基于德尔菲法构建抗菌药物治疗性使用前标本送检依从性缺口干预工具

An intervention tool for poor compliance of specimen submission before therapeutic use of antibiotics based on the Delphi method

    摘要
  • 摘要:
    目的 构建抗菌药物治疗性使用前标本送检依从性缺口干预工具。
    方法 通过文献检索、课题组讨论、两轮专家函询形成抗菌药物治疗性使用前标本送检依从性缺口干预工具, 将工具应用于临床验证效果。
    结果 函询专家权威系数0.95, 两轮函询反馈率均为100.00%, 两轮函询变异系数分别为14.77%和8.60%, 肯德尔和谐系数分别为0.787和0.854(均P < 0.05)。最终形成由2个一级条目, 9个二级条目, 19个三级条目组成的抗菌药物治疗性使用前标本送检依从性缺口干预工具, 一轮次的工具干预后抗菌药物治疗性使用前标本送检率、医院感染诊断相关病原学送检率、重点药物联用前病原学送检率将达到预期目标(69.36%、99.00%、100.00%)。
    结论 基于德尔菲法构建的抗菌药物治疗性使用前标本送检依从性缺口干预工具具有较高可靠性与实用性, 可用于提高抗菌药物治疗性使用前标本送检的行为干预, 在提高目标人群的标本送检意识、送检标本医嘱下达正确时机以及医嘱执行的合理时间节点的行为的干预方案提供了参考依据。

     

    Abstract:
    OBJECTIVE To construct an intervention tool for poor compliance of specimen collection and submission before the therapeutic use of antimicrobial agents.
    METHODS An intervention tool for the poor compliance of specimen collection and submission before the therapeutic use of antimicrobial agents was developed through literature review, research group discussions, and two rounds of expert consultations.The tool was subsequently applied in clinical practice to verify its effectiveness.
    RESULTS The authority coefficient of the consulted experts was 0.95, the feedback rate of the two rounds of expert consultations was 100.00%.The coefficients of variation of the two rounds of consultations were 14.77% and 8.60%, and Kendall′s Concordance Coefficients were 0.787 and 0.854(all P < 0.05).Finally, an intervention tool for the poor compliance of specimen collection and submission before the therapeutic use of antimicrobial agents was formed, which consisted of 2 first-level items, 9 second-level items, and 19 third-level items.After one round of intervention with this tool, the rates of specimen collection and submission before the therapeutic use of antimicrobial agents, the rates of pathogen detection related to healthcare-associated infections, and the rates of pathogen detection before the combined use of key drugs reached the expected targets (69.36%, 99.00% and 100.00%, respectively).
    CONCLUSIONS The intervention tool for the poor compliance of specimen collection and submission before the therapeutic use of antimicrobial agents constructed based on the Delphi method demonstrates high reliability and practicality.It can be used to improve the behavior intervention of specimen collection and submission before the therapeutic use of antimicrobial agents.Moreover, it provides a reference for the intervention strategies in increasing the awareness of specimen collection and submission among the target population, ensuring the correct timing of specimen collection orders, and excuting medical orders at reasonable time nodes.

     

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