智能化病房基数药品管理系统的设计与实践

本文从医院临床信息系统集成改造角度,分析病房基数药品管理业务环节存在的问题,基于保障病人用药安全、提高护士工作效率、提高药房精细化管理和自动化水平等基本目标,提出基于药房基数药品管理的信息系统规划,并运用于具体实践。     

某院病房基数药设置和使用情况调查分析

目的:探讨病房基数药的设置和使用情况。方法:采用回顾性研究方法,对某"三甲"医院各病房基数药储存量及2009年8月1～31日使用情况进行了调研。结果:该院基数药总量为2618种,18936支(片),未使用种类占58.21%,在使用的药品中,每班次最高使用量不超过基数总量20%的药品占45.80%。结论:基数药种类和数量大,管理成本高,使用率低,建议完善支持系统,减少以至取消基数药。     

病房小药柜药品的贮存和保管

临床科室的住院病房都设有小药柜 ,用于存放少量临床急需的急救药品、普通药品、毒、麻、精神药品和医院制剂等。对于病区小药柜的管理 ,卫生部颁发的《医院工作制度》〔1〕中作了具体的规定。但对其中药品的贮存保管与养护方法 ,医护人员却不一定了解 ,因而常常未按规定的贮存条件来存放。药品在有效期内能保证质量稳定的前提就是在其规定的贮存条件下依据其性质进行科学的贮存养护 ,否则 ,将加速它的变质失效。这样的药品虽然未超过有效期 ,但实际上有效成分可能降解 ,毒性也可能增加 ,不能充分保证病人用药的安全性与有效性。下面是一些…     

输液泵在ICU病房输液中的应用

现代医疗护理工作中，静脉输液是一项量大、面广且不可缺少的治疗和护理方法。传统的吊瓶输液方式存在一定的不足，无法满足现代临床输液的更高要求，因此随着医疗护理工作的发展，产生了应用输液泵输液。智能输液泵是一种在微电脑控制下能精确控制输液速度和输液总量，并能对输液过程中的气泡、阻塞等异常情况进行监测和报警的泵力仪器。目前，在各个医院已广泛应用，我科ICU病房2003年10月-2004年10月对100例急性冠脉综合征，20例心衰竭病人维持血压平稳基础上使用硝酸甘油或硝普纳扩血管中，应用输液泵与应用输液泵对治疗护理质量的影响进行探讨，现报告如下。     

自动化智能药柜在ICU临床的应用及管理

目的探讨ICU自动化智能药柜的应用及管理效果。方法应用智能药柜对病房临时非口服药品进行封闭式智能化管理,制订智能药柜使用流程,规范使用和管理方法。结果使用智能药柜后,(1)药品品种和数量增加;近效期和过期药品报损金额下降;(2)取药时间缩短,每日自药房取临时非口服药频次下降,抗生素使用时间缩短(P0.01);(3)未发生与取药相关错误。结论自动化智能药柜用于ICU病房药品管理可以保障病房基数药品有效期和库存安全,减少运营成本,提高工作效率,保证患者用药的及时性和安全性。     

多元化护理在ICU病房中的应用

2006年1月～2006年7月，我院对356例ICU病房患者应用多元化护理理论，取得满意效果。现报告如下。     

加强医疗病房（ICU）的发展与现状

历史回顾文献报道的第一个加强医疗单位(Intensive Care Unit,ICU)1952年出现在欧洲的Scandinavia,是为抢救流行性脊髓灰质炎病人所设立的呼吸治疗单位(Respiratory Care Unit,RCU)。寻其根源,ICU的萌芽几乎可上溯至十九世纪五十年代的克里米亚战爭时期,当时Nightingale(南丁格尔)就把     

整体护理在ICU病房中的应用

我院心胸外科ICU病房多为术后患者，通过与患者交谈，了解其心理状态，以优良的态度，娴熟的技术，赢得患者的信赖，建立了良好的护患关系，使他们能主动配合治疗和护理，现将整体护理在ICU病房中的效果评价介绍如下。     

ICU病房实施风险管理的做法与效果

为保证ICU病房护理质量,运用风险管理理论,针对医疗风险的主要成因,加强专业培训,增强护士责任心,保证仪器设备正常运行,各种物品呈备用状态,合理安排人员,保证夜间护理安全,健全各项规章制度,加强护患沟通,建立完善统一的护理记录。减少了护理差错事故的发生,在护理工作中取得了良好的效果。     

