CN113035312A - Intelligent management and control system for using antibacterial drugs in perioperative period - Google Patents
Intelligent management and control system for using antibacterial drugs in perioperative period Download PDFInfo
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- CN113035312A CN113035312A CN202110237553.9A CN202110237553A CN113035312A CN 113035312 A CN113035312 A CN 113035312A CN 202110237553 A CN202110237553 A CN 202110237553A CN 113035312 A CN113035312 A CN 113035312A
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Abstract
The invention discloses an intelligent management and control system for using antibacterial drugs in a perioperative period, which comprises: the perioperative antibacterial medicine preventive use knowledge base module is used for storing information of indications of various operative and operative preventive use antibacterial medicines, incision types, restriction of suitable varieties of preventive use antibacterial medicines, postoperative preventive use medication course limitation and the like based on ICD-9 standard codes; the medicine taking state judging and selecting submodule is used for judging the current medicine taking state of the patient according to the ID of the patient, the operation application form and the operation state, displaying a path bar including operation medicine taking, including preoperative preventive medicine, intraoperative additional medicine, postoperative preventive medicine and postoperative prolonged preventive medicine, and setting different non-selectable states and default selection states in different paths; and the medication selection sub-module selects a medication path from the set selectable options in the medication path selection page according to the actual situation of the patient, and performs corresponding operation according to the medication path.
Description
Technical Field
The invention belongs to the technical field of information processing, and particularly relates to an intelligent management and control system for using antibacterial drugs in a perioperative period.
Background
The perioperative period is a whole process surrounding the operation, and comprises a period of time before, during and after the operation from the beginning of the planned operation of the patient to the completion of the operation and rehabilitation, specifically, from the confirmation of the operation and the beginning of the preparation of the operation until the diagnosis and treatment work related to the operation is basically finished.
Since the incision, the operative organ and the lacuna are inevitably polluted by the bacteria planted in the skin mucosa or resident bacteria in the bacteria-carrying cavity of the human body during the operation, postoperative operative site infection (SSI) may occur. Postoperative infection is one of the most major factors affecting the prognosis, prolonged hospitalization and increased medical costs of patients undergoing surgery.
The standardized prevention and use of antibacterial drugs in the perioperative period is an important measure for effectively reducing the infection (SSI) of operative sites, and comprises standardized preoperative prevention and use, intraoperative addition and postoperative prevention and use. Because of the various types of operations, 13600 operation ICD-9 standard codes and related names exist so far, the incision types are very complicated, and a clinician is difficult to comprehensively master whether various operations have indications of preventive antibacterial drugs, suitable preventive use varieties and postoperative preventive use time. Due to long-term clinical practice, the national perioperative antibacterial drug code has been used for less than 40% of prevention. The nonstandard prevention and use of the antibacterial agent in the perioperative period leads to increased postoperative surgical site infection, and the postoperative infection increases the proportion of the antibacterial agent used for treatment, thereby not only increasing the limited medical resource consumption, but also promoting the further development of the bacterial drug resistance.
Therefore, whether the usage of the antibacterial drugs in the perioperative period is standardized or not is related to the prognosis of patients, the consumption of medical resources and the development of bacterial drug resistance, and is an important ring for the management of medical quality and medical safety. The information technology is used for realizing the intelligent management and control of the whole process of each node used by the antibacterial agent in the perioperative period, the use of the antibacterial agent in the perioperative period of various operations is comprehensively standardized, and the infection of the postoperative operative part is reduced, so that the information technology is very necessary.
Disclosure of Invention
In view of the above technical problems, the present invention is directed to providing an intelligent management and control system for perioperative use of antibacterial drugs.
