This Conference is by municipal Standing Committee research decided held of, main task is in-depth learning implement XI General Secretary on \o learn a do\ng education of important indicates spirit and provincial Secretary XXX important speech spirit, according to central deployment and provincial requirements, on I city \n a do\ducation work for arrangements deployment, education guide General members further firm ideal faith, and keep on party loyalty, and set breeze upright, and courage to play as, for in province first full built well-off social, and Building higher levels of ecological vitality city provide a strong organizational guarantee of happiness. All party members in the \on Party rules, series of speeches, be qualified party members\ducation, Party Central Committee to deepen the inner-party education, advancing the comprehensive yet another important practice in strictly administering the party, is to promote the inner-party education from \of party members expanded, from the concentration of important measures to extend education to regular education, is leading the task of party building this year. This year, the XI General Secretary on many occasions \nd education issued instructions, profoundly illustrates the significance of education, brilliantly describes the overall objectives, basic requirements and main tasks of education, made clear that the main responsibility of the head of the party organization at all levels and shall carry out, point in the right direction for the us to carry out study and education, provide the fundamental follow. On April 6, Liu Yunshan, Comrade Zhao Leji in Central \on educational work, a careful deployment of this work, put forward a clear requirement. On April 13, the Party Secretary, Xie Fuzhan, Director of the provincial people's Congress, the province's \onal Conference, made specific arrangements to carry outstudy and education in the province. We want to seriously study led And further implementation. Party according to the spirit of the Central and provincial requirements, based on actual city, research has developed a \onal programmes and study contents specific programmes, we want to pay special attention to follow-up. Now, I make a few remarks. First, deepening understanding, enhancing grasp \o\party's 18, Comrade XI Jinping as General Secretary of the CPC Central Committee made a series of major deployment around the party's construction, making a series of punch, construction of a new political styles and the aspirations of the Party greatly condensed. \on, reflects the interlocking, step by step, further promote the comprehensive strictly administering the party's firm determination and political will, to push forward the \hensive\nce. We should be supported bypolitical and overall商都县中医院抗菌药物分级管理实施细则
第一章 总则
第一条 根据《药品管理法》、《药品管理法实施条例》等有关法律法规，以及《基本医疗保险药品目录》、《抗菌药物临床应用指导原则》（简称《指导原则》，下同），经医院药事管理委员会组织专家论证，对我院使用的每种抗菌药物的特点、临床疗效、细菌耐药性、不良反应以及当地经济状况、药品价格等因素进行综合分析，将抗菌药物分为非限制使用、限制使用与特殊使用三类进行分级管理，制定本实施细则。
第二章 分级原则
第二条 非限制使用：经临床长期应用证明安全、有效，对细菌耐药性影响较小，价格相对较低的抗菌药物。
第三条 限制使用：与非限制使用抗菌药物相比较，这类药物在疗效、安全性、对细菌耐药性影响、药品价格等某方面存在局限性，不宜作为非限制使用药物。
第四条 特殊使用：不良反应明显，不宜随意使用或临床需要倍加保护以免细菌过快产生耐药而导致严重后果的抗菌药物；新上市的抗菌药物；其疗效或安全性任何一方面的临床资料尚较少，或并不优于现用药物者；药品价格昂贵。
第三章 临床用药选择原则
第五条 临床选用抗菌药物应遵循《指导原则》，根据感染部位、严重程度、致病菌种类以及细菌耐药情况、患者病理生理特点、药品价格等因素加以综合分析考虑，参照《指导原则》中“各类细菌性感染的治疗原则及病原治疗”的有关要求合理选择。
第六条 一般对轻度与局部感染患者应首先选用非限制使用抗菌药物进行治疗。
第七条 中、重度感染、免疫功能低下者合并感染或病原菌只对限制使用抗菌药物敏感时，可选用限制使用抗菌药物治疗；特殊使用抗菌药物的选用应从严控制。
height, deep understanding of %udy and education on strengthening education of party members and cadres and building a contingent of cadres with high quality, maintaining and developing the party's advanced nature and purity of the significance of practical thought and action into Central and provincial requirements. First, the \nd education, is continuously strengthening the party's ideological and political construction of major deployment. Attach importance to party ideology, is the specialty of our party, since he party's 18 distinct characteristic of strictly administering the party. XI General Secretary pointed out that our party must improve itself, the first task is to strengthen ideological and political construction, the key is the educational management of party members and cadres. At present, the ideas and values have become increasingly active, social trends are largely stirring blend, cultural exchanges and the complexity of the situation, drove, some party members ' ideological and political problems, there is an urgent need to strengthen party ideology: clearing the fog, was centering. Like, some belief confused, \confidence\nt, praised Western value concept; some spirit empty, not letter Marty letter ghosts; some political discipline relaxation, in party not statements party, and not love party, and not nursing party, and not for party, even denied party of some most basic of principles and position; some organization discipline