规培护士发生给药错误的常见原因分析及对策

目的探讨规培护士发生给药错误常见原因并进行分析,制定相应的措施,降低规培护士发生给药错误的频率,保证患者用药安全。方法通过医院2015—2019年4年中规培护士发生71例给药错误进行回顾性统计分析。结果规培护士在给药过程中发生患者错误占7.04%、给药途径错误占11.27%、药物剂量错误占26.76%、药物错误占15.49%、给药时间不准确占29.58%、漏服占9.86%。结论应健全给药相关制度及监管,严格用药查对,重视药品知识培训,加强诊疗过程中医务人员的有效沟通与合作,注重规培护士的思想教育,提供安全、舒适的工作环境,确保给药安全。     

Patient safety in radiology: Our experience

BackgroundPresent-day radiology departments have very high footfall of patients and are prone to patient safety errors. This study analyses such errors in our hospital.MethodsObservational cross-sectional analysis of errors over the last 30 months was performed. These were classified using the Eindhoven classification model into technical, organizational, and human errors. Technical errors focused on equipment safety. Organizational errors related to policies. Human errors were subclassified as per the skill rule knowledge model. Root cause analysis was performed wherever necessary, and possible mitigation strategies for ensuring safety were suggested. Errors peculiar to the Armed Forces environment were specifically addressed.ResultsSeventy-seven errors were analyzed. Two were equipment based including faulty pressure injector syringes and radiation leakage from the computed tomography gantry. Of 44 skill-based errors, 09 involved dispatch of wrong reports to dependents owing to identifying patients with serving personnel's name. Four were due to scanning wrong sites. Eleven involved reporting abnormality on the wrong side. Six involved underreporting due to not viewing specific images. The rest were due to failure to omit conflicting elements in the report. Rule-based errors included wrong protocol selection (9 errors), omitting a particular sequence due to individual preference (6 errors), and so on. Knowledge-based errors were due to misinterpretation of findings (4 errors), reporting an abnormality as normal (3 errors), and selection of wrong modality (3 errors).ConclusionThe findings of this study highlights the importance of voluntary reporting, diligent recording, and in-depth analysis of errors for understanding the causes and formulating possible mitigation strategies.     

Two RFID-Based Solutions for Secure Inpatient Medication Administration

Medication error can easily cause serious health damage to inpatients in hospital. Consequently, the whole society has to spend huge amount of extra resources for additional therapies and medication on those affected inpatients. In order to prevent medication errors, secure inpatient medication administration system is required in a hospital. Using RFID technology, such administration system provides automated medication verification for inpatient??s medicine doses and generates corresponding medication evidence, which may be audited later for medical dispute. Recently, Peris-Lopez et al. (Int. J. Med. Inform., 2011) proposed an IS-RFID system to enhance inpatient medication safety. Nevertheless, IS-RFID system does not detect the denial of proof attack efficiently and the generated medication evidence cannot defend against counterfeit evidence generated from the hospital. That is, the hospital possesses enough privilege from the design of IS-RFID system to modify generated medication evidence whenever it is necessary. Hence, we design two lightweight RFID-based solutions for secure inpatient medication administration, one for online verification environment and the other for offline validation situation, to achieve system security on evidence generation and provide early detection on denial of proof attack.     

基于RFID的供应室管理信息系统设计与实现

目的：对供应室的医疗包进行完整、灵活和实时的可追溯管理.方法：利用无线射频识别技术（RFID）进行管理.结果：方便了医疗包成本核算、审计和工作量统计,确保了医疗包使用的安全,健全了医院安全管理机制.结论：提供与HIS系统接口,实现全院系统数据共享,系统的设计与实现是有效的,具有操作简便、灵活、安全性好、便于扩充等优点.     

