CN108257652B - Intelligent reminding regulation and control system for infusion sequence - Google Patents
Intelligent reminding regulation and control system for infusion sequence Download PDFInfo
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- CN108257652B CN108257652B CN201810034105.7A CN201810034105A CN108257652B CN 108257652 B CN108257652 B CN 108257652B CN 201810034105 A CN201810034105 A CN 201810034105A CN 108257652 B CN108257652 B CN 108257652B
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Abstract
The invention discloses an infusion sequence intelligent reminding regulation and control system based on improvement of medication safety and effectiveness. The logic judgment module compares the medication of the patient advice with the data in the seven sub-databases, displays the comparison result in the display module, plays a role in prompting a PIVAS pharmacist, and finally marks the infusion sequence by the PIVAS pharmacist through the infusion sequence marking module according to the infusion sequence label marking quality standard. The invention follows the trend of the times of artificial intelligence, explores the infusion sequence regulation and control method based on the maximization of the curative effect of intravenous medication, the minimization of adverse reaction, the guarantee of medication safety and the reduction of medication disputes through intelligent reminding, greatly reduces the times of changing bottles (bags) and flushing tubes for continuous infusion by clinical nurses, improves the working efficiency and saves sanitary resources at the same time.
Description
Technical Field
The invention relates to the field of hospital PIVAS, in particular to an intelligent infusion sequence reminding and regulating system and an infusion sequence label marking quality standard (technical specification) based on improvement of medication safety and effectiveness.
Background
The inpatients in China use about 3.5-5.0 bags (bottles) of venous transfusion every day, the transfusion sequence is unreasonable, and the following problems are caused frequently:
(1) among 256 intravenous medicines in our hospital, which have the phenomena of turbidity, precipitation or discoloration in the infusion tube, 488 groups of incompatibility occur in the continuous infusion tube, which may cause medication disputes and even harm to human bodies.
(2) The stability of the prepared medicine is reduced, 15.8 percent of the medicine within 4 hours (including infusion time) of the validity period after the medicine is safely prepared in our hospital, and 22.3 percent of the total infusion amount per day cannot be ensured, and the infusion with short storage time after the preparation is not used in advance within the specified time, so that the treatment effect can be reduced, and even unsafe factors can be increased.
(3) Increasing adverse drug reactions or decreasing efficacy had approximately 36 groups of order-dependent drug interactions. In the combined chemotherapy scheme, adverse reactions such as bone marrow suppression and the like of the cisplatin are increased according to the infusion sequence of the cisplatin and the paclitaxel; the sequence of the infusion of 5-fluorouracil first and then calcium tetrahydrofolate reduces the antitumor effect of the former.
(4) The preventive medication is not used firstly, the medicine does not play a role in reducing adverse reactions and accounts for about 11.7 percent, the finished infusion accounts for 16.9 percent of the total daily infusion amount, and the chemotherapy drugs such as antiemetics, proton pump inhibitors, glucocorticoids, dexrazimine, reduced glutathione and the like are infused before the chemotherapy drugs for preventing vomiting, gastric mucosa injury, anaphylactic reactions, anthracycline cardiotoxicity and the like. However, reduced glutathione should be used immediately thereafter and the infusion is completed within 15 minutes to prevent adverse reaction of cyclophosphamide to urinary system injury.
(5) The best curative effect cannot be achieved without grasping the administration time point: some drugs are best administered at a time point during the day, at which time point infusion of the drug may be scheduled; the antimicrobial agent may be administered at a suitable frequency and time depending on the PK, PD characteristics.
In the face of a large amount of daily infusion, diversified patients, diversified medical advice which can be changed at any time, and the problems that in all the daily infusion of one patient, which two types of infusion can cause turbidity, color change and the like in the infusion tube due to continuous infusion, the infusion of which patient can improve the safety or the treatment effect through regulating and controlling the infusion sequence, and the like, the manual work cannot judge and the restraint is not done. The problem is solved by exploring an infusion sequence regulation and control method based on improvement of medication safety and effectiveness through intelligent reminding, and the hot and difficult problems in the field of centralized blending of intravenous medication are solved, so that the curative effect of intravenous medication is maximized, adverse reactions are minimized, medication safety is ensured, and medication disputes are reduced. Meanwhile, the times of replacing the infusion tube by a nurse and needing to wash the infusion tube are greatly reduced, the working efficiency of the nurse is improved, and the infusion cost for washing the tube is saved by about 120 ten thousand yuan/year.
To date, there is no infusion sequence control software or system that fully covers various pharmaceutical information and sequences all intravenous infusions for each inpatient for one day based on improved medication safety and effectiveness.
