高危药品单次最大剂量确定及其警示系统开发

目的:基于医院信息系统探索高危药品有效的风险防范措施,以保证患者的用药安全。方法:参考美国医疗安全协会高危药品目录制定我院高危药品目录,依据药品说明书、中国国家处方集、新编药物学、实用内科学等研究确定每种药品的单次最大剂量。结果与结论:采用Oracle数据库管理剂量信息,嵌入医生工作站,开发了高危药品单次最大剂量警示系统,以减少用药差错的发生。     

我院药品电子医嘱标签自动生成系统的建立与应用

目的:为医院药剂科改进调剂工作模式提供参考。方法:介绍我院药品电子医嘱标签自动生成系统的运行环境、所需硬件及应用情况,并对系统应用成效及存在不足进行探讨。结果与结论:我院药品电子医嘱标签自动生成系统简化了药品调配流程,提升了门、急诊药房工作质量,降低了调配差错发生率,提高了门、急诊药房及护理人员工作效率(电子医嘱标签与手工书写标签相比耗时减少最高达36.45%),降低了药学服务成本(比例达13.97%)。但实际应用中仍存在数据转换的局限性和医嘱标签损耗等方面的不足,有待进一步完善。     

基于医院信息系统的高危药品管理软件的设计与开发

在确定高危药品目录的基础上,开发了适合我院的高危药品管理系统软件,使高危药物的管理贯穿于整个医疗过程中。该软件由基础信息管理模块、信息维护模块、审查模块、预警模块、统计模块组成。通过此软件的应用,可将潜在的、可能导致严重后果的用药差错消灭在萌芽状态中,有效地降低了高危药品使用的医疗风险,提高临床用药的安全性。此软件值得在临床应用和推广。     

我院高危药品管理的实践和体会

目的 探索医院内高危药品管理的方法和切入点,以提升药物安全管理水平.方法 制定我院高危药品目录,开设用药安全宣传栏及安全用药教育,介绍常用高危药品种及注意事项,通过计算机信息化管理系统和临床决策支持系统,结合我院实际管理工作情况,加强我院高危药品管理.结果 我院通过实施有效的管理降低了高危药品在各个环节的潜在风险.结论 在目前"以患者为中心"、加强合理安全用药的情况下,有必要在医疗机构内对高危药品实施针对性管理.建议各医疗机构制定本机构相应的高危药品目录和管理制度,以提高对高危药品安全管理水平和风险防范能力.     

高危药品中医疗缺陷的防范

目的探索建立高危药管理制度、工作流程和监督干预力度、防范高危药品差错。方法根据国内外文献资料结合本院高危药品实际情况制定高危药品目录、管理制度、三级金字塔式ABC管理策略及高危药品管理信息系统。结果严格执行临床路径,规范合理使用高危药品。结论高危药品的管理科学化、规范化,降低高危药品风险。     

我院高危药品的管理

目的探讨高危药品的管理。方法从高危药品管理的必要性着手,介绍我院高危药品的管理。结果与结论通过对高危药品的安全管理,可有效降低使用高危药品的风险,确保患者的用药安全。     

计算机辅助体检综合报告生成系统的开发应用

介绍了“计算机辅助体检综合报告生成系统”软件的设计思路、功能特点及其应用情况     

临床常见的不适宜用药医嘱

<正>我院静脉用药调配中心(PIVAS)的建立及运行,在提高静脉药物治疗水平的同时,给药师提供了一个平台,让药师充分发挥专业作用:在调配之前进行处方适宜性审查,纠正处方上的给药错误和配伍禁忌,为临床提供药物载体、给药时间、给药速度等方面的合理化建议,及时干预不合理医嘱,保障了患者的用药安全[1-3]。2012年8月至2013年8月之间,PIVAS累计调配与处理的医嘱有790797条(组),干预过6784组不合理用药医嘱,占全部用药医嘱的0.86%,医嘱合格率为99.14%。这些不适宜医嘱大致可分为五种类型:理化禁忌(1210条)、药理学禁忌(29条)、溶媒选择不恰当     

医疗机构减少药品调配和给药差错的研究

医疗机构中用药差错比较普遍,而调配和给药错误在用药差错中占有较高比例。美国的研究表明,虽然总体上调配和给药错误的发生率比较低,但是由于医疗机构中药品使用量大,一个比较繁忙的医疗机构药房7个月内共发生5075次差错,其中79％被发现。另有研究指出,备药和发药错误占用药差错的11％～21％。我国对调配和给药错误尚缺乏全国性的实证数据,但个别医院的研究表明,调配和给药错误对病人安全的影响是比较显著的。本文从调配和给药差错的影响因素、国外减少相关差错的先进技术与干预措施角度进行分析,提出建议,供国内药学工作者参考。     

基层医院高危药品的管理

用药安全是医院实施患者安全目标管理的重要目标之一,高危药品管理是用药安全管理的核心内容。现对笔者所在医院的药品归类及药品监管制度进行分析,并根据本院实际情况制定高危药品的监管措施。     

探讨药师在高危药品管理中的作用

目的探讨药师在医疗机构内高危药品管理的作用和具体方法。方法参考美国ISMP公布的2012年版最新高危药品目录和中国药学会医院药学专业委员会2012年推荐目录,并查阅文献搜集国内多家医疗机构的管理经验和策略。结果阐述了高危药品概念、产生的背景和最新的国内外公布的药品分类和管理办法;总结了目前国内医疗机构在高危药品管理上的新理念、技术和举措;分析了药师在高危药品管理中的作用;介绍了我院开展高危药品管理的实践及体会。结论建立高危药品安全管理体系是非常重要的,建议各医疗机构应结合推荐目录和自身特点制定本机构内的高危药品目录,建立符合自身的管理策略,充分发挥药师的作用。     

