Research On Drug Utilization For Orthopedic Patients In Our Hospital

Objective:The purpose of this study was to investigate the current situation and developing trend of drug utilization of the orthopedic department in our hospital for three consecutive years, evaluate drug utilization for orthopedic patients receiving antibiotics and anticoagulants,and analyze the influencing factors of inappropriate utilization, in order to offer the scientific basis for safe, effective and economical drug utilization,and promote the rational use of drugs.Methods:1. Drugs used in orthopedic patients from2009to2011were analyzed with the methods of amount of sorting, DDDs and statistical description.2. We selected the cases of orthopedic surgery patients by simple random sampling in September2010to August2011, and a retrospective review was conducted to assess the appropriateness of antibiotics prescribing.3. We selected the cases undergoing major orthopedic surgery in September2008to August2011, and a retrospective review was conducted to assess the appropriateness of anticoagulants prescribing.4. SPSS(version16.0)was used for statistical analyses.Unconditional logistic regression analysis was used to analyze the influencing factors of inappropriate drug utilization.Results:1. The drugs on the number of varieties were roughly equal from the year2009to2011. The consumption proportion of anti-infective drugs was much higher than other drugs (for three consecutive years were61.28%,56.64%,25.23%respectively), followed by digestive system drugs (for three consecutive years were9.06%,9.61%,16.48%respectively); The annual growth rate of the consumption of anti-infective drugs were19.14%,-63.88%respectively; and the annual growth rate of the consumption of digestive system drugs were36.80%,38.93%respectively.2. The utilization ratio of antimicrobial drugs was99.58%among the1200patients undergoing orthopedic surgery, and the rate of prophylaxis was90.58%.The irrational use of antimicrobial drug prescriptions accounted for82.76%of investigation cases, and the irrational prophylaxis ratio was89.05%, irrational drug treatment ratio was19.44%.3. The unreasonable form of prophylaxis of antibiotics:no indication for drug utilization(11.22%), choice of drug on the high starting point (16.37%),inappropriate types of drug selection(23.83%), more than2hours preoperative administration (26.22%), postoperative administration (4.66%), unadditional administration when the operative time is more than3hours or bleeding is more than1500ml surgery (7.36%),over the dosage (24.15%), long treatment (51.50%), no indication for joint-medication (31.50%). The unreasonable form of therapeutic use of antibiotics:frequently change the drug with no indication (7.41%) long treatment (15.74%)4. Multivariate unconditional logistic regression was used to analyze the relevant factors for the inappropriate use of antimicrobial agents, those factors enter the regression equation:length of stay, type of incision, surgical grade, the number of varieties of antimicrobial agents using, medication purpose.5. Low molecular weight heparin, fondaparinux sodium and rivaroxaban were used in581patients who undergoing major orthopedic surgery in our hospital, the rate of anticoagulants utilization was75.22%. Before the publication of guideline of venous thromboembolism prevention after major orthopedic surgery in china, the anticoagulants utilization ratio was26.21%, but85.77%after the publication.6. Among the anticoagulants utilization after major orthopedic surgery, the incorrect timing of the administration accounted for20.37%, the unreasonable dosing course accounted for50.34%.Conclusion:1. The most consumption were anti-infective drugs, and followed by digestive drugs in orthopedic patients of our hospital from2009to2011. The amount of consumption of anti-infective drugs increased in2010, and decreased significantly in2011.The amount of digestive system drugs was growing year by year.2. Most of patients undergoing orthopedic surgery using antimicrobial agents were for prevention, irrational antimicrobial agents utilization still existed with high ratio.3. Multivariate unconditional logistic regression analysis showed that the long hospital stay, more varieties of antimicrobial drug use, clean surgery,no major surgery, and prophylaxis were the risk factors leading to irrational drug use.4. After the publication of guideline of venous thromboembolism prevention after major orthopedic surgery in china, anticoagulants utilization preventing VTE after major orthopedic surgery has been used widely, there was certain irrationality in the administration of the timing and dosing regimen.5. There was a certain phenomenon of irrational drug utilization in orthopedic ward of the hospital, related education and training should be strengthened,and the guideline of rational drug utilization should be improved,emphasising on the value of clinical pharmacist, and strengthening clinical pharmacy guidance to promote the irrational use of medicine.