Association between cancer fatalism and optimistic attitudes in colorectal cancer patients and the moderating effects / 国际外科学杂志

Objective:To investigate the association between cancer fatalism and optimistic attitudes among colorectal cancer patients, and how the above linkage is moderated by the involvement of patients′ opinions, the family members′ opinions and the physicians′ opinions in treatment decision-making.Methods:A cross-sectional survey was conducted on 64 patients diagnosed with colorectal cancer and awaiting radical colorectal cancer surgery in the Department of General Surgery of Beijing Friendship Hospital Affiliated to Capital Medical University, from January 2021 to December 2021. There were 38 males and 26 females, aged (61.2±13.0) years from 30 to 84 years. Cancer fatalism, optimism attitudes, and the involvement of patients′ opinions, the family members′ opinions and the physicians′ opinions in treatment decision-making were assessed. The patients′ cancer fatalism beliefs were measured by the " Chance" subscale of the Form C of the Multidimensional Health Locus of Control (MHLC-C), optimism attitudes were assessed by the Chinese version of the revised Life Orientation Test (CLOT-R), and the influence of patients′, family members′, and physicians′ opinions in the medical decision-making process was measured by a self-designed single factor scale. Measurement data of normal distribution were expressed as mean±standard deviation ( ± s). Measurement data of skewed distribution were expressed as M( Q1, Q3). Spearman correlation analysis and Chi-square test was used to examine the association between the main outcome variable (patients′ optimistic attitudes) and demographic and clinical characteristics. Interaction was examined by hierarchical linear regression analysis combined with simple slope tests. Results:Cancer fatalism was negatively associated with patients′ optimistic attitudes ( r=-0.35, P<0.01). Optimistic attitude of patients was significantly and negatively correlated with the influence of family members′ opinions on medical decision-making ( r=-0.25, P<0.05). There were significant positive correlations between the influence of patients′ and family members′ opinions ( r=0.50, P<0.01), family members′ and physicians′ opinions ( r=0.67, P<0.01), and physicians′ and patients′ opinions ( r=0.38, P<0.01) in medical decision making. Hierarchical linear regression analysis showed a negative association between cancer fatalism and optimism ( β=-0.32, P=0.01). This association was further moderated by the involvement of family members′ opinions ( β=-0.56, P<0.01) and the involvement of physicians′ opinions ( β=-0.36, P=0.04) in medical decision-making. Simple slope tests revealed that the negative impact of fatalistic attitudes on patients′ optimism attitudes may be potentiated when family members′ opinions have high influence on medical decision-making, while the negative impact may be buffered to some extent when physicians′ opinions have high influence on medical decision-making. Conclusions:Cancer fatalism had a negative effect on patients′ optimism. The high influence of physicians in treatment decision-making buffered the negative effect of cancer fatalism on optimism; the high influence of family members in treatment decision-making potentiated the negative effect of cancer fatalism on optimism. In the process of doctor-patient communication and shared decision-making, for patients with strong fatalistic attitudes, consideration should be given to appropriately increasing direct informational communication between physicians and patients and reducing excessive family intervention in medical decision-making, so as to enhance patients′ autonomy for treatment, promote optimism, and reduce the negative effects of cancer fatalism.

The Frequency and Cost of Redundant Biochemistry Test in Tertiary Teaching Hospital

@#Introduction: Laboratory tests account for 66% of clinical decision making and reducing inappropriate test utilisation is a step towards optimising patients’ care and hospital cost savings. This study aims to identify the rate and cost of redundant test requests in our centre. Methods: A cross-sectional study comprising laboratory results of 14 analytes in renal function test (RFT) and liver function test (LFT) were made. Data involved blood results from adult patients admitted to Hospital Universiti Sains Malaysia from January to December 2018. The redundant test is defined as test results consecutively normal twice and requested within 26 hours for analytes in RFT and 50 hours for analytes in LFT. Cost contributions were estimated by multiplying cost-per-test with total redundant requests. The test redundancy in different wards and disease groups were also evaluated. Results: Equal distribution of RFT and LFT requests were observed in both genders (50% respectively), with the most requests seen in the 60 – 79 years age group. More than 20% redundancy rate was observed for seven analytes (ALT, total bilirubin, sodium, urea, potassium, AST, Chloride), and overall redundancy was 19.7%, equals to Malaysian Ringgit (MYR) 669,105.00. Oncology wards and genitourinary diseases contribute to the highest redundancy rate. Conclusion: This study estimated MYR 600 thousands of saving if test redundancy were to be eliminated. The finding is hoped to serve as a platform for future intervention and policymaking. Future planning to optimise the current laboratory request system and collaboration among physicians and laboratory professionals can minimise test inappropriateness.

