冠状动脉搭桥术后早期给予阿司匹林-通过两周期审计改变医院文化。

BMJ quality improvement reports Pub Date : 2017-03-10 eCollection Date: 2017-01-01 DOI:10.1136/bmjquality.u211402.w6306
Shefali Parikh, Justin Ratnasingham
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引用次数: 1

摘要

国际指南(EACTS 2007/AHA 2011指南,1a级证据)强烈推荐“早期阿司匹林”或冠状动脉搭桥术(CABG)手术后6小时服用中剂量阿司匹林,以保护静脉移植通畅。然而,由于长期的医院文化习俗和缺乏意识,我们中心对早期阿司匹林处方的依从性很差。我们完成了对53例(2015年9月基线)、65例(2016年1月第一周期)和58例(2016年6月第二周期)连续CABG患者的两周期回顾性审计。间歇干预措施包括教育演讲、教育传单/海报、药房联络和修改电子处方集。医疗、护理和药房工作人员参与了审计战略。早期阿司匹林处方从23%提高到48%到55%,而早期阿司匹林的使用从17%提高到38%,最后在第二个改善周期提高到48%。值得注意的是,尽管有明确的临床指征,但早期未服用阿司匹林的患者比例在审计期间下降了50%。重要的实际考虑因素是术前抗血小板的最后剂量和术后纵隔引流管的出血量。基于多学科团队的方法导致CABG手术后处方改善139%,“早期阿司匹林”管理改善182%。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Early Aspirin administration post Coronary Artery Bypass Graft Surgery - Changing hospital culture through a two-cycled audit.

Early Aspirin administration post Coronary Artery Bypass Graft Surgery - Changing hospital culture through a two-cycled audit.

Early Aspirin administration post Coronary Artery Bypass Graft Surgery - Changing hospital culture through a two-cycled audit.

Early Aspirin administration post Coronary Artery Bypass Graft Surgery - Changing hospital culture through a two-cycled audit.

"Early Aspirin" or a medium dose of aspirin 6 hours after Coronary Artery Bypass Graft (CABG) Surgery is strongly recommend by international guidelines (EACTS 2007/AHA 2011 guidelines, Level1a evidence) to protect venous graft patency. However, compliance with Early Aspirin prescription at our centre is poor due to long standing hospital cultural practices and lack of awareness. We completed a two-cycled retrospective audit of 53 (September 2015 Baseline), 65 (January 2016 First Cycle) and 58 (June 2016 Second Cycle) consecutive CABG patients. Interval interventions included educational presentations, educational leaflets/posters, pharmacy liaison and modifications to e-prescription order-sets. Medical, nursing and pharmacy staff were involved in the audit strategies. Early aspirin prescription improved from 23% to 48% to 55% while administration of Early Aspirin improved from 17% to 38% and finally to 48% by second improvement cycle. Significantly, the proportion of patients with omission of early aspirin despite a clear clinical indication, decreased by 50% over the audit period. Important practical considerations were the last dose of anti-platelets preoperatively and amount of of bleeding from mediastinal drains post operatively. A multidisciplinary team based approach led to a 139% improvement in prescription and 182% improvement in administration of "Early Aspirin" after CABG surgery.

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