Deployment of RFID in Healthcare Facilities—Experimental Design in MRI Department

Patient safety has become an important issue due to medical errors. Some health care systems use Radio Frequency Identification (RFID) to identify patients during medical procedures. However, the RFID data readability especially depends upon the environment, an investigation of data reliability and signal loss is essential to making an effective deployment plan. The operation of Magnetic Resonance Imaging (MRI) is the major source of electromagnetic interference in the hospital. Therefore, this research conducts an experimental design of reading performance considering various notable factors in the MRI department. In addition to the readability experiment, this paper also measures the efficiency and reliability of implementing RFID technology in the MRI department using a simulation approach and helps hospitals by providing the measured outcomes.     

中间件在医院供应室管理系统中的设计应用

RFID系统在医疗行业应用日益广泛.基于SOA的RFID中间件系统由边缘代理、事件服务器和控制台系统三个主要部分组成.通过对基于该中间件技术的医院供应室管理系统的开发及集成改造,从根本上改善了医院RFID应用系统架构的灵活性和可扩展性,为开发后续RFID应用提供了便利.基于RFID的医院供应室管理系统的成功应用,明显改善医院在手术器械消毒管理环节的处理能力,提升了医院数字化管理水平.     

A New Method to Guard Inpatient Medication Safety by the Implementation of RFID

Since life is invaluable, the patient safety is always an important issue. How to reduce the malpractices and advance the patient safety is the primary goal of many countries. The current problem is that the hospitals cannot quickly and precisely identify the name of medicine, the position of patient and staff and the servicing time and dosage taken by patients. The application of Radio Frequency Identification (RFID) is rocketing in popularity as varieties of expanded uses. However, due to the investment consideration, there are few cases that practically implement such a technology in healthcare industries. This paper presents a Wisely Aware RFID Dosage (WARD) system, which based on an integration of barcodes and RFID tags, to demonstrate effective and safe patient care environment, for preventing the risk of medication error. Finally, through an evaluation of users’ satisfaction, a reliability of 0.92 and a criterion-related validity of 0.82 show that this system is able to effectively construct the patient-safety-centric environment.     

无线射频识别技术在医疗垃圾管理系统中的应用

RFID系统在医疗行业应用日益广泛,提出了一种RFID中间件系统的设计,系统由设备管理代理和事件过程管理器组成。事件过程管理器采用一种依赖时序的、基于Petri网的RFID复杂事件检测方法和基于订阅／发布的服务机制。另外,中间件系统能屏蔽低端各种RFID物理设备的多样性,为企业级应用提供动态灵活部署框架。通过基于该中间件技术的医疗垃圾管理系统的成功应用,验证了该中间件系统的设计,也明显改善医疗垃圾处理环节的监控和管理力度,提升了医院的信息化水平。     

Critical Elements and Lessons Learnt from the Implementation of an RFID-enabled Healthcare Management System in a Medical Organization

Healthcare services are complex and life-critical. One mistake in any procedure may lead to irremediable consequences; numerous researchers, thus, introduce information and communication technology to improve quality of services and enhance patient safety by reducing the medical errors. Radio frequency identification (RFID) is considered as one of the emerging tool assist in meeting the challenges of the present situation. In recent years, RFID has been applied in medical organizations for the purpose of managing and tracking medical equipment, monitoring and identifying patients, ensuring that the right medication is given to the right patient, and preventing the use of counterfeit medicine. However, most of the existing literature focuses on demonstrating how RFID can benefit the healthcare industry, whereas little attention has been given to the management issues involved in constructing an RFID project in medical organizations. In this paper, an exploratory case study is conducted in a medical organization to illustrate the development framework and critical issues that should be taken into consideration in the preparation, implementation and maintenance stage of constructing such a project. All the experiences and results discussed in this paper offer valuable and useful insights to steer those who would like to start their journey using RFID in medical organizations.     

Characterization of Class 1 Integron Gene Cassettes among Clinical Bacteria Isolated from One Large Hospital in Northern China

The class 1 integron and complex gene cassettes among different species of clinical isolates in northern China were characterized in this study. 383 clinical isolates were obtained from northern China, and class 1 integrons containing gene cassettes widely distributed among gram negative clinical isolates was observed. We find that the class 1 integron showed positive correlation with multidrug resistance phenotype of gram negative bacteria. In addition, we find that isolates belonged to one species harbored different types of gene cassette arrays, while same types of gene cassette arrays were observed in different species of isolates. The diversity of gene cassette arrays among the isolates indicated the complexity of multidrug resistance in clinical isolates in northern China.     