Literature Analysis for Clinical Application and Existing Problems of 2 Medical Order Auditing Modes / 中国药房

OBJECTIVE：To summari ze clinical application and existing problems of artificial auditing and information-based medical order auditing modes so as to provide reference for improving rational medication. METHODS ：Collecting data by literature search ，using “Prescription auditing ”“Medical order auditing ”“Prescription pre-auditing ”“Medication error ” “Medication-related problems ”“Medication safety ”“Alert fatigue ”“Medication review ”“Decision support medication review ” “Real-time medication review ”“Real-time prescription surveillance ”“Clinical alarms decision support systems ”“Clinical pharmacy information systems ”“Medication errors ”“Medication related problem ”as keywords ，the related literatures from Jan. 2000 to Nov. 2019 were retrieved from CNKI ，Wanfang database ，PubMed，Embase，Web of Science and other databases. The clinical application and existing problems of 2 medical order auditing modes were analyzed and summarized. RESULTS & CONCLUSIONS：The artificial auditing mode can reduce medication-related problems （such as poor drug treatment effect ， untreated symptoms or indications ，potential adverse drug events ，unnecessary drug treatment ，etc.），improve life quality of patients，but can not decrease the mortality and the length of hospitalization stay ；there are some problems ，such as many pharmacists needed for medical order auditing ，insufficient auditing time ，different auditing standards ，auditing time lagging. The information-based medical order auditing mode can reduce medication-related problems ，save auditing time ，reduce the incidence of medication errors ，reduce unreasonable medical orders ，and improve audit efficiency. Compared with the artificial auditing mode ，it has certain advantages ，but there are problems such as alarm fatigue. At present ，the domestic medical order auditing mode is dominated by artificial audit mode ；the information-based medical order auditing mode is still in the initial stage ，and the most attention is paid to its influence on the qualified rate of prescription ，while the research on the incidence of adverse events and other clinical effects is less. Later ，the 2 midical order can be D181100000218002）； improve to provide a reference for medical order auditing of 2019 hospital pharmacy personnel.

Comparison of Open-Source Electronic Health Record Systems Based on Functional and User Performance Criteria / 대한의료정보학회지

OBJECTIVES: Open-source Electronic Health Record (EHR) systems have gained importance. The main aim of our research is to guide organizational choice by comparing the features, functionality, and user-facing system performance of the five most popular open-source EHR systems. METHODS: We performed qualitative content analysis with a directed approach on recently published literature (2012–2017) to develop an integrated set of criteria to compare the EHR systems. The functional criteria are an integration of the literature, meaningful use criteria, and the Institute of Medicine's functional requirements of EHR, whereas the user-facing system performance is based on the time required to perform basic tasks within the EHR system. RESULTS: Based on the Alexa web ranking and Google Trends, the five most popular EHR systems at the time of our study were OSHERA VistA, GNU Health, the Open Medical Record System (OpenMRS), Open Electronic Medical Record (OpenEMR), and OpenEHR. We also found the trends in popularity of the EHR systems and the locations where they were more popular than others. OpenEMR met all the 32 functional criteria, OSHERA VistA met 28, OpenMRS met 12 fully and 11 partially, OpenEHR-based EHR met 10 fully and 3 partially, and GNU Health met the least with only 10 criteria fully and 2 partially. CONCLUSIONS: Based on our functional criteria, OpenEMR is the most promising EHR system, closely followed by VistA. With regards to user-facing system performance, OpenMRS has superior performance in comparison to OpenEMR.

