知识管理和医学知识管理系统

讨论了知识管理和医学知识管理的基本概念、必要性和可行性。随着知识经济的到来,知识的占有将成为企业竞争力的主要来源,知识管理的基本内涵是创新、反应能力、生产率和技能素质,包含在知识生成管理、交流管理、积累管理、应用管理的全过程中医学是知识密集型行业,医学行业的竞争实质是医学知识管理水平的竞争,也就是核心竞争力的问题。借助计算机技术,实现医学知识管理的目标,有大量相关的管理和技术问题需要讨论。     

计算机管理系统在医院药库的应用

目的：加强医院药品规范化、科学化管理，准确掌握用药动态。提高工作效率，使计算机信息系统更好地为药库工作服务。方法：通过对现用药库计算机系统的构成及流程设置进行介绍，分析计算机在门诊药房管理中的应用情况。结果：不断完善的计算机系统加强了药品管理，提高了工作效率和药学服务水平。结论：药房信息管理系统的应用改变了传统医院管理模式。是医药领域实现科学化管理的必然趋势。     

临床药学管理系统在我院的应用及体会

目的：介绍临床药学管理系统在我院的上线、运行及经验.方法：从医院对临床药学管理系统的需求分析入手,经过调查研究,前期准备,数据的导入,数据的分析运用.结论：临床药学管理系统能较好的提高医院药品管理质量,降低临床不合理病例数,同时为药品管理者提供客观可靠的数据支持.对药历进行分析研究.     

静脉药物配置中心信息系统设计问题探讨

目的：为促进静脉药物配置中心信息系统的发展提供参考。方法：结合南通市肿瘤医院实际情况,对设计PIVAS信息系统中几个关键问题进行分析并提出建议。结果与结论：设计了静脉药物配置中心信息系统,为PIVAS日常工作提供便利,加强了药物的监控管理,但需要解决库房、退药等几个主要问题。     

医疗纠纷投诉原因的调查分析

目的 调查医疗投诉原因,总结经验,减少或避免医疗纠纷的发生.方法 对某医院2011和2012年纠纷的发生原因和解决途径进行统计、分析.结果 医疗纠纷的发生是由于医患之间的知识差异,沟通不畅;医疗管理存在缺陷,就诊流程不完善;医务人员的责任心不强;病案管理存在安全问题等原因造成.结论 加强卫生法律法规的学习,严格执行技术操作规程,不断提高医务人员的法律意识,规范病案管理,提升服务质量可防范医疗纠纷的发生.     

How to Effectively Implement an Indicator System to Improve Performance from a Management Perspective: The Case of Taiwan Healthcare Indicator Series (THIS) System

This study uses the Taiwan Healthcare Indicator Series (THIS) system as an example to examine which determinants would improve performance by sharing indicators from a management perspective. This study population included all 227 hospitals participating in the THIS system in 2006. A structured questionnaire was sent to the director who was responsible for the THIS system via electronic mail. A total of 111 responses were returned by February 10, 2006. Questions included current implementation and impacts of the system. Hierarchical regression models were performed to identify which variables were significantly associated with performance improvement, adjusted for hospital characteristics. Four variables significantly associated with implementing the THIS system to improve performance were ‘senior management support,’ ‘benchmarking,’ ‘making departments improve the underperforming indicators and report the improvement results in performance management meetings,’ and ‘integration with the National Health Insurance payment regulations’. This study contributes substantially to the evidence base about what works to improve performance by information sharing. Although information sharing is the basis of efforts to improve performance, senior management support and how to effectively apply the information are the most important determinants of performance enhancement.     

The effectiveness of a new generation of computerized drug alerts in reducing the risk of injury from drug side effects: a cluster randomized trial

Context

Computerized drug alerts for psychotropic drugs are expected to reduce fall-related injuries in older adults. However, physicians over-ride most alerts because they believe the benefit of the drugs exceeds the risk.

