Vancomycin administration: the impact of multidisciplinary interventions

BACKGROUND: The clinical microbiology team observed that patients were not receiving all prescribed doses of vancomycin. Ward staff was confused about ordering and interpreting vancomycin therapeutic drug monitoring (TDM) levels. AIM: To audit the incidence of vancomycin dose omission. To implement a series of interventions to improve vancomycin dose administration, and to repeat the audit process to assess these interventions. METHODS: Three prospective audits were conducted to assess the impact of vancomycin TDM on administration of vancomycin. After the first audit, a number of changes in the TDM process were undertaken. After review of the second audit, a senior pharmacist coordinated ward-based pharmacists in assisting staff to interpret levels, and TDM interpretative charts were designed for drug charts. Following the third audit, feedback to hospital management and a plan for ongoing education were undertaken. RESULTS: There was a significant reduction in the number of vancomycin doses held inappropriately in the third (10% (78/782) of prescribed doses) when compared to the first audit (16% (161/1007) of doses) (p<0.01). Of doses that were held inappropriately, there was a significant decrease in doses held for no apparent reason in audit 3 (16% (27/170) of prescribed doses) when compared to audit 1 (25% (69/282) of doses) (p<0.05). CONCLUSIONS: The interventions resulted in a 37.5% reduction in inappropriately held vancomycin doses over a one-year period; 10% of doses are still being held inappropriately. This study highlights the difficulties in identifying barriers to change and changing healthcare worker behaviour.     

GLP体系下对实验动物供应商审核的要求

目的：规范实验动物供应商管理。方法：依据《药物非临床研究质量管理规范》（GLP）等相关法规要求,对实验动物供应商审核相关流程和要求进行了论述。结果与结论：实验动物在药物安全性评价中占有极其重要的地位。通过规范实验动物供应商审核流程,加强动物来源控制,可以有效地提高药物非临床原始资料的有效性和真实性,充分发挥GLP体系下实验动物供应商审核的优越性,保证非临床研究水平。     

探索利用外部专家开展信息系统投资审计的方法

本文通过利用外部信息技术专家对信息系统工程投资审计的案例,探索对公立医院信息系统软件开发项目实施投资价格评估的审计方法,并将审计结果加以利用,建立长效机制,制定针对信息系统开发的合同模板,取得软件开发的知识产权,引进监理服务,强化对软件开发公司的全过程质量管理,形成对信息系统投资审计的新模式。     

There is still a care gap in osteoporosis management for patients with rheumatoid arthritis

ObjectivesTo assess compliance rates with the current Canadian osteoporosis guidelines and whether the Fracture Risk Assessment Tool score in patients with rheumatoid arthritis correlated with the likelihood of receiving osteoporosis treatment and having a bone mineral density test.MethodsCharts of serial outpatients with rheumatoid arthritis were reviewed to collect bone mineral density test data and patients’ use of calcium, vitamin D, and osteoporosis treatment. Odds ratios (OR) were calculated to determine if a higher Fracture Risk Assessment Tool score increased the likelihood of osteoporosis treatment or having a bone mineral density test.ResultsUsing the Fracture Risk Assessment Tool, the 10-year risk of major osteoporotic fracture was high in 92 (12.5%), moderate in 216 (29.3%), and low in 429 (58.2%) patients. Compared to those at low risk, patients identified as high risk were more likely to receive osteoporosis treatment (OR 16.31, 95% CI 9.45–28.13, P < 0.001); calcium (OR 3.89, 95% CI 2.43–6.25, P < 0.001); vitamin D (OR 3.46, 95% CI 2.12–5.64, P < 0.001); and to have had a bone mineral density test (OR 10.22, 95% CI 5.50–18.96, P < 0.001). Among 124 patients currently taking prednisone, half (46.8%) were prescribed a bisphosphonate.ConclusionsAlthough compliance with current osteoporosis guidelines remains low among all patients with rheumatoid arthritis, higher risk patients were more likely to have a bone mineral density test and receive treatment for osteoporosis, as indicated by the clear dose response seen along the 10-year fracture risk from low to high-risk groups.     

刍议军队医院内部审计

医院内部审计工作是现代医院管理的一项重要内容。本文从医院内部审计工作的必要性入手,探讨军队医院内部审计的基本原则,并对发挥军队医院内部审计作用提出建议。     

输血科不合格标本的原因探析及改进

目的:探讨分析临床输血不合格标本产生的原因,保证临床用血安全。方法:选取2012年1―12月期间西安市红会医院输血科接收临床输血样本9 211例,对不合格标本进行原因分析,并指定出改进方案。结果:统计分析2012年上半年和下半年拒收例数分别为107例和24例,同比下降63.34%。样本不合格因素包括:申请单信息有误、血型填写错误、医师未签字、血样信息有误、血量不足、样本溶血、血样无标识。各指标下半年较上半年下降率分别为:28.25%、8.16%、4.58%、14.50%、2.29%、2.29%、4.01%。结论:严格执行输血前样本审核制度,保证临床输血安全有效。