Design and Application of Medical Order Evaluation Software of Proton Pump Inhibitors in the Inpatients from a Third Grade Class A Hospital / 中国药房

OBJECTIVE： To design Proton pump inhibitor （PPI） medical order evaluation software， and to promote rational drug use in clinic. METHODS： According to the use of PPI （PPI injection as an example） of inpatients in a Third Grade Class A hospital （hereinafter referred to as "sample hospital"）， the evaluation process of medical order evaluation software was designed. On this basis， medical order evaluation software for inpatients was developed in collaboration with computer engineers. Taking the detection rate of irrational drug use and the time consuming per capita as indicators， the effects of software evaluation and manual evaluation were compared. Dispensing medical orders of PPI injection in PIVAS of sample hospital was evaluated with the software pre-evaluation in Feb. 2018. Irrational use of PPI injection （including irrational medication for treatment， prevention and non-indication） in the inpatients was evaluated retrospectively during Jan. 2015-Dec. 2017. RESULTS： The software of PPI audit includes four modules：users and tasks （timing audit）， system settings， confirmation of audit results （check the results audited by the software automatically） and reports exporting. Compared with manual evaluation， there was no significant difference in detection rate of irrational drug use in software audit （69.50％ vs. 77.00％， P＞0.05）； the time consuming per capita was shortened significantly （9.25 min vs. 1.50 min， P＜0.05）. In the application of pre-evaluation， 27 （2.23％） were irrational for treatment， 318 （26.24％） were irrational for prevention and 602 （49.67％） for non-indications. In the application of retrospective review， 4 884 （2.68％） were irrational medication for treatment， 50 399 （27.67％） irrational medication for prevention and 85 106 （46.72％） medication without indications. CONCLUSIONS： The application of PPI medical order evaluation software shortens the time of pharmacist's evaluation， improves the efficiency of evaluation， and promotes the rational use of PPI in clinic.

Optimization and Practice of Prescription Audit Platform of PIVAS in Our Hospital / 中国药房

OBJECTIVE： To optimize prescription audit platform of PIVAS in our hospital， and to provide reference for rational drug use in pediatric department. METHODS： The records of irrational drug use and prescription comment record of physicians were collected and sorted out. Retrieved from drug instruction， China’s National Prescription Collection： Chemicals and Biological Products Volume （Children’s Edition） （2013） and other data， PIVAS prescription audit guideline of our hospital was filed. Based on it， PIVAS prescription audit platform was optimized. The efficiency and accuracy of prescription audit were evaluated using average daily medical order audit time， the number of audit pharmacists， average daily number of telephone communication with clinicians， average daily number of irrational medical orders， the detection rate of irrational medical order as indexes. RESULTS： The revised PIVAS prescription audit guideline is simple and easy to consult. After optimizing and implementing PIVAS prescription  auditor platform， average daily medical order audit time， the number of audit pharmacists， average daily number of telephone communication with clinicians， average daily number of irrational medical orders decreased by 33.33 ％， 50.00 ％， 57.89 ％， and 57.14 ％， respectively； the detection rate of irrational medical orders decreased from 1.38％ to 0.54％， with statistical significance （P＜0.05）， which indicated the efficiency and accuracy of prescription audit were improved significantly. CONCLUSIONS： The optimized PIVAS prescription audit platform can significantly improve the standardization of medical order audit and the level of rational drug use， and contribute to rational drug use in pediatric department.

Um sistema eletrônico de alerta ajuda a reduzir o tempo para diagnóstico de sepse / An electronic warning system helps reduce the time to diagnosis of sepsis

RESUMO Objetivo: Descrever os efeitos de melhorias sucessivas nos sistemas de alerta precoce para identificação de pacientes com sepse, no que se refere ao tempo até o diagnóstico, à administração de antibióticos e à mortalidade. Métodos: Trata-se de um estudo observacional de coorte, que descreve as sucessivas melhorias implantadas em um período de 10 anos no sistema de alerta precoce para detecção de sepse, incluindo vigilância ativa manual sistemática, alertas eletrônicos via telefonista, e alertas enviados diretamente a dispositivos móveis da enfermagem. Para todos os períodos, após o desencadeamento do alerta, o tratamento foi realizado segundo as diretrizes institucionais para sepse. Resultados: Durante estes anos, detectaram-se 637 pacientes com sepse. O tempo mediano entre a triagem e o diagnóstico foi reduzido de 19:20 (9:10 - 38:15) horas para 12:40 (2:50 - 23:45) horas quando se utilizou o método manual de vigilância (p = 0,14), para 2:10 (1:25 - 2:20) horas quando o alerta foi enviado automaticamente ao serviço telefônico do hospital (p = 0,014) e para 1:00 (0:30 - 1:10) horas quando o alerta foi enviado diretamente ao telefone celular da enfermagem (p = 0,02), com manutenção de valores similares nos anos que se seguiram. Não houve diferença no tempo até o tratamento em relação aos pacientes sobreviventes e não sobreviventes. Conclusão: Sistemas eletrônicos auxiliam na redução do tempo entre a triagem e o diagnóstico e entre o diagnóstico e o início da antibioticoterapia em pacientes com sepse.