Effect of Computerized Physician Order Entry and Clinical Decision Support System on Adverse Drug Events Prevention in the Emergency Department: A Systematic Review

Objective: An adverse drug event (ADE) is an injury resulting from a medical intervention related to a drug. The emergency department (ED) is a ward vulnerable to more ADEs because of overcrowding. Information technologies such as computerized physician order entry (CPOE) and clinical decision support system (CDSS) may decrease the occurrence of ADEs. This study aims to review research that reported the evaluation of the effectiveness of CPOE and CDSS on lowering the occurrence of ADEs in the ED. Data Sources: PubMed, EMBASE, and Web of Science databases were used to find studies published from 2003 to 2018. The search was conducted in November 2018. Study Selection and Data Extraction: The search resulted in 1700 retrieved articles. After applying inclusion and exclusion criteria, 11 articles were included. Data on the date, country, type of system, medication process stages, study design, participants, sample size, and outcomes were extracted. Data Synthesis: Results showed that CPOE and CDSS may prevent ADEs in the ED through significantly decreasing the rate of errors, ADEs, excessive dose, and inappropriate prescribing (in 54.5% of articles); furthermore, CPOE and CDSS may significantly increase the rate of appropriate prescribing and dosing in compliance with established guidelines (45.5% of articles). Conclusion: This study revealed that the use of CPOE and CDSS can lower the occurrence of ADEs in the ED; however, further randomized controlled trials are needed to address the effect of a CDSS, with basic or advanced features, on the occurrence of ADEs in the ED.     

Evaluating Incorporation of Drug Restrictions into Computerized Drug Order Entries after Transition to an Electronic Health Record

Background:

Incorporation of drug restriction policy into electronic drug order entries (DOEs) can promote responsible medication use and resource utilization when implemented systematically.

Objective:

To identify drugs that require further incorporation of formulary restriction policy into their DOEs after migration to an electronic health record with computerized prescriber order entry (CPOE).

Methods:

After transition to CPOE, test orders for formulary restricted drugs were entered in the CPOE environment. Data were collected about rationale for drug restriction, type of formulary restriction, presence of incorporation of restriction policy into the DOE, and whether incorporation was consistent with a recommended method. Restricted drugs requiring revision of policy incorporation into their DOEs were analyzed to create a prioritized task list based on rationale for the restriction.

Results:

Of all restricted drugs, 63.6% (287/451) did not have restriction policy incorporated into their DOEs consistent with the recommended method and therefore required revision. Eighteen percent (81/451) of restricted drugs had no incorporation of restriction policy in their DOEs. Safety was the rationale for restriction in 21% (17/81) of these, which received highest priority for revision. When drugs were orderable but restricted, 61.9% (78/126) lacked optimal incorporation of policy in DOEs to promote adherence. When drugs were not orderable, 64% (206/322) did not provide guidance to formulary alternatives in DOEs when they should have.

Conclusion:

After transition to CPOE, almost two-thirds of all analyzed restricted drugs lacked optimal incorporation of formulary restriction policies in their DOEs. DOEs with restrictions related to safety reasons were among those most frequently requiring revision. Some DOEs can better promote adherence and provide guidance to prescribers through revision. Predefined, systematic implementation strategies should be used during changes in computerized drug use processes.     

Nursing,Pharmacy, and Prescriber Knowledge and Perceptions of High-Alert Medications in a Large,Academic Medical Hospital

Background:

High-alert medications pose a greater risk of causing significant harm to patients if used in error. The Joint Commission requires that hospitals define institution-specific high-alert medications and implement processes to ensure safe medication use.

Method:

Nursing, pharmacy, and prescribers were asked to voluntarily complete a 34-question survey to assess their knowledge, experience, and perceptions regarding high-alert medications in an academic hospital.

Results:

The majority of respondents identified the organization’s high-alert medications, the consequences of an error involving a high-alert medication, and the reversal agent. Most of the risk-reduction strategies within the institution were viewed as being effective by respondents. Forty-five percent of the respondents utilized a high-alert medication in the previous 24 hours. Only 14.2% had experienced an error with a high-alert medication in the previous 12 months, with 46% being near misses. The survey found the 5 rights for medication administration were not being utilized consistently. Respondents indicated that work experience or hospital orientation is the preferred learning experience for high-alert medications.

Conclusions:

This study assessed all disciplines involved in the medication use process. Perceptions about high-alert medications differ between disciplines. Ongoing discipline-specific education is required to ensure that individuals accept accountability in the medication use process and to close knowledge gaps on high-alert medications and risk-reduction strategies.     

关注抗肿瘤类高警示药品的用药安全

学习美国卫生系统药师协会最新发布的防范化疗和生物治疗的差错指南,结合我国日常工作,探讨从遴选药品到安全使用整个用药闭环各环节的警示点。用药风险不容忽视,优化和全面关爱患者需要团队参与服务。医疗机构、医师、药师、护士、生产企业和监管部门应各负其责,并加强沟通交流,多角度获取信息、了解潜在风险,提供专业技术支持和服务来提高用药安全性。抗肿瘤类药物无论是品种、剂型、给药方案都有其复杂性,有很多可能因疏失带来的风险,所以每个环节都要不断学习,持续改进,确保安全。