1. Most prescription reviewing software reminds unreasonable medication information such as overdose and improper administration frequency in the prescription and does not relate to sequential regulation and control of intravenous infusion.
2. Only one document, design and implementation of a venous sequence instillation monitoring system based on incompatibility, reports a software system related to an infusion sequence, and also only monitors incompatibility generated in an infusion tube between two groups (bags) of continuous infusion of intravenous drugs in real time, and does not relate to infusion sequence regulation and control prompting according to the administration frequency, auxiliary drugs after drugs are treated, storage time limit after blending, chronopharmacology, sequence-dependent drug interaction, venous irritation and the like. And the system can only avoid or reduce the generation of incompatibility in the infusion tube by adjusting the infusion sequence, and the system developed by the project avoids or reduces the generation of incompatibility in the infusion tube on the basis of improving the medication safety and effectiveness of patients. At present, no comprehensive intelligent system for regulating and controlling the infusion sequence exists.
3. Only a few cases are analyzed and reported, the medication safety and effectiveness are improved by sequencing the infusion sequence, and the method is not a method for comprehensively regulating the infusion sequence. The project explores that the infusion sequence is regulated and controlled by an intelligent method, and also finds that about 66.8 percent of inpatients need to be regulated and controlled in the infusion sequence based on the purpose of improving the medication safety and effectiveness.
The invention aims to provide an intelligent infusion sequence reminding and regulating system based on improvement of medication safety and effectiveness, so as to solve the problem that the infusion sequence in the prior art is difficult to regulate and control effectively.
In order to achieve the purpose, the technical scheme adopted by the invention is as follows:
the utility model provides a regulation and control system is reminded to infusion order intelligence which characterized in that: the method comprises the following steps of adopting a WCF data channel technology and an SOA design method in a PIVAS system, constructing seven sub databases based on a C/S framework, a logic judgment module, a display module and an infusion sequence marking module, wherein:
the first sub-database stores the incompatibility data of intravenous medication, namely stores the intravenous medication data with incompatibility in each group (2 types);
the second sub-database stores intravenous medication sequence dependency interaction data, namely stores intravenous medication data with interaction in each group (2 types);
the third sub-database stores the intravenous administration data of each pharmacology at the time of day;
the fourth sub-database stores the intravenous administration data with certain storage time limit after the preparation;
the fifth sub-database stores vein medication data as auxiliary medication;
the sixth sub-database stores vein drug data with vein stimulation;
the seventh sub-database stores intravenous medication data which can be used as preventive medication;
the logic judgment module provides a data interface facing the PIVAS pharmacist, and the PIVAS pharmacist inputs seven sub-database information except the administration frequency to the logic judgment module through the data interface; the logic judgment module extracts the vein medication used by each medical advice from each patient medical advice respectively, and then:
the logic judgment module compares the intravenous medication used by each medical advice with the data in the first sub-database to determine the intravenous medication with a incompatibility relation in the medical advice;
the logic judgment module compares the infusion medicines used by each medical advice with the data in the second sub-database to determine the intravenous medicines with sequence dependence interaction in the medical advice;
the logic judgment module compares the intravenous medication used by each medical advice with the data in the third sub-database to determine the intravenous medication with chronopharmacology in each medical advice;
the logic judgment module compares the intravenous medication used by each medical advice with the data in the fourth sub-database to determine the intravenous medication with a certain storage time limit after the blending in the medical advice;
the logic judgment module compares the venous transfusion used by each medical advice with the data in the fifth sub-database to determine the auxiliary medication in the medical advice;
the logic judgment module compares the intravenous medication used by each medical advice with the data in the sixth sub-database to determine the intravenous medication with vein irritation in the medical advice;
the logic judgment module compares the venous transfusion used by each medical advice with the data in the seventh sub-database to determine preventive medication in the medical advice;
the seven comparison results are sent to a display module by a logic judgment module and displayed to a PIVAS pharmacist in a list form by the display module so that the PIVAS pharmacist can manually judge the infusion sequence of each medical advice of the patient;
the infusion sequence marking module provides a data interface facing a PIVAS pharmacist, the PIVAS pharmacist writes the infusion medication sequence into the infusion sequence marking module through the data interface, and finally the infusion medication sequence is displayed in an interface mode through the infusion sequence marking module.