lax, not by provides participate in party of organised, not completed party distribution of task, not by party of organization principles do; some egoism serious, and people race Lee, and self-dealing; some depressed, and escape responsibility, Omission, not as good as some moral decline, violating public morality, professional ethics and family virtues, not personal morality; some honesty and self-discipline awareness is not strong, with no fear, lawlessness, abuse, and corruption among political, and so on. These problems, after all, and ignore the Constitution Party rules, ignore advanced theory, and lack of sense of consciousness, consciousness, pioneer of the party has a lot to do with it. Thought, belief and faith, stick to the spiritual pursuit of Communists, has always been the Communists to settle down at all. \nd education, is to enable each party to party rules etched in the heart of the party Constitution, and speech into a series of powerful weapon, clearing the barriers and gain the fetters of the mind, improve the ideological and political quality, worthy of the glorious title of the party members. Second, the %udy and education, comprehensively strengthen the construction of grass-roots party organizations and party members is an important ... Awake, our party members and party organizations, especially at the grassroots level, some of the party member's quality is not high, lax discipline and some primary party organizations are weak and lax, wiped out somgrassroots cadres as, chaos as, thick friends, eating, and so on. These problems are likeThis Conference is by municipal Standing Committee research decided held of, main task is in-depth learning implement XI General Secretary on \o learn a do\ng education of important indicates spirit and provincial Secretary XXX important speech spirit, according to central deployment and provincial requirements, on I city \n a do\ducation work for arrangements deployment, education guide General members further firm ideal faith, and keep on party loyalty, and set breeze upright, and courage to play as, for in province first full built well-off social, and Building higher levels of ecological vitality city provide a strong organizational guarantee of happiness. All party members in the \on Party rules, series of speeches, be qualified party members\ducation, Party Central Committee to deepen the inner-party education, advancing the comprehensive yet another important practice in strictly administering the party, is to promote the inner-party education from \of party members expanded, from the concentration of important measures to extend education to regular education, is leading the task of party building this year. This year, the XI General Secretary on many occasions \nd education issued instructions, profoundly illustrates the significance of education, brilliantly describes the overall objectives, basic requirements and main tasks of education, made clear that the main responsibility of the head of the party organization at all levels and shall carry out, point in the right direction for the us to carry out study and education, provide the fundamental follow. On April 6, Liu Yunshan, Comrade Zhao Leji in Central \on educational work, a careful deployment of this work, put forward a clear requirement. On April 13, the Party Secretary, Xie Fuzhan, Director of the provincial people's Congress, the province's \onal Conference, made specific arrangements to carry outstudy and education in the province. We want to seriously study led And further implementation. Party according to the spirit of the Central and provincial requirements, based on actual city, research has developed a \onal programmes and study contents specific programmes, we want to pay special attention to follow-up. Now, I make a few remarks. First, deepening understanding, enhancing grasp \o\party's 18, Comrade XI Jinping as General Secretary of the CPC Central Committee made a series of major deployment around the party's construction, making a series of punch, construction of a new political styles and the aspirations of the Party greatly condensed. \on, reflects the interlocking, step by step, further promote the comprehensive strictly administering the party's firm determination and political will, to push forward the \hensive\nce. We should be supported bypolitical and overall第八条 临床医师可根据诊断和患者病情开具非限制使用抗菌药物处方；患者需要应用限制使用抗菌药物治疗时，应经具有主治医师以上专业技术职务任职资格的医师同意，并签名；需要应用特殊使用抗菌药物时，应具有严格的临床用药指征或确凿依据，主治医生要在病程记录中对于用药指征和依据加以阐述，并经过二级科室主任签名同意，方可使用。
第九条 紧急情况下临床医师可以越级使用高于权限的抗菌药物，但仅限于1天用量。
第十条 住院病人进行抗菌治疗前，必须先留取相应样本，送细菌培养，以尽早明确病原菌的药敏结果，有针对地予以抗菌治疗，在药敏结果出来以前，可根据临床诊断经验用药结果出来以后及时进行用药调整。
第十一条 严格掌握氟喹诺酮类药物的临床应用指征，加强管理。除泌尿系统外，不得作为其他系统的外科围手术期预防用药。
第十二条 严格执行《抗菌药物临床应用指导原则》中关于预防用药指导原则的有关规定，纠正当前过度依赖抗菌药物预防手术感染的现象，加强围手术期抗菌药物预防应用的管理，对具有预防使用抗菌药物指征的常见手术，要参照《常见手术预防用抗菌药物表》选择抗菌药物，并且要严格用药时机，保证术中血清及组织中抗菌药物浓度。
第四章 管理与督查