In order to solve the technical problems, the invention adopts the following technical scheme:
an intelligent management and control system for perioperative use of antibacterial drugs, comprising:
the perioperative antibacterial medicine prevention use knowledge base module is used for storing antibacterial medicine prevention use indication, operation incision type, antibacterial medicine variety limitation for prevention use and postoperative prevention use course limitation information of all operations and operations based on the ICD-9 standard code;
the medicine taking path judging and selecting submodule is used for judging the current medicine taking path of the patient according to the ID of the patient, the operation application form and the operation state and displaying a medicine taking path bar comprising an operation medicine taking path bar, wherein the operation medicine taking path bar comprises preoperative preventive medicine, intraoperative additional medicine, postoperative preventive medicine and postoperative prolonged preventive medicine, and different non-selectable states and default selection states are set in different paths;
and the medication selection sub-module selects a medication path from the set selectable options in the medication path selection page according to the actual situation of the patient, and performs corresponding operation according to the medication path.
Preferably, the administration route comprises in particular: the medication state is 1, the operation arrangement plan is obtained according to the ID of the patient for judgment, and if the patient does not have operation arrangement within 7 days in the future, the options of preoperative preventive medication, intraoperative additional medication and postoperative prolonged preventive medication are not selectable in the medication path selection page;
the medication state 2 is judged by acquiring a surgical scheduling plan according to the patient ID, surgical scheduling exists in 7 days in the future, the surgical state does not start, and in the medication path selection page, preoperative preventive medication, intraoperative additional prevention and postoperative preventive use are optional, and postoperative prolonged preventive medication is not optional;
a medication state 3, acquiring a surgical scheduling plan according to the patient ID, judging that surgical scheduling exists 3 days ago, judging whether the surgical state is an 'ended' state or not when the surgical time from the start of surgery is within the longest preventive use time of the surgery allowed by the knowledge base, if not, judging that the surgical state is 'intraoperative', selecting a medication path selection page, selecting options of preoperative preventive medication and postoperative prolonged preventive medication, and selecting postoperative preventive medication by default; if the operation state is the 'finished' state, judging that the operation state is 'finished', selecting the options of preoperative preventive medication, intraoperative preventive medication and postoperative prolonged preventive medication in a medication path selection page, and selecting postoperative preventive medication by default;
the medication state 4 is that a surgical scheduling plan is obtained according to the patient ID, the surgical scheduling is judged before three days, the surgical state is the 'finished' state, and the postoperative time to the start of the surgery exceeds the longest preventive use time of the surgery allowed by the knowledge base, so that the options of preoperative preventive medication, intraoperative preventive medication and postoperative preventive medication are not selectable in the medication path selection page, and postoperative prolonged preventive medication is selected by default;
and 5, acquiring a surgical scheduling plan according to the patient ID, judging that surgical scheduling exists before three days and the surgical state is an 'ended' state, and if the time from the beginning of the surgery to the beginning of the surgery exceeds 5 days, selecting treatment medicines by default in the options of preoperative medicines, intraoperative medicines, postoperative medicines and postoperative prolonged preventive medicines in the medication path selection page.
Preferably, when the corresponding operation is performed according to the medication path to select pre-operation preventive medication, whether the type of the operation incision needs to be used for preventive medication or not is judged according to the operation ICD code in the electronic medical record and the type of the operation incision in the knowledge base, if the type of the operation incision does not need to be used for preventive medication, a prompt box is popped up to show that the operation does not need to be used for preventive medication in principle, and whether a doctor selects to continue to use the antibacterial medication or not is further judged. If the antibacterial drugs are continuously used, popping up an indication table (K-I) for the preventive use of the antibacterial drugs for the operation according to indication data of the preventive use of the antibacterial drugs for the operation, clicking to determine to enter the next step after the doctor selects the indication or fills in the reason for the drugs, recording indication information of the preventive drugs for the operation by a system background, and judging whether the antibacterial drugs prescribed by the doctor are consistent with the drugs recommended by a knowledge base; if the doctor chooses not to use the antibacterial drugs, the sub-process is finished and the main process is returned to the page for selecting the antibacterial drug administration route.
Preferably, when the corresponding operation is performed according to the medication path to select intraoperative additional medication, an intraoperative additional preventive medication indication selection interface is popped up, a doctor selects an indication or clicks to determine to enter the next step after filling in a medication reason, the intraoperative additional preventive medication indication is recorded in the background, and whether the antibacterial medicine prescribed by the doctor is consistent with the medicine recommended by the knowledge base or not is judged.