The invention solves the difficult problem of centralized blending of intravenous medicines. The invention conforms to the trend of the times of artificial intelligence, discovers that the curative effect is maximized and the adverse reaction is minimized based on intravenous medication through intelligent reminding, ensures the medication safety, reduces the infusion sequence regulation and control of medication disputes, greatly reduces the times of changing bottles (bags) and flushing tubes for continuous infusion of clinical nurses, improves the working efficiency of the clinical nurses, and saves sanitary resources at the same time. Compared with the prior art, the invention has the following advantages:
1. the curative effect is maximized: the optimal time point is arranged according to chronopharmacology for administration; regulating the administration frequency; the antibacterial drug is administrated according to PK and PD characteristics and according to proper frequency and time; the beneficial drug interactions are utilized to improve the efficacy.
2. Adverse reactions were minimized: avoiding adverse drug interactions; first, preventive medication and then chemotherapy; reducing renal toxicity upon biorhythmic dosing; drugs with strong vein irritation are preferably used.
3. Ensuring the medication safety: avoids incompatibility of two kinds of continuous infusion in the infusion tube; ensures the stability of the medicine, and has short storage time after preparation and preferential infusion.
4. Reducing disputes of medication
5. The work flow of the clinical nurse is optimized, the work efficiency is improved, and the sanitary resources are saved.
The invention has milestone significance in the field of intravenous medication centralized allocation, fills the gap of infusion sequence regulation and control based on improvement of intravenous medication safety and effectiveness, and opens up a new idea for hospitals to expand safe medication and reasonable medication.
Drawings
Fig. 1 is a schematic diagram of the system of the present invention.
FIG. 2 is a schematic diagram of a sub-database of the present invention.
Detailed Description
As shown in fig. 1 and 2, a transfusion sequence intelligent reminding regulation and control system adopts a WCF data channel technology and an SOA design method in a PIVAS system to construct seven sub-databases based on a C/S architecture, and a logic judgment module, a display module, and a transfusion sequence labeling module, wherein:
the first sub-database stores the incompatibility data of intravenous medication, namely stores the intravenous medication data with incompatibility in each group (2 types);
the second sub-database stores intravenous medication sequence dependency interaction data, namely stores intravenous medication data with interaction in each group (2 types);
the third sub-database stores the intravenous administration data of each pharmacology at the time of day;
the fourth sub-database stores the intravenous administration data with certain storage time limit after the preparation;
the fifth sub-database stores vein medication data as auxiliary medication;
the sixth sub-database stores vein drug data with vein stimulation;
the seventh sub-database stores intravenous medication data which can be used as preventive medication;
the logic judgment module provides a data interface facing the PIVAS pharmacist, and the PIVAS pharmacist inputs a plurality of medical orders of the patient into the logic judgment module through the data interface; the logic judgment module extracts the vein medication used by each medical advice from each patient medical advice respectively, and then:
the logic judgment module compares the intravenous medication used by each medical advice with the data in the first sub-database to determine the intravenous medication with a incompatibility relation in the medical advice;
the logic judgment module compares the intravenous medication used by each medical advice with the data in the second sub-database to determine the intravenous medication with sequence dependence interaction in the medical advice;
the logic judgment module compares the intravenous medication used by each medical advice with the data in the third sub-database to determine the intravenous medication of the chronopharmacology in the medical advice;
the logic judgment module compares the intravenous medication used by each medical advice with the data in the fourth sub-database to determine that the medical advice has stored intravenous medication after being prepared;
the logic judgment module compares the intravenous medication used by each medical advice with the data in the fifth sub-database to determine the intravenous medication which is used as auxiliary medication in the medical advice;
the logic judgment module compares the intravenous medication used by each medical advice with the data in the sixth sub-database to determine the intravenous medication with vein irritation in the medical advice;
the logic judgment module compares the intravenous medication used by each medical advice with the data in the seventh sub-database to determine the intravenous medication which can be used as preventive medication in the medical advice;
the seven comparison results are sent to the display module by the logic judgment module and are displayed to a PIVAS pharmacist in a list form by the display module so that the PIVAS pharmacist can manually judge the infusion medication sequence of each medical advice of the patient;
the infusion sequence marking module provides a data interface facing a PIVAS pharmacist, the PIVAS pharmacist writes the infusion medication sequence into the infusion sequence marking module through the data interface, and finally the infusion medication sequence is displayed in an interface mode through the infusion sequence marking module. After the coastal lake hospital in the fertilizer market carries out the method, the number of times of flushing the tube by changing the bottle (bag) by a clinical nurse in a continuous infusion mode is reduced from 32.56 times per day in each disease area (the tube is flushed every time the bottle (bag) is changed according to the requirement) to 1.39 times per day in each disease area, and the infusion for flushing the tube by changing the bottle (bag) can be saved by about 120 ten thousand yuan per year.
The invention can control the administration time point and improve the curative effect: some drugs are best administered at a time point during the day, at which time point infusion of the drug may be scheduled; the antimicrobial agent may be administered at a suitable frequency and time depending on the PK, PD characteristics.