Objective

To determine whether computerized prescribing decision support with patient-specific risk estimates would increase physician response to psychotropic drug alerts and reduce injury risk in older people.

Design

Cluster randomized controlled trial of 81 family physicians and 5628 of their patients aged 65 and older who were prescribed psychotropic medication.

Intervention

Intervention physicians received information about patient-specific risk of injury computed at the time of each visit using statistical models of non-modifiable risk factors and psychotropic drug doses. Risk thermometers presented changes in absolute and relative risk with each change in drug treatment. Control physicians received commercial drug alerts.

Main outcome measures

Injury risk at the end of follow-up based on psychotropic drug doses and non-modifiable risk factors. Electronic health records and provincial insurance administrative data were used to measure outcomes.

Results

Mean patient age was 75.2 years. Baseline risk of injury was 3.94 per 100 patients per year. Intermediate-acting benzodiazepines (56.2%) were the most common psychotropic drug. Intervention physicians reviewed therapy in 83.3% of visits and modified therapy in 24.6%. The intervention reduced the risk of injury by 1.7 injuries per 1000 patients (95% CI 0.2/1000 to 3.2/1000; p=0.02). The effect of the intervention was greater for patients with higher baseline risks of injury (p<0.03).

Conclusion

Patient-specific risk estimates provide an effective method of reducing the risk of injury for high-risk older people.

Trial registration number

clinicaltrials.gov Identifier: NCT00818285.     

基于医院信息管理系统的注射用雷贝拉唑钠临床安全性评价：真实世界研究

背景　雷贝拉唑属于质子泵抑制剂,而注射用雷贝拉唑钠相对于口服雷贝拉唑具有起效迅速、对胃肠黏膜刺激小等特点。目前注射用雷贝拉唑钠的已知药物不良反应主要来源于药品说明书、国家药物不良反应中心反馈及现有的文献报道,缺乏真实世界广泛人群应用的安全性评价数据。目的　通过真实世界研究方法,评估注射用雷贝拉唑钠（奥加明?）在广泛人群使用中的安全性,包括药物不良反应类别、严重程度、发生率等,以期为提高临床用药安全性和合理性提供参考。方法　采用单臂开放、非干预性、病例登记、多中心临床研究的设计方法,收集沧州市中心医院、沧州市人民医院、哈励逊国际和平医院、福建医科大学附属第二医院、新乡市中心医院2016年11月-2018年6月使用注射用雷贝拉唑钠的3 004例住院患者的病历信息,5家研究中心的患者病历信息由各医院信息管理系统（HIS系统）导出。收集患者病历信息中的一般情况、生命体征、临床诊断、用药情况（用药剂量、用药频次、用药时间）、药物不良反应。结果　3 004例患者来源于沧州市中心医院600例,沧州市人民医院385例,哈励逊国际和平医院198例,福建医科大学附属第二医院1 322例,新乡市中心医院499例。3 004例患者临床诊断,前4位分别是高血压338例（11.25%）,肠部肿瘤258例（8.59%）,肠梗阻254例（8.46%）,消化道出血199例（6.62%）。3 004例患者注射用雷贝拉唑钠使用情况：单次剂量为10 mg/次13例（0.43%）,20 mg/次2 949例（98.17%）,30 mg/次5例（0.17%）,40 mg/次21例（0.70%）,80 mg/次1例（0.03%）,有15例未记录单次剂量;给药频次为1次/d 1 924例（64.05%）,2次/d 911例（30.33%）,3次/d 23例（0.77%）,有146例未记录给药频次;用药时间为≤5 d 1 620例（53.93%）,6~10 d 886 例（29.49%）,11~20 d 405例（13.48%）,>20 d 80例（2.66%）,有13例未记录用药时间。61例（2.03%）患者在接受注射用雷贝拉唑钠治疗过程中发生药物不良反应,其白细胞计数降低、丙氨酸氨基转移酶升高、肌酸激酶升高、收缩压升高、天冬氨酸氨基转移酶升高、谷氨酰转肽酶升高、中性粒细胞计数降低、血小板计数降低、舒张压升高的发生率均介于0.10%~0.50%,在注射用雷贝拉唑钠的药物不良反应说明书提供的参考范围内;活化部分凝血活酶时间延长的发生率为0.03%,低于注射用雷贝拉唑钠的药物不良反应说明书提供的参考值（0.10%）;注射用雷贝拉唑钠的药物不良反应说明书中未提供肌酸激酶升高发生率的参考值,本研究中患者肌酸激酶升高的发生率为0.30%;未发现罕见、新的、非预期的药物不良反应及药物间相互作用。患者发生的药物不良反应轻微,医生均根据临床经验做出相应治疗及处理。结论　注射用雷贝拉唑钠常见药物不良反应轻微,临床应用安全性高,未发现严重的药物间相互作用,可满足临床用药安全需求。     

