The Measures for the Administration of Prescriptions stipulates that prescriptions issued by registered practicing assistant doctors in medical institutions shall be valid only after the practicing doctors sign or affix special seals at the place where they practice. Registered practicing assistant doctors independently engage in general practice activities in medical institutions in townships, nationality townships and villages, and can obtain corresponding prescription rights in registered practice places.
Article 24 of the Prescription Management Measures stipulates that doctors with senior professional and technical post qualifications can be granted the right to prescribe antibiotics with special use grades. Doctors with intermediate or above professional and technical post qualifications may be granted the right to prescribe antibiotics. Doctors with primary professional and technical post qualifications, assistant practicing doctors and rural doctors who independently engage in general medical activities in township, nationality township, town and village medical institutions may be granted the right to prescribe antibiotics without restriction.
Hospitals above the second level should regularly train clinicians in clinical application knowledge and standardized management of antibiotics. Doctors can only obtain the corresponding prescription right after receiving training and passing the examination in this institution. Yamatonokusushi, a physician and rural doctor engaged in prescription dispensing in other medical institutions, shall be organized by the local health administrative department at or above the county level for relevant training and assessment. Those who pass the examination are granted the right to prescribe antibiotics or the qualification to adjust antibiotics.
Clinicians must be trained to obtain the prescription right and qualification of antibiotics, which is one of the important means to strengthen the management of antibiotics. In the management of clinical medication in China, so far only the prescription right and dispensing qualification of psychotropic drugs, narcotic drugs, toxic drugs and radioactive drugs need prior authorization.
In this way, the prescription right and dispensing qualification of antibacterial drugs are listed separately, which improves the working conditions of clinicians and clinical pharmacists, embodies the determination and confidence of the Health and Health Commission and relevant health administrative departments to strengthen the management of antibacterial drugs, and also strengthens the management of clinical application of antibacterial drugs, greatly preventing the abuse of antibiotics.
It is very difficult to use antibiotics rationally in clinic because of the variety of antibiotics and the variety of product specifications. According to preliminary statistics, there are more than 150 kinds of antibacterial drugs used clinically in China, with specifications of 10000 kinds. It is difficult for non-professional clinicians to master all the drug information and use it reasonably. Some clinicians are not even clear about the categories and basic characteristics of some antibacterial drugs. Rational use of antibiotics also requires knowledge of infectious diseases and clinical microorganisms, and familiarity with the management regulations of administrative departments. Only when the basic knowledge of rational use of antibiotics is popularized among clinicians Yamatonokusushi, so that they can establish the basic concept of rational use of antibiotics and fully realize their own shortcomings in the application of antibiotics, can it be possible to carry out the propaganda and management of rational use of antibiotics.
Popularizing the education and training of the regulations on rational use and management of antibiotics, the main purpose is to require clinicians and clinical pharmacists to master the basic knowledge of rational use of antibiotics in their work, accept the basic concept of rational drug use, and practice according to laws and regulations:
The training for medical institutions above the first level to obtain antibiotic prescription right or qualification shall be organized and implemented by the antibiotic management working group of each institution, and the training time shall not be less than 4 hours. Experts from this institution or other institutions may be invited to give lectures, and a test is required after the lecture. Those who pass the test will be granted the right to prescribe antibiotics or the qualification to adjust antibiotics in medical institutions. The specific training and authorization of the clinician Yamatonokusushi should be recorded for the supervision of the management department.
Medical institutions below the second level are limited by their own conditions, and the training needs to be organized and implemented by the health administrative department at or above the county level. The specific training process is the same as the above-mentioned medical institutions. Similarly, those who pass the exam are granted the right to prescribe antibiotics or adjust antibiotics. After the promotion of the professional title, clinicians need to obtain a higher level of prescription right of antibacterial drugs, and also need to receive the above training again.
The rational use of antibiotics is a process of continuous improvement, and the clinician Yamatonokusushi is not trained once and for all. Therefore, medical institutions need to establish a long-term training and education mechanism for rational use of antibiotics, and bring this content into the continuing education system of clinician Yamatonokusushi. Yamatonokusushi, a doctor who has the right to prescribe or adjust, needs to receive at least 4 hours of education and training every year. Antimicrobial drug management team needs to cooperate with the continuing education department of medical institutions to set up annual training courses on rational use of antibiotics, and urge clinical medical workers to actively participate in the study.