第十三条 医院建立抗菌药物质量监控体系，成立抗菌药物干预领导小组，药事管理委员会督导本单位临床合理用药工作,药事管理委员会下成立抗菌药物干预小组；各科室主任负责抗菌药物合理使用的自查；医务处和临床药学科负责组织开展合理用药系统培训与教育，并同质量办公室一起组织抗菌药物使用的合理性检查、评价和奖惩。
第十四条 抗菌药物合理使用纳入医疗质量检查内容和科室综合目标管理考核体系。临床药学科每月抽查终末病历，评价抗菌药物使用的合理性；医务处和质量办公室组织检查环节病历；有争议的病历请抗菌药物干预小组讨论，评估结果上报药事管理委员会、医务处和医院质量办公室。
第十五条 细菌室建立正确的病原微生物培养、分离、鉴定技术,针对每种病原菌和我院的用药特点,规范细菌药物敏感试验条件与方法，并及时报告细菌药
height, deep understanding of %udy and education on strengthening education of party members and cadres and building a contingent of cadres with high quality, maintaining and developing the party's advanced nature and purity of the significance of practical thought and action into Central and provincial requirements. First, the \nd education, is continuously strengthening the party's ideological and political construction of major deployment. Attach importance to party ideology, is the specialty of our party, since the party's 18 distinct characteristic of strictly administering the party. XI General Secretary pointed out that our party must improve itself, the first task is to strengthen ideological and political construction, the key is the educational management of party members and cadres. At present, the ideas and values have become increasingly active, social trends are largely stirring blend, cultural exchanges and the complexity of the situation, drove, some party members ' ideological and political problems, there is an urgent need to strengthen party ideology: clearing the fog, was centering. Like, some belief confused, \confidence\nt, praised Western value concept; some spirit empty, not letter Marty letter ghosts; some political discipline relaxation, in party not statements party, and not love party, and not nursing party, and not for party, even denied party of some most basic of principles and position; some organization discipline lax, not by provides participate in party of organised, not completed party distribution of task, not by party of organization principles do; some egoism serious, and people race Lee, and self-dealing; some depressed, and escape responsibility, Omission, not as good as some moral decline, violating public morality, professional ethics and family virtues, not personal morality; some honesty and self-discipline awareness is not strong, with no fear, lawlessness, abuse, and corruption among political, and so on. These problems, after all, and ignore the Constitution Party rules, ignore advanced theory, and lack of sense of consciousness, consciousness, pioneer of the party has a lot to do with it. Thought, belief and faith, stick to the spiritual pursuit of Communists, has always been the Communists to settle down at all. \nd education, is to enable each party to party rules etched in the heart of the party Constitution, and speech into a series of powerful weapon, clearing the barriers and gain the fetters of the mind, improve the ideological and political quality, worthy of the glorious title of the party members. Second, the %udy and education, comprehensively strengthen the construction of grass-roots party organizations and party members is an important ... Awake, our party members and party organizations, especially at the grassroots level, some of the party member's quality is not high, lax discipline and some primary party organizations are weak and lax, wiped out somgrassroots cadres as, chaos as, thick friends, eating, and so on. These problems are likeThis Conference is by municipal Standing Committee research decided held of, main task is in-depth learning implement XI General Secretary on \do\ng education of important indicates spirit and provincial Secretary XXX important speech spirit, according to central deployment and provincial requirements, on I city \do\ning education work for arrangements deployment, education guide General members further firm ideal faith, and keep on party loyalty, and set breeze upright, and courage to play as, for in province first full built well-off social, and Building higher levels of ecological vitality city provide a strong organizational guarantee of happiness. All party members in the \on Party rules, series of speeches, be qualified party members\on, Party Central Committee to deepen the inner-party education, advancing the comprehensive yet another important practice in strictly administering the party, is to promote the inner-party education from \s expanded, from the concentration of important measures to extend education to regular education, is leading the task of party building this year. This year, the XI General Secretary on many occasions %udy and education issued instructions, profoundly illustrates the significance of education, brilliantly describes the overall objectives, basic requirements and main tasks of education, made clear that the main responsibility of the head of the party organization at all levels and shall carry out, point in the right direction for the us to carry out study and education, provide the fundamental follow. On April 6, Liu Yunshan, Comrade Zhao Leji