Personal health records: a randomized trial of effects on elder medication safety

Purpose

To examine the impact of a personal health record (PHR) on medication-use safety among older adults.

Background

Online PHRs have potential as tools to manage health information. We know little about how to make PHRs accessible for older adults and what effects this will have.

Methods

A PHR was designed and pretested with older adults and tested in a 6-month randomized controlled trial. After completing mailed baseline questionnaires, eligible computer users aged 65 and over were randomized 3:1 to be given access to a PHR (n=802) or serve as a standard care control group (n=273). Follow-up questionnaires measured change from baseline medication use, medication reconciliation behaviors, and medication management problems.

Results

Older adults were interested in keeping track of their health and medication information. A majority (55.2%) logged into the PHR and used it, but only 16.1% used it frequently. At follow-up, those randomized to the PHR group were significantly less likely to use multiple non-steroidal anti-inflammatory drugs—the most common warning generated by the system (viewed by 23% of participants). Compared with low/non-users, high users reported significantly more changes in medication use and improved medication reconciliation behaviors, and recognized significantly more side effects, but there was no difference in use of inappropriate medications or adherence measures.

Conclusions

PHRs can engage older adults for better medication self-management; however, features that motivate continued use will be needed. Longer-term studies of continued users will be required to evaluate the impact of these changes in behavior on patient health outcomes.     

广西城乡不同医保制度衔接对策的思考

通过对广西不同医保制度衔接现状与需求的分析,探讨目前解决广西不同医保制度衔接的现实可行方案,提出了引入医疗保险统筹缴费替代率系数,科学折算不同医保制度之间的缴费年限;适当提高统筹层次;科学划转医保统筹基金;建立区内异地费用结算机制,科学有效地解决好异地就医费用结算问题;完善和理顺管理体制;逐步推进社会保险管理信息系统建设,推广使用统一的医保个人信息账户等配套措施和政策。     

高标准落实"三个代表"重要思想 努力创建具有南战区特色的一流总医院

本文阐述了以“三个代表”思想为指导,从科技强院、文化兴院和质量建院三个方面加强医院全面建设的经验,可供医院学习借鉴。     

医院静脉液体配制中心信息系统的设计与应用

静脉液体配制中心先进的设备增强了保护配置化疗药物人员的健康，同时为药师指导用药与医生合理用药提供了平台，保证了静脉用药的安全性、合理性与有效性。PIVAs信息系统的建立与运行不仅大大提高了护理人员与配置人员的工作效率，而且对药品库存的管理提供了一种更科学、更规范的管理模式。     

Data from clinical notes: a perspective on the tension between structure and flexible documentation

Clinical documentation is central to patient care. The success of electronic health record system adoption may depend on how well such systems support clinical documentation. A major goal of integrating clinical documentation into electronic heath record systems is to generate reusable data. As a result, there has been an emphasis on deploying computer-based documentation systems that prioritize direct structured documentation. Research has demonstrated that healthcare providers value different factors when writing clinical notes, such as narrative expressivity, amenability to the existing workflow, and usability. The authors explore the tension between expressivity and structured clinical documentation, review methods for obtaining reusable data from clinical notes, and recommend that healthcare providers be able to choose how to document patient care based on workflow and note content needs. When reusable data are needed from notes, providers can use structured documentation or rely on post-hoc text processing to produce structured data, as appropriate.     