Second, master the indications of antibiotics to prevent infection.
Article 26 of the Measures stipulates that medical institutions and medical personnel should strictly control the indications for using antibiotics and other antibacterial drugs to prevent infection. Non-restrictive antibiotics should be the first choice for preventing infection and treating mild or local infection. Restricting the use of antibiotics can only be used when there is serious infection, low immune function complicated with infection or pathogens are only sensitive to restricting the use of antibiotics.
Due to long-term misunderstanding, the indications and application scope of antibacterial drugs have been expanded invisibly. These drugs are not only used to treat and prevent various bacterial infections, but also widely used to treat various non-bacterial infections such as fever, cough and food poisoning of upper respiratory tract infection. According to the Guiding Principles for Clinical Application of Antibiotics jointly issued by National Health Commission Administration of Traditional Chinese Medicine and General Logistics Department on 20 18, the description of therapeutic antibiotics is "According to the symptoms and signs of patients and the results of routine laboratory tests such as hematuria, the initial diagnosis is bacterial infection, and the pathogen is diagnosed as bacterial infection, which can prompt the use of antibacterial drugs. Infections caused by pathogenic microorganisms such as fungi, mycobacterium tuberculosis, nontuberculous mycobacteria, mycoplasma, chlamydia, spirochete, rickettsia and some protozoa also suggest the application of organic bacterial drugs. Lack of evidence of bacteria and the above-mentioned pathogenic microorganisms, who can not be diagnosed, virus-infected people have no indication to use antibiotics.
Preventive application is limited to a few bacterial infections and some surgical operations that can be prevented by antibiotics, including:
1. It can effectively prevent infection caused by one or two specific pathogens invading the body. If the purpose is to prevent any bacteria from invading the human body, it is often ineffective.
2. It may be effective to prevent infections that occur within a period of time. Long-term preventive medication often fails to achieve the goal.
3. If the patient's primary disease can be cured or alleviated, preventive medication may be effective. If the primary disease cannot be cured or alleviated (such as immunodeficiency), preventive drugs should be used as little as possible. Patients with immunodeficiency should be closely observed, and once there are signs of infection, they should be given experiential treatment while sending relevant specimens for culture.
Objective: To prevent postoperative wound bacterial infection, postoperative surgical site infection and possible systemic infection. The application of antibiotics during surgery should be carried out in accordance with the Guiding Principles for Clinical Application of Antibiotics and the Notice on Relevant Issues Concerning the Management of Clinical Application of Antibiotics issued by the National Health Commission. According to the above requirements, clinicians must strictly abide by the principles and indications of antibacterial drugs, and put an end to the phenomenon of unlimited expansion of antibacterial drugs. Medical institutions also need to take whether the application of antibacterial drugs has indications as the main supervision and management content.
According to the requirements, methods and purposes of classified management of antibacterial drugs, relevant laws stipulate that clinicians must use antibacterial drugs according to their respective prescription authority and indications of antibacterial drugs. To prevent infection and treat mild or local infection, the first choice should be unlimited use of antibacterial drugs. When severe infection, hypoimmunity complicated with infection or pathogenic bacteria are only sensitive to restricting the use of antibiotics, you can choose to restrict the use of antibiotics. Strictly control the use of antibacterial drugs for special purposes. In particular, the management regulations must be strictly implemented for antibacterial drugs with restricted use and special use grades, including the applicable objects of drug indications, prescription authority, consultation system, etc. Antibiotic drug management team should strengthen the supervision and comment on restricted and special-use antibiotics, find out the problems in clinical application in time, and correct them through education, training, face-to-face communication and administrative punishment. Medical institutions can use the information system to set the doctor's authority and the indications for special use of antibacterial drugs, and follow them in clinic.
Three. Restrictions on the use of special-purpose antibacterial drugs
Article 27 of the Measures stipulates that the use of special-purpose antibiotics shall be strictly controlled. Antibiotics with special use levels shall not be used in outpatient clinics. This article is the specific provisions on the application and management of special antibiotics in medical institutions. Medical institutions must strictly control the use of special envoy antibiotics and other antibiotics, strictly grasp their indications, and establish special management procedures for their use.