Preferably, when the corresponding operation is performed according to the medication path to select postoperative preventive medication, judging whether the operation state is a completed state, if so, continuing to judge whether an antibacterial postoperative preventive medication order is given, and performing the corresponding operation after obtaining a judgment result; if the operation is not in the finished state, reminding the system to detect the current operation or the unfinished state, determining whether to take post-operation medication, judging the selection of the doctor, if the doctor chooses to continue taking post-operation medication, continuously judging whether to take post-operation preventive medication orders of the antibacterial drugs, carrying out corresponding operation after obtaining a judgment result, and if the doctor chooses not to continue taking post-operation medication, ending the sub-process and returning to an antibacterial drug medication path selection page.
Preferably, the step of continuously judging whether an antibacterial postoperative preventive medication order has been prescribed or not, and the corresponding operation after obtaining the judgment result specifically includes: if the postoperative preventive medication advice of the antibacterial drugs is already given, reminding the operation that postoperative preventive medication has already been given, and whether postoperative prolonged preventive medication is given or not, and if the postoperative prolonged preventive medication is selected, further judging whether postoperative prolonged preventive medication is given or not; if the post-operation prolonged preventive medication is not selected, further judging whether the post-operation prolonged preventive medication is the same as the post-operation preventive medication already prescribed, if the post-operation prolonged preventive medication is the same as the post-operation preventive medication already prescribed, continuing judging whether the previous medical advice is stopped, if the previous medical advice is not stopped, prompting that the post-operation preventive medication of the same antibacterial medication already exists, and the medical advice can not be prescribed any more, and returning to an EMR medical advice interface after the sub-process is finished; if the previous medical advice is stopped, continuously judging whether the ICD code and the incision type in the operation are in need of preventive use of antibacterial drugs in principle, and carrying out corresponding operation; if the operation is different from the previously opened antibacterial drugs, whether the operation ICD code and the incision type need to be used with the antibacterial drugs in a preventive manner or not is continuously judged, and corresponding operation is carried out.
Preferably, the continuous judgment of whether the ICD code and the surgical incision category in principle require the preventive use of antibacterial drugs or not specifically includes the following steps: if the incision type does not need to be used for preventing the antibacterial medicine in principle, popping up a reminding box to show that the operation does not need to be used for preventing the antibacterial medicine in the perioperative period in principle, continuously judging whether the doctor selects to continuously use the antibacterial medicine or not, if the doctor selects to continuously use the antibacterial medicine, popping up an indication table (K-I) of the antibacterial medicine for preventing the operation, clicking to determine to enter the next step after the doctor selects the indication or fills in the medicine reason, and recording the indication information of the pre-operation preventive medicine in a background; then judging whether the antibacterial medicines prescribed by the doctor are consistent with the medicines recommended by the knowledge base or not, and if so, ending the sub-process and entering the main process; if the antibacterial drug prescribed by the doctor is inconsistent with the drug recommended by the knowledge base, reminding that the recommended antibacterial drug is inconsistent with the recommended antibacterial drug, providing a recommended drug list, judging whether the doctor selects the recommended drug, if the original variety is still used, popping up an antibacterial drug variety selection table (K-II) for preventive use in the operation by the system, clicking to determine to enter the next step after the doctor selects the reason or fills in the medication reason, recording antibacterial drug variety selection information in a background, and ending the sub-process to enter the main process; and if the doctor chooses to use the recommended variety, ending the sub-process and entering the main process.