in Central \, a careful deployment of this work, put forward a clear requirement. On April 13, the Party Secretary, Xie Fuzhan, Director of the provincial people's Congress, the province's \ducational Conference, made specific arrangements to carry out study and education in the province. We want to seriously study led And further implementation. Party according to the spirit of the Central and provincial requirements, based on actual city, research has developed a \o\nd study contents specific programmes, we want to pay special attention to follow-up. Now, I make a few remarks. First, deepening understanding, enhancing grasp \onal responsibility since the party's 18, Comrade XI Jinping as General Secretary of the CPC Central Committee made a series of major deployment around the party's construction, making a series of punch, construction of a new political styles and the aspirations of the Party greatly condensed. \nd education, reflects the interlocking, step by step, further promote the comprehensive strictly administering the party's firm determination and political will, to push forward the \prehensive\We should be supported by political and overall敏试验结果。定期公布病原菌检出和药敏情况，作为临床医师正确选用抗菌药物的依据。
第十六条 临床药学科根据质量控制办公室提供的病原菌检出和药敏情况数据，对抗菌药物使用情况进行细菌耐药趋势进行分析，建立抗菌药物临床应用预警机制，对细菌耐药率超过50%的抗菌药物，应及时将预警信息通报医疗质量办公室和感染办及医务人员，应参照药敏试验结果用药；对细菌耐药率超过75%的抗菌药物，上报药事管理委员会应该暂停该类抗菌药物的临床应用，根据细菌耐药监测结果再决定是否恢复临床应用。相关问题定期在《临床药学通讯》上刊登。
第十七条 药剂科严把合理用药关，不合理处方拒绝调配并反馈给临床医师修改，且进行登记。
第十八条 因不合理应用抗菌药物而导致的医疗事故及纠纷，按医院相关规定处理。
第十九条 住院患者进行抗菌药物治疗前，必须进行细菌培养和药敏试验,特殊情况未送检者,须在病程记录中注明原因，科室病原菌的送检率要求达到75%。临床应根据药敏结果及时调整治疗方案，治疗方案与药敏结果的符合率需达到75%。
第二十条 围手术期预防应用抗菌药物严格按照《指导原则》要求，用药时机、用药选择、术中追加或用药疗程不合格者，均为不合格病历。如果患者存在术后感染需抗菌药物治疗应用时，在病历中应明确记录抗感染治疗的指征。
第二十一条 临床药学科每月（季度）抽查各科室病历，评价抗菌药物使用情况，有争议的评价结果经抗菌药物干预小组复核，最终的评价结果上报医疗质量办公室和药事委员会，由医疗质量办公室经过院长批准，予以处罚。
抗菌药物干预领导小组
组 长：杜建民
副组长：王占斌 张启 赵艾生
成 员：渠秀萍 张玉明 刘志广 张利军 杨广瑞 王东 郅红军
秘书：郅红军
height, deep understanding of %udy and education on strengthening education of party members and cadres and building a contingent of cadres with high quality, maintaining and developing the party's advanced nature and purity of the significance of practical thought and action into Central and provincial requirements. First, the \nd education, is continuously strengthening the party's ideological and political construction of major deployment. Attach importance to party ideology, is the specialty of our party, since the party's 18 distinct characteristic of strictly administering the party. XI General Secretary pointed out that our party must improve itself, the first task is to strengthen ideological and political construction, the key is the educational management of party members and cadres. At present, the ideas and values have become increasingly active, social trends are largely stirring blend, cultural exchanges and the complexity of the situation, drove, some party members ' ideological and political problems, there is an urgent need to strengthen party ideology: clearing the fog, was centering. Like, some belief confused, \confidence\nt, praised Western value concept; some spirit empty, not letter Marty letter ghosts; some political discipline relaxation, in party not statements party, and not love party, and not nursing party, and not for party, even denied party of some most basic of principles and position; some organization discipline lax, not by provides participate in party of organised, not completed party distribution of task, not by party of organization principles do; some egoism serious, and people race Lee, and self-dealing; some depressed, and escape responsibility, Omission, not as good as some moral decline, violating public morality, professional ethics and family virtues, not personal morality; some honesty and self-discipline awareness is not strong, with no fear, lawlessness, abuse, and corruption among political, and so on. These problems, after all, and ignore the Constitution Party rules, ignore advanced theory, and lack of sense of consciousness, consciousness, pioneer of the party has a lot to do with it. Thought, belief and faith, stick to the spiritual pursuit of Communists, has always been the Communists to settle down at all. \nd education, is to enable each party to party rules etched in the heart of the party Constitution, and speech into a series of powerful weapon, clearing the barriers and gain the fetters of the mind, improve the ideological and political quality, worthy of the glorious title of the party members. Second, the %udy and education, comprehensively strengthen the construction of grass-roots party organizations and party members is an important ... Awake, our party members and party organizations, especially at the grassroots level, some of the party member's quality is not high, lax discipline and some primary party organizations are weak and lax, wiped out somgrassroots cadres as, chaos as, thick friends, eating, and so on. These problems are like