Computer assisted management of information in an intensive care unit

Summary In order to use the capability of computers for handling large amounts of information, we developed a program for the acquisition, handling, storage and retrieval of administrative and clinical information generated in the 20 bedded multidisciplinary critical care unit of a University Hospital. At an initial phase a personal computer (PC) was used to collect information from 4362 patients, that included registration data, coded admission problems, techniques and special treatments, and final diagnosis. This information combined with free text provided a discharge report. Complementary programs allowed calculation and storage of hemodynamic and gas exchange parameters. This experience led to a second phase in which a computer with microprocessor Intel 80386 at 25MHz, 8MB RAM, 310 MB hard, disk and a streamer for 150MB cartridge tape back up, using UNIX operating system, permitted multiple users working simultaneously through 1 central console and 7 ASCII terminals. Data input included demographic data, previous and admission problems in coded form, present history and physical examination in free text, list of present problems in coded form, comments on evolution, record of special techniques and treatments, laboratory data, treatment, final diagnosis and facility for using all the information to elaborate the final report. Side modules provide help for drugs dosing, protocols for specific conditions and clerical routines. The system is open for connection to other areas of the Hospital. Data from more than 2000 patients have been included so far. The program is used by medical, nursing and clerical staff with high degree of acceptance. All patients have their clinical information filed and 100% of the final reports are elaborated with the program.We conclude that a PC supported application is not adequate for implementing a historical database. On the contrary the integration of a relational database management system with a text editor in a more potent multiuser set up, provides a highly efficient tool to handle all the data generated during the patients' admission.     

A data base system for pediatric intensive care

Summary A data base system has been designed at the pediatric intensive care unit of St. Görans Hospital in Stockholm. Information on all cases treated during 1982 was retrieved, including information from another file containing data on inpatient stays in the county of Stockholm. Thus an automatic follow-up study was made and the results of intensive care were expressed as mortality occurring at the intensive care unit (ICU), mortality up to 180 days after discharge, average length of stay in the ICU and average number of bed days as inpatients from discharge from the ICU up to 180 days later. Altogether, 705 ICU days of 626 patients were retrieved. Mortality in the ICU was 8.6% and increased to 12.5% 180 days after discharge from the ICU. The average period of hospitalization after discharge from the ICU was 19 days.Cases diagnosed as IRDS were studied specifically and the mortality was 53% in cases with birth weights less than 1500 g and 13% in cases with birth weights of 1500 g or more. High mortality and long hospitalization after discharge from the ICU was seen in cases with neurological complications. All information was retrieved interactively from a display terminal at the department. This could be done at any hour of the day.     

儿童重症监护室非计划性拔管现状调查及分析

目的描述非计划性拔管在儿童重症监护室的现状及原因。方法2008年1—12月上海某三级甲等儿科医院中3个重症监护室发生非计划性拔管的患儿共21例,根据意外事件报告单,对发生非计划性拔管的原因进行系统分析。结果患儿的年龄、患儿身体约束不当、镇静不足、胶布固定无效和护理人力不足是造成患儿非计划性拔管的高危因素。结论非计划性拔管率是重症监护质量的重要指标,建立一套有效的预防非计划性拔管标准包括有效约束、有效胶布固定、有效的镇静,合理护理人力配置以及提高护士的评估能力将有助于降低非计划性拔管发生率,提升重症监护室的护理品质。     

Physical restraints practice in adult intensive care units in Egypt

Physical restraints are commonly used in intensive care units to reduce the risk of injury and ensure patient safety. However, there is still controversy regarding the practice of physical restraints in such units. The purpose of this study was to investigate the practices of physical restraints among critical care nurses in El‐Mansoura City, Egypt. The study involved a convenience sample of 275 critically ill adult patients, and 153 nurses. Data were collected from 11 intensive care units using a “physical restraint observation form” and a “structured questionnaire.” The results revealed that physical restraint was commonly used to ensure patient safety. Assessment of physical restraint was mainly restricted to peripheral circulation. The most commonly reported physically restrained site complications included: redness, bruising, swelling, and edema. The results illustrated a lack of documentation on physical restraint and a lack of education of patients and their families about the rationale of physical restraint usage. The study shed light on the need for standard guidelines and policies for physical restraint practices in Egyptian intensive care units.     