Preferably, the corresponding operation is selected according to the medication path, and then whether the postoperative preventive medication has been prescribed or not is judged, if the postoperative preventive medication has been prescribed, whether the postoperative preventive medication medical advice has not been stopped or not is further judged, if the medical advice has been stopped, the hours for reminding that the operation has been completed are popped up, and whether the preventive medication actually needs to be prolonged or not is inquired, and further operation is carried out; if the stopping advice does not exist, continuously judging whether the started antibacterial drug is the same as the drug variety of the postoperative preventive medication, if so, reminding that the same antibacterial drug is used for postoperative prevention, first stopping the original medication advice and then starting, and returning to the main flow antibacterial drug administration path selection page after the sub-flow is finished; if not, popping up the number of hours for reminding that the operation is completed, and inquiring whether the preventive medicine needs to be prolonged or not to perform further operation.
Preferably, popping up the number of hours that the procedure has been completed and asking if prolonged prophylactic administration is indeed needed, and performing further operations specifically comprises: popping up a postoperative prolonged preventive medication indication table (K-III), setting a medical advice time after selecting an indication or filling a reason, setting the maximum postoperative preventive medication time allowed by the operation, defaulting the maximum postoperative preventive medication time allowed by the operation to be selected by a doctor, entering an antibacterial drug combined use management sub-process, returning to an electronic medical record to open a medical advice page after the sub-process is finished, modifying or not modifying the start time of the medical advice by the doctor, popping up the medical advice pre-stop time, wherein the submitted medical advice has the pre-stop time, only the preset pre-stop time is allowed to be shortened, and the pre-stop time cannot be deleted or prolonged.
The invention has the following beneficial effects:
(1) the prevention and the use of the perioperative antibacterial drugs of various doctors and various operations at all levels can be comprehensively regulated, and the prevention and the use indications, the variety selection and the postoperative prevention and the use treatment period are included;
(2) by comprehensively preventing and using the antibacterial drugs in a standardized way, the incidence rate of postoperative surgical site infection is expected to be remarkably reduced, the proportion of the antibacterial drugs used for treating the postoperative infection is reduced, the adverse reaction of the antibacterial drugs is reduced, the medical quality and the medical safety are improved, the economic burden of patients is reduced, and the limited medical resources are saved;
(3) the system can help hospitals to reduce the utilization rate and the use strength of antibacterial drugs, improve the turnover rate of hospital beds and reduce the investment of hospital antibacterial drug management human resources;
(4) because the dosage of the bacterial drug resistance and the antibacterial drug is positively correlated, the large-scale application of the technical scheme of the invention is beneficial to inhibiting the rapid development of the bacterial drug resistance.
Drawings
Fig. 1 is a block diagram illustrating an intelligent management and control system for perioperative use of antibacterial agents according to an embodiment of the present invention;
FIG. 2 is a medication path diagram in accordance with an embodiment of the present invention;
FIG. 3 is a flowchart illustrating the administration control procedure when pre-operative preventive medication is selected according to an embodiment of the present invention;
FIG. 4 is a flowchart illustrating medication administration control when intraoperative additional medication is selected according to an embodiment of the present invention;
FIG. 5 is a flowchart illustrating medication management and control when selecting post-operative preventive medication in an embodiment of the present invention;
FIG. 6 is a flowchart illustrating the operation performed after determining whether an antibacterial agent-prescribed postoperative preventive medication order has been prescribed, and obtaining a determination result, in accordance with an embodiment of the present invention;
FIG. 7 is a flow chart illustrating the case where the antibacterial agent prescribed by the doctor is inconsistent with the drug recommended by the knowledge base in the embodiment of the present invention;
FIG. 8 is a flowchart illustrating administration control when selecting a post-operative extended prophylactic medication in accordance with an embodiment of the present invention;
FIG. 9 is a flow chart of an embodiment of the present invention popping up the number of hours that the procedure has been completed and asking if extension of preventive medication is indeed needed.
Detailed Description
The technical solutions in the embodiments of the present invention will be clearly and completely described below with reference to the drawings in the embodiments of the present invention, and it is obvious that the described embodiments are some, not all, embodiments of the present invention. All other embodiments, which can be derived by a person skilled in the art from the embodiments given herein without making any creative effort, shall fall within the protection scope of the present invention.
