Læknablaðið - 15.04.1998, Side 9

LÆKNABLAÐIÐ 1998; 84
277
Gæðaeftirlit með sýklalyfjaávísunum á
Landspítalanum
Gunnar Gunnarsson11, Rannveig Einarsdóttir21, Siguröur Guömundsson1’, Siguröur B. Þorsteinsson11
Gunnarsson G, Einarsdóttir R, Guðmundsson S,
Þorsteinsson SB
Analysis of Antibiotic Utilization Review at Land-
spítalinn, the University Hospital in Iceland
Læknablaðið 1998; 84: 277-81
Objective: To describe the application of and ana-
lyze the cost effects of antibiotic utilization review at
Landspítalinn, the National University Hospital in
Iceland, and review the use of prophylactic antibiot-
ics 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 ser-
vice) were enrolled. A specialist in infectious disea-
ses 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 calcu-
lated by subtracting the cost of the antibiotic treat-
ment after recommended modifications from the cost
of the previous treatment. Prophylactic surgical treat-
ment was examined in ward 12-G during an addi-
tional 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 respec-
tively. 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
Frá "lyflækningadeild og 2|apóteki Landspítalans. Fyrir-
spurnir, bréfaskipti: Gunnar Gunnarsson lyflækningadeild
Landspítalans, 101 Reykjavík. Netfang: gunnarbg@rsp.is
Lykilorð: sýklalyfjaeftirlit, varnandi meðferð fyrir skurðað-
gerð, kostnaðaráhrif.
(31%) and switching to oral agents (19%). The min-
imum 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 opti-
mize 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%.
Keywords: antibiotic utilization review, surgical prophy-
laxis, cost effects.
Ágrip
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-Aog 11-B (almennar lyflækningadeild-
ir), 12-G (almenn handlækningadeild) og 11-E
(blóðfræðideild). Sérfræðingur í smitsjúkdóm-
um og klínískur lyfjafræðingur fóru yfir sýkla-
lyfjameðferðina daglega. Ef ástæða þótti til var
lögð fram ráðlegging um breytingu á sýkla-
lyfjameðferð. Læknar sjúklings ákváðu hvort
ráðleggingum var fylgt. Skráður var fjöldi
sjúklinga á sýklalyfjum, fjöldi ráðlegginga,
eðli þeirra og hlutfall sem var fylgt. Lágmarks-
sparnaður var fundinn með því að draga kostn-
að 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.