The invention can improve the curative effect or reduce the adverse reaction: in the combined chemotherapy scheme, the calcium tetrahydrofolate is firstly administered and then the 5-fluorouracil is administered, so that the anti-tumor effect of the calcium tetrahydrofolate can be improved; the adverse reactions such as bone marrow suppression and the like of the paclitaxel can be reduced by firstly administering the paclitaxel and then administering the cisplatin;
the invention can avoid incompatibility in the infusion tube: the cefoperazone sodium tazobactam sodium, the ambroxol hydrochloride injection and the doxofylline injection are common combined medicines for respiratory system infection, white precipitates can be generated in an infusion tube when the cefoperazone sodium tazobactam sodium and the ambroxol hydrochloride injection are continuously infused, and the doxofylline injection is preferably arranged between the cefoperazone sodium tazobactam sodium and the ambroxol hydrochloride injection for infusion. If the doxofylline injection is stopped, two groups (bags) of infusion are connected and the tube is flushed. In addition, the transfusion sequence is not properly arranged, and the tube is flushed between every two bags (groups) of transfusion, thereby increasing the workload of nurses.
The invention can ensure the stability of the medicine: after the intravenous medicines are intensively prepared, medicines with certain storage time limit requirements after preparation are prepared according to the sequence of short storage time to long storage time, and then the medicines are prepared and firstly infused, so that the medication safety is ensured.
In addition, the treatment medicine is infused firstly, then the auxiliary medicine is infused, and the like, in a word, the infusion of the finished product is a very complicated technical work which is beneficial to patients and is carried out according to a scientific and reasonable sequence.
Claims (1)
1. The utility model provides a regulation and control system is reminded to infusion order intelligence which characterized in that: the method comprises the following steps of adopting a WCF data channel technology and an SOA design method in a PIVAS system, constructing seven sub databases based on a C/S framework, a logic judgment module, a display module and an infusion sequence marking module, wherein:
the first one stores the incompatibility data of intravenous medication, namely the intravenous medication data of 2 medicines in each group with incompatibility is stored, the incompatibility between every two 3 medicines is calculated according to 2 groups, and the rest is done in the same way;
the second sub-database stores drug interaction data of intravenous medication, namely intravenous medication data of 2 drugs in each group with sequence dependence drug interaction, 3 drugs with interaction between each two are calculated according to 2 groups, and the rest is done in the same way;
the third sub-database stores the data of each intravenous medication with chronopharmacology;
the fourth sub-database stores certain storage time limit data after each intravenous administration is prepared;
the fifth sub-database stores vein medication data as auxiliary medication;
the sixth sub-database stores vein drug administration data with vein irritation;
the seventh sub-database stores intravenous medication data used as preventive medication;
the logic judgment module provides a data interface facing the PIVAS pharmacist, and the PIVAS pharmacist inputs seven sub-database information except the administration frequency to the logic judgment module through the data interface; the logic judgment module extracts the vein medication used by each medical advice from each patient medical advice respectively, and then:
the logic judgment module compares the intravenous medication used by each medical advice with the data in the first sub-database to determine whether the intravenous medication in the medical advice has a incompatibility relationship;
the logic judgment module compares the intravenous medication used by each medical advice with the data in the second sub-database to determine whether the intravenous medication in the medical advice has the interaction of sequence dependence;
the logic judgment module compares the intravenous medication used by each medical advice with the data in the third sub-database to determine whether the intravenous medication in the medical advice has chronopharmacology;
the logic judgment module compares the intravenous medication used by each medical advice with the data in the fourth sub-database to determine whether each intravenous medication in the medical advice has a storage time limit after being prepared;
the logic judgment module compares the intravenous medication used by each medical advice with the data in the fifth sub-database to determine whether each intravenous medication in the medical advice contains auxiliary medication;
the logic judgment module compares the intravenous medication used by each medical advice with the data in the sixth sub-database to determine whether each intravenous medication in the medical advice has intravenous irritation;
the logic judgment module compares the intravenous medication used by each medical advice with the data in the seventh sub-database to determine whether each intravenous medication in the medical advice is preventive medication;
the seven comparison results are sent to the display module by the logic judgment module and are displayed to a PIVAS pharmacist in a list form by the display module so that the PIVAS pharmacist can manually judge the infusion medication sequence of each medical advice of the patient;
the infusion sequence marking module provides a data interface facing a PIVAS pharmacist, the PIVAS pharmacist writes the infusion medication sequence into the infusion sequence marking module through the data interface, and finally the infusion medication sequence is displayed in an interface mode through the infusion sequence marking module.
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