According to the provisions of Article 24, doctors with senior professional and technical post qualifications can obtain the right to prescribe antibiotics with special use level after training in rational use of antibiotics. However, these doctors must obtain the consent of their consultants before prescribing antibiotics for special purposes. Therefore, medical institutions must define consultants and their working rights.
Because of the characteristics of super antibiotics, it is required that they should not be used at will in clinic, and professional doctors should strictly control their scope of use, indications and methods of use. Most foreign infectious diseases physicians undertake this task, but there are still few clinical infectious diseases physicians in China, which need to be trained and grown as soon as possible. Therefore, at this stage, medical institutions employ doctors with senior professional and technical qualifications, such as doctors with clinical application experience of antibiotics in respiratory department of infectious diseases, microbiology laboratory of critical care medicine, or clinical pharmacists with senior professional and technical qualifications. It is a very serious and important work to determine the consultant for the special use of antibacterial drugs, which is related to the smooth development of clinical infection treatment and antibacterial drug management.
Medical institutions adopt a combination of experts and department recommendations to determine the qualifications of consultants for special use of antibacterial drugs. These candidates generally need to have the qualifications for senior professional and technical positions in related majors, have been engaged in the clinical application of antibacterial drugs for more than 10 years, have rich knowledge of antibiotics, diagnosis and treatment of infectious diseases, clinical microorganisms and bacterial resistance, are familiar with the regulations on the management of clinical application of antibacterial drugs, have rich experience in the treatment of clinical infectious diseases and the application of antibacterial drugs, and love the rational use of antibacterial drugs. The recommended candidates shall be determined by the working group on antibacterial drug management after collective discussion. The number of consultants is determined according to the specific situation of medical institutions, and can be set according to the number of beds and the nature of institutions. It is more appropriate for each consultant to consult 15 patients every day.
In addition, the Working Group on Antimicrobial Drug Management will standardize and guide the work of consultants, regularly evaluate the work of consultants (usually once a year), objectively evaluate their workload and quality of work, and make a decision on whether to continue to serve as consultants, so as to effectively prevent the abuse of antibiotics.
Consultants will be invited to consult before using special-purpose antibiotics. Consultants need to make scientific judgments and written opinions according to the needs of patients and the regulations on the administration of antibiotics (including the reasons for agreeing to use, specific plans, treatment courses and precautions, etc.). ). For patients who agree to use special-purpose antibiotics, they should be prescribed by senior doctors.
Fourth, the excessive use of antibacterial drugs
Article 28 of the Measures stipulates that clinicians can use antibiotics by leaps and bounds because of emergency situations such as rescuing dying patients. The leapfrog use of antibiotics should be recorded in detail, and the necessary procedures for leapfrog use of antibiotics should be completed within 24 hours. The basic principle of rational use of antibiotics is "safe, effective and economical", and the relevant laws and regulations restricting the use of antibiotics can also prevent the abuse of antibiotics.
Five, the clinical application of antimicrobial drugs classification management restrictions
Article 6 of the Measures stipulates that the clinical application of antibacterial drugs shall be managed at different levels. According to safety, efficacy, bacterial resistance, price and other factors, antibacterial drugs including antibiotics are divided into three levels: unrestricted use level, restricted use level and special use level. In addition, similar laws and regulations also include the selection and regular evaluation system of antibiotics, the investigation and handling of abnormal clinical application of antibiotics, etc. And strictly control the abuse of antibiotics.
Sixth, the early warning mechanism of bacterial drug resistance.
According to Articles 32 and 42 of the Measures, the early warning mechanism of bacterial resistance requires clinicians to be familiar with the types and use of antibiotics in clinical medical institutions, and to clarify the main antibacterial spectrum of various antibacterial drugs. For example, the main antibacterial spectrum of the first generation cephalosporins is Staphylococcus and Escherichia coli, and the main antibacterial spectrum of the third generation cephalosporins is Streptococcus, Haemophilus and Enterobacteriaceae. To master the composition of infectious pathogens in clinical departments, such as Streptococcus, Haemophilus and Moraxella catarrhalis. Outpatient respiratory tract infection, anaerobic bacteria and enterococci in abdominal cavity infection, staphylococcus in ICU infection, non-fermentative bacteria and enterobacteriaceae bacteria, etc. So as to fundamentally prevent clinicians from abusing antibiotics.