【摘要】 目的 通过加强重点监控抗菌药物管控，寻求药物使用、疗效与成本控制的平衡，提升临床合理用药水平。方法 应用计划-执行-研究-处理（PDSA）循环法改进重点监控抗菌药物的使用管理，收集2024年1月至2月浙江省海盐县人民医院重点监控抗菌药物相关使用情况作为基线资料，通过绘制鱼骨图、柏拉图寻找真因，5W2H表制定改进措施；2024年3月至9月为措施执行、关键指标监控及研究阶段；2024年10月至12月再次确认改进效果，总结现有工作。结果 重点监控抗菌药物使用金额占抗菌药物总金额比例由改善前的60.66%下降至改善后的51.46%，住院患者抗菌药物使用强度限定日剂量数（DDDs）由47.41下降至29.56，住院患者重点监控抗菌药物使用量占比也由56.79%下降至47.82%，表明本改进活动有效控制了抗菌药物成本支出，并对抗菌药物的使用结构产生一定影响，在一定程度上改变了临床用药倾向性。结论 采用PDSA循环法，通过加强医生与点评药师培训、加大指标达标奖惩力度、扩大点评范围及适当控量管理，在减少抗菌药物支出、降低用量、优化抗菌药物使用结构方面具有实践意义。更多还原

【Abstract】 Objective To strengthen the management of key monitored antimicrobial drugs, achieve a balance between drug use, therapeutic efficacy and cost control, and enhance the rationality of medication.Methods The PDSA cycle method was applied to optimize the use and management of key monitored antibacterial agents. The baseline data on the use of these agents in Haiyan People′s Hospital, were collected from January to February 2024. Fishbone diagrams and Pareto charts were used to identify the root causes of irrational use, and5W2H tables were employed to formulate improvement measures. The implementation of these measures, monitoring of key indicators, and data collection were conducted from March to September 2024. The effectiveness of the improvements was re-assessed from October to December 2024, and the existing work was summarized. Results After the intervention, the pro-portion of expenditure on key monitored antimicrobial agents relative to the total antibacterial drug expenditure de-creased from 60.66% to 51.46%. The overall intensity of antimicrobial drug use among inpatients decreased from 47.41 DDDs to 29.56 DDDs, and the proportion of key monitored antimicrobial agents used by inpatients also decreased from 56.79% to 47.82%. These results indicated that this improvement initiative effectively controlled antimicro-bial drug costs, exerted a positive impact on the structure of antimicrobial drug use, and partially altered clinical prescribing tendencies. Conclusions The application of the PDSA cycle:through enhanced training for physicians and drug review pharmacists, increased the reward and punishment intensity for achieving the targets, expanded the scope of the drug review, and implemented appropriate quantity control measures. These measures proved to be practically meaningful in reducing antimicrobial drug expenditure,decreasing drug utilization, and optimizing the use structure of antibacterial drugs.更多还原