Referring to fig. 1, a structural block diagram of an intelligent management and control system for perioperative antibacterial use according to an embodiment of the present invention is shown, and includes a perioperative antibacterial preventive use knowledge base module, a medication path determination and selection sub-module, and a medication selection sub-module, wherein the perioperative antibacterial preventive use knowledge base module is used for storing antibacterial preventive use indications, surgical incision categories, antibacterial preventive use variety restrictions and post-operative preventive medication course restriction information of all operations and operations based on ICD-9 standard codes; the medicine taking path judging and selecting submodule is used for judging the medicine taking path of the patient according to the ID of the patient, the operation application form and the operation state and displaying a medicine taking path bar comprising an operation medicine taking path bar, wherein the operation medicine taking path bar comprises preoperative preventive medicine, intraoperative supplementary medicine, postoperative preventive medicine and postoperative prolonged preventive medicine, and different non-selectable states and default selection states are set in different paths; and the medication selection sub-module selects a medication path from the set selectable options in the medication path selection page according to the actual situation of the patient, and performs corresponding operation according to the medication path.
In a specific application example, referring to fig. 2, the medication path specifically includes:
the medication state is 1, the operation arrangement plan is obtained according to the ID of the patient for judgment, and if the patient does not have operation arrangement within 7 days in the future, the options of preoperative preventive medication, intraoperative additional medication and postoperative prolonged preventive medication are not selectable in the medication path selection page;
the medication state 2 is judged by acquiring the operation state according to the patient ID, the operation is scheduled within 7 days in the future, the operation state is not started, and the medication path selection page can be used for preoperative preventive medication, intraoperative additional prevention and postoperative preventive use;
a medication state 3, acquiring a surgical state according to the ID of a patient, judging that surgical arrangement is performed 3 days ago, judging whether the surgical state is an 'ended' state or not within the longest preventive use time of the surgery allowed by a knowledge base from the surgical start time, if not, judging that the surgical state is 'intraoperative', selecting a medication path selection page, wherein options of preoperative preventive medication and postoperative prolonged preventive medication are not selectable, selecting postoperative preventive medication by default, and if the surgical state is 'ended', judging that the surgical state is 'ended', selecting the medication path selection page, wherein the options of preoperative preventive medication, intraoperative preventive medication and postoperative prolonged preventive medication are not selectable, and selecting postoperative preventive medication by default;
the medication state 4 is obtained according to the patient ID, the surgical arrangement is judged before three days, the surgical state is judged to be the 'finished' state, the postoperative time to the start of the operation exceeds the longest preventive use time of the operation allowed by the knowledge base, the options of preoperative preventive medication, intraoperative preventive medication and postoperative preventive medication are not selectable in the medication path selection page, and postoperative prolonged preventive medication is selected by default;
and a medication state 5, acquiring a surgery state according to the ID of the patient, judging that the surgery is scheduled before three days and the surgery state is an 'ended' state, and if the time from the beginning of the surgery to the beginning of the surgery exceeds 5 days, selecting options of preoperative medication, intraoperative medication, postoperative medication and postoperative prolonged preventive medication in a medication path selection page, and selecting treatment medication by default.
Through the arrangement of different operation states and corresponding different operation medication routes, doctors can be helped to standardize the indication of the antibacterial drugs for the whole operation process, the variety selection and the treatment period for the prevention, the incidence rate of postoperative operation part infection is reduced, and the hospitalization time of patients is shortened.
In a specific application example, referring to fig. 3, when the corresponding operation is performed according to the medication path to select pre-operative preventive medication, according to the ICD standard code of the operation in the electronic medical record system and the type of the operation incision in the knowledge base, whether the operation needs to be prevented from using the antibacterial agent is judged, if not, then a prompt box is popped up to show that the operation does not need to be prevented from using the antibacterial medicine in principle, and whether the doctor chooses to continue using the antibacterial medicine is further judged, if the doctor continues using the antibacterial medicine, popping up an indication table (K-I) of the antibacterial drugs for operation according to the rule of the knowledge base of the antibacterial drugs for operation, clicking to determine to enter the next step after a doctor selects an indication or fills in a drug reason, recording the indication information of the pre-operation preventive drugs in a background, and judging whether the antibacterial drugs prescribed by the doctor are consistent with the drugs recommended by the knowledge base; if the doctor chooses not to use the antibacterial drugs, the sub-process is finished and the main process is returned to the page for selecting the antibacterial drug administration route.