ABSTRACT Objective: To describe the improvements of an early warning system for the identification of septic patients on the time to diagnosis, antibiotic delivery, and mortality. Methods: This was an observational cohort study that describes the successive improvements made over a period of 10 years using an early warning system to detect sepsis, including systematic active manual surveillance, electronic alerts via a telephonist, and alerts sent directly to the mobile devices of nurses. For all periods, after an alert was triggered, early treatment was instituted according to the institutional sepsis guidelines. Results: In total, 637 patients with sepsis were detected over the study period. The median triage-to-diagnosis time was reduced from 19:20 (9:10 - 38:15) hours to 12:40 (2:50 - 23:45) hours when the manual surveillance method was used (p = 0.14), to 2:10 (1:25 - 2:20) hours when the alert was sent automatically to the hospital telephone service (p = 0.014), and to 1:00 (0:30 - 1:10) hour when the alert was sent directly to the nurse's mobile phone (p = 0.016). The diagnosis-to-antibiotic time was reduced to 1:00 (0:55 - 1:30) hours when the alert was sent to the telephonist and to 0:45 (0:30 - 1:00) minutes when the alert was sent directly to the nurse's mobile phone (p = 0.02), with the maintenance of similar values over the following years. There was no difference in the time of treatment between survivors and non-survivors. Conclusion: Electronic systems help reduce the triage-to-diagnosis time and diagnosis-to-antibiotic time in patients with sepsis.

El pedido de resonancia magnética de rodilla: ¿puede ser reducido por especialistas? / The order of knee magnetic resonance: can it be reduced by specialists?

Introducción: El dolor de rodilla es una de las consultas más comunes en el consultorio traumatológico. Es comúnencontrarnos con pacientes que llegan a la consulta con una Resonancia Magnetica Nuclear (RMN) diciendo que tienenun menisco roto y buscando un turno en el quirófano. La mayoría de estos pacientes son factibles de tratamientoortopédico y es suficiente realizar maniobras semiologicas correctas para determinarlo. A pesar de ello hay un númerocreciente de solicitud de RMN de rodilla por miembros del equipo de salud. La hipótesis de este trabajo postula quelas RMN solicitadas por los especialistas en ortopedia y traumatología ofrecen resultados positivos tanto para los diagnósticos como para los planes de tratamiento.Objetivos: El objetivo de este trabajo es comparar la utilidad en el diagnóstico y en la definición terapéutica de las RMNde rodillas solicitadas por especialistas médicos...

Introduction: Knee pain is one of the most common complications in the trauma clinic. It is common to find patients whocome to the office with a Nuclear Magnetic Resonance (MRI) who have a broken meniscus and who are looking for a lathe inthe operating room. The majority of these patients are feasible for orthopedic treatment and it is sufficient to perform correct semiological maneuvers to determine it. Although there is a growing demand for knee MRI by members of the health team.The hypothesis of this work postulates that the NMR requested by the specialists in orthopedics and traumatology offerpositive results both for the diagnoses and for the treatment plans.Objectives: The aim of this study is to compare the usefulness in diagnosis and in the therapeutic definition of knee MRIs requested by medical specialists...

Practice of Standardization Work of Medical Orders Auditing in PIVAS of Our Hospital / 中国药房

OBJECTIVE:To promote the standardization of medical orders auditing in Pharmacy intravenous admixture service (PIVAS)of our hospital. METHODS:The standardization work of medical orders auditing developed in PIVAS of our hospital was introduced. According to comparing the intervention rate of pharmacists to the irrational medical orders and acceptance rate recom-mended by physicians for pharmacists before(the second quarter of 2016)and after(the third quarter of 2016)developing the stan-dardization work,the effectiveness was evaluated. RESULTS:PIVAS of our hospital had developed the standardization work by standardizing auditing criteria,maintaining and updating drug instructions in time and establishing relevant database,etc. After stan-dardization,pharmacists audited the medical orders more accurately and efficiently according to consistent standards and sufficient evidences. Compared with before,the intervention rate was decreased [1.41%(308/21776)vs. 0.74%(168/22750)] after develop-ing the standardization work,and acceptance rate was increased (95.1% vs. 98.8%). CONCLUSIONS:The standardization work of medical orders auditing developed in PIVAS of our hospital has improved the rationality of clinicians giving medical orders and acceptance degree of pharmacists'medication recommendation.