Overcoming Barriers to the Implementation of a Pharmacy Bar Code Scanning System for Medication Dispensing: A Case Study

Technology has great potential to reduce medication errors in hospitals. This case report describes barriers to, and facilitators of, the implementation of a pharmacy bar code scanning system to reduce medication dispensing errors at a large academic medical center. Ten pharmacy staff were interviewed about their experiences during the implementation. Interview notes were iteratively reviewed to identify common themes. The authors identified three main barriers to pharmacy bar code scanning system implementation: process (training requirements and process flow issues), technology (hardware, software, and the role of vendors), and resistance (communication issues, changing roles, and negative perceptions about technology). The authors also identified strategies to overcome these barriers. Adequate training, continuous improvement, and adaptation of workflow to address one's own needs mitigated process barriers. Ongoing vendor involvement, acknowledgment of technology limitations, and attempts to address them were crucial in overcoming technology barriers. Staff resistance was addressed through clear communication, identifying champions, emphasizing new information provided by the system, and facilitating collaboration.     

Use of a codified medication process for documentation of home medications

To determine the quality and completeness of the list of home medications documented by nurses using a codified process, authors conducted a comparative study of home medications using a non-codified and codified process for documentation of required data fields including drug, dose, route of administration, frequency, and schedule. Each documented home medication (DHM) was evaluated based on the ability to convert to an inpatient medication order. The home medication was classified as non-convertible if one or more of the required data fields were missing, inaccurate, or incomplete. The study compared 176 patients with 1618 DHM in the non-codified group to 94 patients with 646 DHM in the codified group. All DHM could be converted to inpatient orders for 70% of the patients in the codified group compared with 42% in the non-codified group. Based on each DHM, the codified process resulted in 92% of the DHM being able to convert to inpatient orders compared with 82% for the non-codified process. Authors conclude that use of a codified process to document home medications has the potential to increase the number of complete drug entries and in the number of patients with a DHM list in which all of the medication entries have all of the dosing information.     

基于信息化构建的静脉安全用药管理模式的应用研究

背景　静脉用药由于疗效明确、起效迅速等,已经成为临床治疗疾病的重要手段,而静脉用药过程中一个小失误就可能导致严重后果,因此确保患者用药安全是当今医疗安全的基础。目的　利用信息化手段构建静脉安全用药管理模式,保障患者安全。方法　2019年6月绍兴市人民医院全院开始实行静脉安全用药管理模式,采用随机数字表法选取2019年3-5月3个临床科室（肝胆胰二科、血液内科、胸心外科）住院患者为对照组（静脉用药共41 537组）,2019年7-9月3个临床科室（肝胆胰一科、呼吸内科一、消化内科）住院患者为观察组（静脉用药共39 132组）。本院利用现代化信息技术,基于信息化构建静脉安全用药管理模式,即在医嘱系统中新增“警示”模块,对糖尿病患者使用葡萄糖或患者使用过敏类药物起到限制或提醒功能,同时增加输液结束扫描,实现静脉输液全程可追溯。比较两组静脉用药近似错误（糖尿病患者用葡萄糖、药物过敏干预近似错误）发生率、静脉输液追溯完整率。结果　观察组糖尿病患者用葡萄糖近似错误发生率、药物过敏干预近似错误发生率低于对照组（0.02%与0.56%,0.03%与0.32%,P<0.05）。对照组静脉输液追溯完整率为0,而观察组静脉输液追溯完整率为97.34%。结论　基于信息化构建的静脉安全用药管理模式可以减少静脉用药的潜在不安全危险因素,减少静脉用药近似错误的发生,有利于实现静脉输液全程可追溯,责任到人,持续质量改进,提高用药的科学性及合理性,保障患者安全,提升医疗质量。