基于RFID技术的医院设备管理零统研究

医院设备管理目前多采用条形码技术,但条形码无法实现设备的实时定位和追踪。利用RFID射频识别技术为每一个设备设置标签来进行管理,提出了系统结构并介绍了系统功能,最后对设备标签、设备定位和设备追踪等关键问题进行了研究。基于RFID技术的医院设备管理系统,提高了设备管理的效率和医院的技术水平。     

整合子在鲍曼不动杆菌多重耐药机制分析

目的:调查我院鲍曼不动杆菌耐药性;了解整合子类型以及整合子携带耐药基因盒特征。方法:收集我院临床分离鲍曼不动杆菌。细菌鉴定及药敏由MicroScan Walk Away 40仪器完成,整合子分类检测及开放阅读框扩增由PCR法完成。开放阅读框扩增产物经琼脂糖凝胶电泳及凝胶回收试剂盒回收纯化后进行DNA测序分析,测序结果在Genebank上作比对。结果:62株鲍曼不动杆菌有11株呈多重耐药,阳性率17.7%,11株鲍曼不动杆菌对氨基糖苷类药物阿米卡星,妥布霉素,庆大霉素均耐药,其余菌株较敏感。11株鲍曼不动杆菌中均检出整合子;进一步分类鉴定显示均为Ⅰ类整合子,未检出Ⅱ类和Ⅲ类整合子。开放阅读框可变区扩增产物为(0.3～2.5)KB不等条带,测序结果证实11株Ⅰ类整合子含有6个不同耐药基因盒:blam-1,orfX,aacA4,catB3,dfrA1,aadA1。其中7株均出现catB3,aacA4和dfrA1组合。结论:与其他报道相比较,我院鲍曼不动杆菌多重耐药率相对较低,但耐药鲍曼不动杆菌携带整合子率较高,且均为Ⅰ类整合子;其整合子基因盒含有多种耐药基因编码,其中aacA4,catB3和dfrA1耐药基因组合在本地区占优势。     

Radio Frequency Identification (RFID) in Health Care: Privacy and Security Concerns Limiting Adoption

Radio frequency identification (RFID) technology has been implemented in a wide variety of industries. Health care is no exception. This article explores implementations and limitations of RFID in several health care domains: authentication, medication safety, patient tracking, and blood transfusion medicine. Each domain has seen increasing utilization of unique applications of RFID technology. Given the importance of protecting patient and data privacy, potential privacy and security concerns in each domain are discussed. Such concerns, some of which are inherent to existing RFID hardware and software technology, may limit ubiquitous adoption. In addition, an apparent lack of security standards within the RFID domain and specifically health care may also hinder the growth and utility of RFID within health care for the foreseeable future. Safeguarding the privacy of patient data may be the most important obstacle to overcome to allow the health care industry to take advantage of the numerous benefits RFID technology affords.     

SEE: Improving Nurse-Patient Communications and Preventing Software Piracy in Nurse Call Applications

Nurse call system is an electrically functioning system by which patients can call upon from a bedside station or from a duty station. An intermittent tone shall be heard and a corridor lamp located outside the room starts blinking with a slow or a faster rate depending on the call origination. It is essential to alert nurses on time so that they can offer care and comfort without any delay. There are currently many devices available for a nurse call system to improve communication between nurses and patients such as pagers, RFID (radio frequency identification) badges, wireless phones and so on. To integrate all these devices into an existing nurse call system and make they communicate with each other, we propose software client applications called bridges in this paper. We also propose a window server application called SEE (Supervised Event Executive) that delivers messages among these devices. A single hardware dongle is utilized for authentication and copy protection for SEE. Protecting SEE with securities provided by dongle only is a weak defense against hackers. In this paper, we develop some defense patterns for hackers such as calculating checksums in runtime, making calls to dongle from multiple places in code and handling errors properly by logging them into database.     