Improvement of the Timeliness Management of Finished Product Infusion Distribution in PIVAS of Our Hospital / 中国药房

OBJECTIVE:To improve the timeliness of finished product infusion distribution in pharmacy intravenous admixture service(PIVAS)of our hospital,and promote timely and rational drug use of patients. METHODS:The factors affecting the timeli-ness of finished product infusion distribution were analyzed in terms of personnel,software/hardware,and relevant measures were developed. The distribution of long-term medical orders'planning execution time and actual execution time in Jan.-Jun. 2015 (be-fore improvement) and Jan.-Jun. 2016 (after improvement) were summed up,as well as the average time in each link of PIVAS packing-delivery/infusion sending-clinical reception-actual execution time,and the effects were evaluated. RESULTS:For the per-sonnel,software/hardware and other aspects of the factors,measures were developed and implemented,including strengthening the communication of clinicians(issued medical orders)and nurses(performed medical orders)in related information,improving pro-fessional level and ability of pharmacists that reviewing medical orders in PIVAS,optimizing information system functions and im-proving related systems in PIVAS. Compared with the same period in 2015,peak time distribution was dispersed in medical orders' planning execution time and actual execution time in 2016. The average time of delivery/infusion sending-clinical reception de-creased by 10.13 min,and the time of each link in 2016 showed a slight downward trend month by month. CONCLUSIONS:The management improvement measures in PIVAS of our hospital have improved the timeliness of finished product infusion distribu-tion,and provided a guarantee for the timely treatment of clinical patients.

Development and Application of Medical Order Management Module for Chemotherapeutic Drugs in Hos-pitalized Information System / 中国药房

OBJECTIVE:To promote the standardization and rationality of medical order for chemotherapeutic drugs,and im-prove its safety use in clinic. METHODS:Through developing the investigation of relevant status quo,the design factors and infor-mation that should be involved and considered of the medical order management module for chemotherapeutical drugs in hospital-ized information system(HIS)were determined. The reference standard chemotherapy regimen used in medical orders was put for-ward. The basic data was maintained and menu setting was conducted. Based on HIS,the function module of automatically import-ing patients'information,drug and program selection,warning were designed;the docking and effective application of medical or-der management module for chemotherapeutical drugs in hospital medical order management information system was achieved. Its application effects were evaluated by summarizing monthly irrational rate of medical orders within 2 years. RESULTS & CONCLU-SIONS:The medical order management module for chemotherapeutical drugs developed in our hospital can achieve physician autho-rized management,automatically importing patient-related information,preservative chemotherapy regimen for easy entry and selec-tion. The irrational numbers of chemotherapy orders were decreased from 28 orders (1.15%) in prime (Jun. 2014) to 4 orders (0.14%)2 years later(Jun. 2016). Procedures of medical orders for chemotherapeutical drugs are standardized,initially realize in-formation management,improve input efficiency and accuracy of medical orders,which have provided protection and support for standardizing physicians'diagnosis and treatment behavior and avoiding the hospital risk,and promote correct,safe and rational use of chemotherapeutic drugs.

Rationality Evaluation of Medical Order in Oncology Department of a Hospital Before and After the Intervention of Clinical Pharmacist / 中国药师

Objective:To evaluate the rationality of medical order in oncology department of our hospital and analyze the intervention effect of clinical pharmacist.Methods:Totally 180 medical orders in oncology department of our hospital from January to June in 2013 were selected as the pre-intervention group,and those with the same number from January to June in 2014 were selected as the post-intervention group.The rationality of medical orders including drug selection,administration routes,usage and dosage was investigated and compared between the groups. Results:The unreasonable rate was 41.11% before the intervention and 8.33% after the intervention with statistically significant difference(P<0.05).The irrational drug use included inappropriate indications,usage and dosage,improper drug replacement and combination,and inappropriate adjuvant drug use.Conclusion:Irrational drug use in oncology department can be significantly reduced and the level of rational drug use can be improved through the intervention of clinical pharmacist.