重症监护临床信息系统在急诊重症监护室中的应用

目的探讨重症监护临床信息系统(ICIS)在急诊重症监护室(EICU)中的应用效果。方法将本院急诊医学部重症监护室2014年8月—2015年1月收治的重症患者366例设为对照组,2015年2月—2015年7月收治的重症患者353例设为观察组。对照组患者应用"军卫一号",观察组应用重症监护临床信息系统,观察比较2组病情记录时间、观察项维护时间、出入量维护时间、核对确认医嘱时间及病情记录差错率、观察项维护差错率、出入量维护差错率和核对确认医嘱差错率。结果观察组护理记录时间、核对确认医嘱时间、护理工作记录差错率及核对确认医嘱差错率均显著低于对照组(P0.05)。结论 ICIS的应用提高了临床工作效率,节省了护理记录时间,降低了护理差错率,明显提高了临床护理质量和患者满意度。     

Staff knowledge,attitudes and practices regarding glycaemic management in adult intensive care units: A national survey

Background

Hyperglycaemia is common in critically ill adult patients. Many studies have identified the content, methods, and effects of glycaemic control but have not explored the effects of knowledge, attitudes, and practices (KAP) on glycaemic control in critically ill adults. Various factors also influence the KAP of intensive care unit (ICU) staff.

Aims

To assess KAP regarding glucose management for critically ill adults among nurses and medical professionals and identify the factors that influence their KAP in ICUs.

Methods

A multicentre cross-sectional survey.

Results

In total, 403/459 (response rate: 87.8%) participants from ICUs in nine tertiary hospitals in China participated in this study, 82.4% of whom were female and 93.4% of whom were nurses. The mean work experience was 8.88 years, and the mean critical care experience was 6.59 years. The scoring rate for the three dimensions of knowledge, attitudes, and practices were 82.35%, 87.69%, and 76%, respectively. We did not find any other factors affecting the KAP scores except for the level of knowledge awareness (p < 0.001), awareness of the importance (p < 0.001), and training for glucose control (p = 0.004).

Conclusion

ICU staff KAP regarding glycaemic control in critically ill adults among ICU professionals were acceptable in China. However, ICU professionals' current knowledge regarding nutrition, glucose variability, and skills related to glucose management could be improved.

Relevance to Clinical Practice

ICU educators should provide more skills-related training for healthcare professionals in the glycaemic management of critically ill adults. Moreover, the process of managing blood glucose in adult ICU patients is a collaborative, multidisciplinary team effort, with monitoring and feedback required during implementation.     

急诊重症监护病房患者的护理管理

目的探讨急诊及重症监护病房（ICU）监护患者的护理管理。方法对514例急诊ICU监护患者的临床护理管理进行回顾性分析。结果514例急诊ICU监护患者在护士的密切观察和严格护理管理下，家属满意度为99％。结论加强急诊ICU监护患者的护理管理，是减少患者在住院期间护理差错和纠纷的关键，值得临床推广。     

超声造影在重症监护病房中的应用现状

常规超声监测在危重症患者中已广泛应用,但在某些特殊情况如器官血流灌注下易出现误诊和漏诊。超声造影可以反映器官组织的血流灌注情况,特别是微灌注情况,在监测危重症患者时可弥补常规超声血流灌注的不足。本文初步总结超声造影在重症监护病房中的应用现状及进展。     

Communication with dying patients--perception of intensive care units nurses in Brazil

Aims and objectives. This study aimed to assess whether nurses working in intensive care units view the establishment of communication with patients beyond therapeutic possibilities as an effective palliative therapeutic resource, and which aspects of this communication they valued most. Method. Data were collected in November 2002, by semi‐structured interviews with 10 nurses of both clinical and surgical intensive care unit at a school hospital in Sao Paulo city, Brazil. Interviews were recorded and transcribed to be further analysed according to the qualitative methodology of content analysis. Results. Four categories of thematic order raised from the collected statements, which clarify (i) the value of communication with terminal patients; (ii) the obstacles found during this process; (iii) the need to identify the individual demands of each patient, (iv) be able to use communication as a tool in the palliative care of the dying patient. Conclusion. In conclusion, we found that the nurses working at the intensive care unit do consider communication with dying patients an effective therapeutic resource, in spite of their own difficulties in communicating with dying patients, viewing themselves as ill prepared to the task, and often, distancing themselves from the dying patients because of their inability to deal with their own feelings, which were brought forth by the confrontation with the imminence of death. Relevance to clinical practice. Although the number of interviewed nurses in our study was small, the results corroborated the findings of other studies and revealed an educational aspect in nursing training that deserves serious consideration.