In a specific application example, referring to fig. 4, when the corresponding operation is performed according to the medication path to select intraoperative additional medication, an intraoperative additional preventive medication indication selection interface is popped up, a doctor selects an indication or fills in a medication reason and clicks to determine to enter the next step, the intraoperative additional preventive medication indication information is recorded in a background, and whether an antibacterial drug prescribed by the doctor is consistent with a drug recommended by a knowledge base or not is judged.
In a specific application example, referring to fig. 5, when the corresponding operation is performed according to the medication path to select post-operative preventive medication, whether the operative state is the completed state is judged, and if the operative state is the completed state, whether an antibacterial post-operative preventive medication order has been prescribed is continuously judged, and the corresponding operation is performed after a judgment result is obtained; if the operation is not in the finished state, the reminding system detects the current operation or the unfinished state, whether postoperative preventive medication needs to be prescribed or not is determined, the selection of the doctor is judged, if the doctor chooses to continue the postoperative preventive medication, whether an antibacterial postoperative preventive medication order is prescribed or not is continuously judged, corresponding operation is carried out after a judgment result is obtained, and if the doctor chooses not to prescribe the postoperative preventive medication, the sub-process is finished and the antibacterial medication path selection page is returned.
Further, referring to fig. 6, continuously determining whether an antibacterial postoperative preventive medication order has been prescribed, and performing corresponding operations after obtaining a determination result specifically includes: if the postoperative preventive medication advice of the antibacterial drugs is already given, reminding the operation that postoperative preventive medication has already been given, and whether postoperative prolonged preventive medication is given or not, and if the postoperative prolonged preventive medication is selected, further judging whether postoperative prolonged preventive medication is given or not; if the post-operation prolonged preventive medication is not provided, further judging whether the post-operation prolonged preventive medication is the same as the prescribed post-operation preventive medication, if the post-operation prolonged preventive medication is the same as the prescribed post-operation preventive medication, continuously judging whether the previous medical advice is stopped, if the previous medical advice is not stopped, prompting that the post-operation preventive medication of the same antibacterial medication is provided, and the medical advice can not be provided, and returning to an electronic medical record medical advice interface after the sub-process is finished; if the previous medical advice is stopped, continuously judging whether the ICD code and incision type combination in the operation needs to be used with antibacterial drugs in principle, and carrying out corresponding operation; if the operation is different from the previously opened antibacterial drugs, whether the operation ICD code and the incision type combination need to use the antibacterial drugs in principle or not is continuously judged, and corresponding operation is carried out.
Further, whether the combination of the ICD code and the incision category needs to use antibacterial drugs in principle is continuously judged, and the corresponding operation specifically comprises the following steps: if the ICD code and the incision category combination do not need to use the antibacterial medicine in principle, popping up a reminding frame to show that the operation does not need to prevent using the antibacterial medicine in the perioperative period in principle, continuously judging whether the doctor chooses to continuously use the antibacterial medicine or not, if the doctor chooses to continuously use the antibacterial medicine, popping up an antibacterial medicine indication table (K-I) used in the operation, clicking to determine to enter the next step after the doctor chooses the indication or fills in the medicine reason, recording the preventive medicine indication information before the operation in a background, judging whether the antibacterial medicine prescribed by the doctor is consistent with the medicine recommended by the knowledge base or not, and entering the main flow if the consistent sub-flow is ended, wherein the above flow is basically consistent with the flow in the figure 3.