Application of FOCUS-PDCA Cycle Management in Reducing the Incidence of Irrational Medical Orders of Parenteral Nutrition / 中国药房

OBJECTIVE:To reduce the incidence of irrational medical orders for parenteral nutrition,and promote the rational use of parenteral nutrition. METHODS:The medical orders for parenteral nutrition of the first quarter of 2016 in general surgery de-partment of our hospital were collected,and the number and types of its irrational medical orders were summed up. Then FO-CUS-PDCA(Find-organize-clarify-understand-select-plan-do-check-act)cycle management was adopted to analyze and improve the existing problems in issuing medical orders for parenteral nutrition. The improved(the third quarter of 2016)medical orders for par-enteral nutrition were collected,the number and types of its irrational medical orders were summed up,and management effect was evaluated. RESULTS:Establishing nutrition support group,strengthening the training and communication of medical staff,adding prescription evaluation module for parenteral nutrition in hospital information system and a number of measures had made the inci-dence of irrational medical orders for parenteral nutrition in general surgery department declined from 48.25%(1433/2970)before improvement to 5.67%(120/2118)after improvement. The incidences of cation excess,inappropriate selection of drugs and inap-propriate compatibility in irrational types were 0. CONCLUSIONS:FOCUS-PDCA cycle management can reduce the irrational rate of medical orders for parenteral nutrition and promote the rational use of parenteral nutrition in hospital.

Research on the Functional Orientation of Public Hospitals Based on Classification Diagnosis and Treatment / 中国卫生经济

Through the hierarchical diagnosis and treatment perspective to examine the functional status of public hospitals and hierarchical division of the status quo,it found that the current functional orientation of the problems and shortcomings.The impact on the medical order was analyzed.Functional ewolution of public hospitals should follow the hierarchical and differentiated development principles.All levels of hospitals needed to be repsitioned under the background of the hierarchy diagnosis.

Research on the Functional Orientation of Public Hospitals Based on Classification Diagnosis and Treatment / 中国卫生经济

Through the hierarchical diagnosis and treatment perspective to examine the functional status of public hospitals and hierarchical division of the status quo,it found that the current functional orientation of the problems and shortcomings.The impact on the medical order was analyzed.Functional ewolution of public hospitals should follow the hierarchical and differentiated development principles.All levels of hospitals needed to be repsitioned under the background of the hierarchy diagnosis.

Comparison and Analysis about Off-indication Use of Psychiatric Drugs in Our Hospital by the Standards of CFDA and FDA / 中国药房

OBJECTIVE:To investigate off-indication use of oral chemical drugs medical orders by the standards of CFDA and FDA,and to compare the differences between the two standards,analyze reasons and rationality of drug use,so as to pro-vide reference for establishing off-indications use management system. METHODS:The oral chemical drugs medical orders of inpatients were analyzed statistically during Jan.-Jun. 2016. Off-label uses was judged according to the standards of CFDA and FDA. RESULTS:Totally 507 oral chemical drugs medical orders were collected,the percentage of off-indications use were in high level,being 58.58% and 55.82% respectively by the standards of CFDA and FDA. The incidence of off-indication use of quetiapine and aripiprazole by the CFDA standards were significantly higher than the results of FDA standards,with statistical significance(P<0.05). Magnesium valproate(54.03%),escitalopram oxalate(10.45%)and quetiapine(10.15%)occupied the top 3 places in the list of constituent ratio. Among off-indication medical orders,7 orders had no evidence-based medicine,ac-counting for 2.36% of total. CONCLUSIONS:Most off-indication medical orders of our hospital could provide the basis and lit-erature support,while there are still a few off-indication use with insufficient evidence. The corresponding management system of the hospital should be formulated to guarantee the medication safety of the patients and legitimate rights and interests of the doctors.

