Development of a Rational Antibiotic Use Model in Fresh Traumatic Wounds by Accidents: A Case Study of Amphawa Hospital, Samuth Songkram.

Abstract

Objective: The purpose is to study factors and appropriateness of antibiotic use in fresh traumatic wounds by accidents for developing and evaluating the effectiveness of rational antibiotic use model.

Methods: This is a research & development (R&D) using a mixed method by studying quantitative data of outpatients with fresh wounds from accidents at the Emergency and Accident Department. Data were collected before development from a retrospective medical records during January 1, 2021–September 30, 2022, and after development during      February 1, 2023–March 31, 2023. The qualitative data were studied using AAR and driver diagram by in-depth interviews with the Pharmaceutical and Therapeutic Committee, Amphawa Hospital. The quantitative data were analyzed using frequency and percentage, and comparing the differences between the two groups with a chi-square test. The researcher acted as a moderator, analyzing content qualitatively by paraphrasing, interpreting, and semantics.

Result: Before implementing the rational antibiotic use model; It was observed that 54.7% of the patients received antibiotics, and 58.9% of the patients received appropriately dispense antibiotics. About the factors related to patients and traumatic wounds, there were significant differences found in factors and adherence to guidelines between antibiotic group and non-antibiotic group between appropriate antibiotic group and non-appropriate antibiotic group (p < .05). The main points from after action review (AAR) such as 1) the patients came more than 6 hours late for treatment 2) the dispensing of antibiotics in clean wounds which antibiotics should not be used 3) most of the treatment was done by internship. In group discussions, a driver diagram was used to develop rational antibiotic use model in the form of a process decision program chart. After implementing rational antibiotic use model; It found that rate of antibiotic dispensing 52.7%, the rate of appropriate dispense antibiotic 77.6%. And we found no dispensing of antibiotics in clean wounds which antibiotics should not be used in class 1.

Conclusion: After the rational antibiotic use model in fresh traumatic wounds from accidents developed from AAR and driver diagram, the rate of antibiotic use decreased by 2%, but still exceeded the target set by the Ministry of Public Health (40%). The rate of appropriate antibiotic use increased by 18.7% and no dispensing of antibiotic in clean wounds which antibiotics should not be used, so it should be done with AAR at regular intervals including studying the effects of antibiotics on wounds caused by animal bites and monitoring the use of antibiotics in the community.