activity. subject to supplementary reimbursement to the coded Homogeneous Group of Diseases.Method. - The assessment criteria were: relevance of the indication, absence of a better alternative, complying to recommended dosage, loading dose and timing. This retrospective study dealt with all prescriptions of all departments. from January to May 2007.Results. - Hundred and eighteen prescriptions were retrospectively analyzed for 81 patients. The rate of overall conformity was 54%. Antifungal therapy was justified for 113 prescriptions (96%). In 30% of the cases, a more efficient alternative was advised, cheaper or less toxic. The dosage and the charge closing were right in 92% and 80% of the cases respectively.Conclusion. -This audit allowed assessing good-use of antifungals. We showed an over-prescription of caspofungin and sometimes insufficient regimen of voriconazole dosages for children. Reporting these audit results and development of new international guidelines stress the need to update local recommendations regularly. (C) 2008 Elsevier Masson SAS. Tous droits reserves.