Referring to fig. 7, if the antibacterial drug prescribed by the doctor is inconsistent with the drug recommended by the knowledge base, reminding that the prescribed antibacterial drug variety is inconsistent with the antibacterial drug recommended by the operation, providing a recommended drug list, judging whether the doctor selects the recommended drug, if the original variety is still used, popping up an antibacterial drug variety selection table (K-II) for preventive use in the operation by the system, clicking to determine to enter the next step after the doctor selects a reason or fills in a medication reason, recording drug category indication information by a background, and ending the sub-process to enter the main process; and if the doctor chooses to use the recommended variety, ending the sub-process and entering the main process.
Referring to fig. 8, the corresponding operation is performed according to the medication path to select the post-operation prolonged preventive use, and determine whether the post-operation preventive medication has been prescribed, and further determine whether the post-operation preventive medication order has not been stopped if the post-operation preventive medication has been prescribed, and if the order has been stopped, pop up the number of hours for reminding that the operation has been completed, and ask whether the preventive medication actually needs to be prolonged, and perform further operation; if the stopping advice does not exist, continuously judging whether the started antibacterial drug is the same as the drug variety of the existing postoperative preventive medication, if so, reminding the existing same antibacterial drug to be used for the postoperative prevention, stopping the original medication advice first and then starting, and returning to the main flow antibacterial drug administration path selection page after the sub-flow is finished; if not, popping up the number of hours for reminding that the operation is completed, and inquiring whether the preventive medicine needs to be prolonged or not to perform further operation. Further, referring to fig. 9, popping up the number of hours that the procedure has been completed and asking if prolonged preventive medication is indeed needed, and performing further operations specifically includes: popping up an extended preventive medication indication table selection table (K-III), checking indications or filling reasons, setting a medical advice time, setting the maximum postoperative preventive medication time allowed by the operation, defaulting the maximum postoperative preventive medication time allowed by the operation to be selected by a doctor, entering an antibacterial drug combined use management sub-process, returning to an electronic medical record to set up an advice page after the sub-process is finished, modifying or not modifying the start time of the medical advice by the doctor, popping up the pre-stop time of the medical advice, ensuring the submitted medical advice to have the pre-stop time, only allowing the pre-stop time to be shortened, and not deleting or prolonging the pre-stop time.
Through the intelligent management and control system for using the antibacterial drugs in the perioperative period, the prevention and use of the antibacterial drugs in the perioperative period of various doctors and various operations at all levels can be comprehensively standardized, and the prevention and use indication, the variety selection and the postoperative prevention and use treatment course are included; by comprehensively preventing and using the antibacterial drugs in a standardized way, the incidence rate of postoperative surgical site infection is expected to be remarkably reduced, the proportion of the antibacterial drugs used for treating the postoperative infection is reduced, the adverse reaction of the antibacterial drugs is reduced, the medical quality and the medical safety are improved, the economic burden of patients is reduced, and the limited medical resources are saved; the system can help hospitals to reduce the utilization rate and the use strength of antibacterial drugs, improve the turnover rate of hospital beds and reduce the investment of hospital antibacterial drug management human resources; because the dosage of the bacterial drug resistance and the antibacterial drug is positively correlated, the large-scale application of the technical scheme of the invention is beneficial to inhibiting the rapid development of the bacterial drug resistance.
It is to be understood that the exemplary embodiments described herein are illustrative and not restrictive. Although one or more embodiments of the present invention have been described with reference to the accompanying drawings, it will be understood by those of ordinary skill in the art that various changes in form and details may be made therein without departing from the spirit and scope of the present invention as defined by the following claims.
Claims (9)
1. The utility model provides a perioperative period uses antibiotic medicine's intelligent management and control system which characterized in that includes:
the perioperative antibacterial medicine prevention use knowledge base module is used for storing antibacterial medicine prevention use indication, operation incision type, antibacterial medicine variety limitation for prevention use and postoperative prevention use course limitation information of all operations and operations based on the ICD-9 standard code;
the medicine taking path judging and selecting submodule is used for judging the medicine taking path of the patient according to the ID of the patient, the operation application form and the operation state and displaying a medicine taking path bar comprising an operation medicine taking path bar, wherein the operation medicine taking path bar comprises preoperative preventive medicine, intraoperative supplementary medicine, postoperative preventive medicine and postoperative prolonged preventive medicine, and different non-selectable states and default selection states are set in different paths;
and the medication selection sub-module selects a medication path from the set selectable options in the medication path selection page according to the actual situation of the patient, and performs corresponding operation according to the medication path.