Review and Analysis of Medical Orders in the Inpatients of Our Hospital during 2014-2015 / 中国药房

OBJECTIVE:To provide reference for rational drug use in the clinic. METHODS:Irrational medication orders eval-uated by the Affiliated Cancer Hospital of Zhengzhou University during Oct. 2014 to Sep. 2015 were arrangemented,summarized and analyzed. RESULTS:A total of 515 inpatient medical records were reviewed and analyzed,among which there were 165 unrea-sonable medical records and 185 irrational medication orders. Irrational medical records of general surgery department were the most(38 items,accounting for 23.03%). Irrational drug use mainly included irrational usage and dosage(80.00%),drug use with-out indications or not suit indications (7.57%),inappropriate solvent selection (4.86%). Including 66.22% of single overdose, 18.92% of longer medication duration. CONCLUSIONS:There are many irrational medical orders which should be standardized in our hospital,especially overdose and longer medication duration,which increase financial burden of patient. Pharmacists should strengthen communication with clinicians,and hold rational drug use trainings regularly base on the types of the irrationality. These can help to improve rational drug use and guarantee the safety of drug use.

To Shorten the Time of Admixture of Temporary Medical Order in PIVAS Using Six Sigma Method / 中国药房

OBJECTIVE:To shorten the time of admixture of temporary medical order in PIVAS,and to guarantee the timely treatment of patients. METHODS:Through the definition,measurement,analysis,improvement and control ie. five steps of six sigma method,the consumed time of each link of temporary medical order admixture in PIVAS was analyzed in our hospital during Mar. 9th-22nd in 2015 (before improvement);key points were found out,and relevant measures were formulated and improved;the consumed time of each link of temporary medical order admixture in PIVAS was collected again during Jul. 27th-Aug. 9th in 2015 in order to evaluate improvement effects. RESULTS:It was quality key point that total length of temporary medical order ad-mixture which included injection sequence,label checking,preparation,package rechecking,drug distribution and so on,was con-trolled within 120 min;through formulating and implementing various measures as improving information system,adjusting prepa-ration sequence and shunting staff posts flexibly,the total time of first 3 batches of temporary order admixture were 120,98 and 77 min after improvement,shortening by about 30,50 and 55 min respectively,compared with before improvement (P<0.05). CONCLUSIONS:The six sigma method has shortened the time of temporary order medical admixture in our hospital. The formulat-ed measures are effective and feasible.

Discussion of Clinical Pharmacists’ Work in the Safety Management of Medical Order / 中国药师

Objective:To screen clinical pharmacists’ intervention points in the medical order safety management according to the classification of irrational medical order, ranking of risk and causes analysis in order to provide ideas and reference for clinical pharma-cists. Methods:The prior interventions and post reviews were conducted on medical orders in an intensive care unit of the hospital from July to December in 2014. Results:A total of 224 medical records and 6583 medical orders were intervened, reviewed and audi-ted. Among the medical orders, 653 cases were irrational with a ratio up to 9. 92%. The 653 irrational medical orders were mainly classified with incompatibility, inappropriate dosage and irrelevant combinations, and mainly D level errors according to the risk rating. Most of the irrational medical orders were due to the lack of professional knowledge. Conclusion: Clinical pharmacists should partici-pate in medical order safety management including interfering drug compatibility, dosage and combination therapy, which can reduce or even avoid the error occurrence in medical orders and promote safe and reasonable medication through reasonable medication training and prior interventions.

Statistics and Analysis of Invalid Medical Order Warned by PASS in PIVAS of Our Hospital / 中国药房

OBJECTIVE:To study invalid medical order warned by Prescription automatic screening system (PASS),and to improve rational drug use monitoring. METHODS:The infusion medical order warned with black light,red light and orange light by PASS were extracted from Pharmacy intravenous admixture services(PIVAS)of our hospital during Oct. to Dec. 2014. Invalid warning items were analyzed statistically in respect of warning level,problem types and reasons. RESULTS & CONCLUSIONS:There are 3 392 warnings items,468 were invalid (13.80%) which include 10 items by black light,219 items by red light and 239 items by orange light;by problem types,there are 218 items of overdose and 136 items of repeated treatment,etc. The main causes of invalid warning include 191 items caused by wrong system prompt,126 items by incomplete system information,143 items by insufficient auditing standards,etc. There are still some defects of invalid warning in practical application of PASS. It is suggested that user and developer add the function of self-defined drug list or user-defined system data by,and unify auditing stan-dards of rational drug use,etc.,so as to timely update the system information,and improve the accuracy of software system moni-toring and warning function.