运动试验对冠心病患者短程心率变异性的影响

目的探讨运动试验对冠心病患者短程心率变异性的影响。方法利用短程频域分析法检测12例冠心病(coronaryheartdisease,CHD)患者及年龄、性别相匹配的12例健康对照者(heaHhycontrolgroup,HCG)运动试验前、中、后不同阶段、体位的心率变异性(hearratevariability,HRV)。结果(1)CHD和HCG两组之间,运动前静卧位5minLFnorm、HFnorm、LF/HF均无显著差异(P>0.05)。CHD组运动前静卧位5min与运动后静卧位5min的频域各指标也无显著差异(P>0.05)。(2)CHD及HCG组LFnorm、HFnorm、LF/HF均表现为运动中逐渐降低,极量运动时达最低水平,恢复期逐渐升高的趋势(P<0.05)。两组组间运动终止后第2个5minLFnorm、HFnorm、LF/HF均无显著差异(P<0.05)。(3)CHD组与HCG组组间试验全程HRV频域分析中,CHD组的LF、HFnorm显著高于HCG组,CHD组的HF、HFnorm显著低于HCG组。结论(1)CHD患者静卧位无心肌缺血时交感迷走神经系统处于平衡状态。(2)运动诱导迷走神经兴奋性降低,恢复期逐渐恢复。(3)CHD患者运动恢复期HRV改变反映其缺血诱导的反射性的交感神经活性占优势。(4)运动状态下CHD患者存在自主神经系统失衡,说明运动试验有助于发现CHD患者的自主神经功能紊乱。     

Security Risks Associated with Radio Frequency Identification in Medical Environments

Radio frequency identification (RFID) is a form of wireless communication that is used to identify assets and people. RFID has significant benefits to the medical environment. However, serious security threats are present in RFID systems that must be addressed in a medical environment. Of particular interest are threats to patient privacy and safety based on interception of messages, interruption of communication, modification of data, and fabrication of messages and devices. This paper presents an overview of these security threats present in RFID systems in a medical environment and provides guidance on potential solutions to these threats. This paper provides a roadmap for researchers and implementers to address the security issues facing RFID in the medical space.     

ECC-Based Grouping-Proof RFID for Inpatient Medication Safety

Several papers were proposed in which symmetric cryptography was used to design RFID grouping-proof for medication safety in the Journal of Medical Systems. However, if we want to ensure privacy, authentication and protection against the tracking of RFID-tags without losing system scalability, we must design an asymmetric cryptography-based RFID. This paper will propose a new ECC-based grouping-proof for RFID. Our ECC-based grouping-proof reduces the computation of tags and prevents timeout problems from occurring in n-party grouping-proof protocol. Based on asymmetric cryptography, the proposed scheme is practical, secure and efficient for medication applications.     

整合子-基因盒体系与细菌耐药关系及研究进展

目前,细菌耐药性已经对公共卫生问题构成严重威胁,整合子-基因盒体系是介导细菌获得耐药性与耐药基因播散的重要分子机制。整合子在整合酶作用下识别并俘获游离耐药基因盒,随着转座子或接合性质粒播散,造成细菌间耐药基因的扩散和多重耐药性的产生。本文就整合子-基因盒体系的结构、分类、分布、起源及播散机制等几方面研究近况开展讨论。     

医院质量监测系统上报数据问题分析及改进研究

目的 分析某院HQMS病案信息上报数据存在的问题,探寻改进措施以提高上报数据质量.方法 对某三甲综合医院HQMS近期上报的数据及问题进行统计分析.结果 HQMS月报数据显示住院重返、患者安全、治疗质量等方面的数据出现异常,发生压疮的出院患者例数、发生新生儿产伤例数、发生输血反应的出院患者例数与实际情况不符;另外HQMS上报数据的日报错误信息中89%的为疾病编码错误.结论 HQMS系统功能还需不断完善,信息提取时应给予相应判断功能,减少逻辑错误的发生;同时医院应采取有效措施,加强病案质量管理、病案回收管理和疾病字典库管理,保证病案信息的及时、完整、准确、真实上报.