2. The system for intelligently managing and controlling perioperative use of antibacterial drugs according to claim 1, wherein the medication route specifically comprises: the medication state is 1, the operation arrangement plan is obtained according to the ID of the patient for judgment, and if the patient does not have operation application and arrangement within 7 days in the future, the options of preoperative medication, intraoperative medication, postoperative prevention and postoperative prolonged prevention medication are not selectable in the medication path selection page;
the medication state 2 is judged by acquiring a surgical scheduling plan according to the patient ID, surgical scheduling exists in 7 days in the future, the surgical state does not start, and in the medication path selection page, preoperative preventive medication, intraoperative additional prevention and postoperative preventive use are optional, and postoperative prolonged preventive medication is not optional;
a medication state 3, acquiring a surgery arrangement plan according to the patient ID, judging that surgery arrangement exists before 3 days, judging whether the surgery state is an 'ended' state or not when the current time interval and surgery start time after surgery are within the longest prevention use time of the surgery allowed by the knowledge base, if not, judging that the surgery state is 'intraoperative', selecting a medication path in a medication path selection page, selecting options of preoperative preventive medication and postoperative prolonged preventive medication, and selecting postoperative preventive medication by default; if the operation state is the 'finished' state, judging that the operation state is 'finished', selecting the options of preoperative preventive medication, intraoperative preventive medication and postoperative prolonged preventive medication in a medication path selection page, and selecting postoperative preventive medication by default;
an administration state 4, which is to obtain an operation arrangement plan according to the patient ID, judge that the operation arrangement is carried out before three days and the operation state is an 'ended' state, and judge that the current time interval after the operation is beyond the longest operation preventing use time allowed by the knowledge base, so that the options of preoperative preventive medication, intraoperative preventive medication and postoperative preventive medication are not selectable in an administration path selection page, and postoperative prolonged preventive medication is selected by default;
and 5, acquiring a surgical scheduling plan according to the patient ID, judging that surgical scheduling exists before three days and the surgical state is an 'ended' state, and if the current time after surgery exceeds the surgical starting time by 5 days, selecting the options of preoperative medication, intraoperative medication, postoperative medication and postoperative prolonged preventive medication in a medication path selection page, and selecting treatment medication by default.
3. The system according to claim 1, wherein when the corresponding operation is performed according to the medication route to select pre-operative preventive medication, the system determines whether the type of surgical incision requires preventive use of antibacterial agent according to the ICD code in the electronic medical record and the type of surgical incision in the knowledge base; if the operation is not needed, popping up a reminding box to show that the operation does not need to be prevented from using antibacterial drugs in principle, further judging whether a doctor selects to continue using the antibacterial drugs, if the doctor continues using the antibacterial drugs, popping up an operation antibacterial drug prevention use indication table (K-I) according to the operation prevention use antibacterial drug indication data, clicking to determine to enter the next step after the doctor selects an indication or fills in a drug reason, recording preoperative prevention drug indication information by a system background, and judging whether the antibacterial drugs prescribed by the doctor are consistent with the drugs recommended by a knowledge base; if the doctor does not select to use the antibacterial drugs, the sub-process is finished and the main process is returned to the page for selecting the antibacterial drug administration route.
4. The system as claimed in claim 1, wherein when the corresponding operation is performed according to the medication path to select intraoperative additional medication, an intraoperative additional preventive medication indication selection interface is popped up, a doctor selects an indication or fills in a medication reason and clicks to determine to enter the next step, intraoperative additional preventive medication indication information is recorded in the background, and judgment is made as to whether the antibacterial medication prescribed by the doctor is consistent with the medication recommended by the knowledge base.
5. The intelligent management and control system for using antibacterial drugs in perioperative period as claimed in claim 1, wherein when the corresponding operation is performed according to the medication path to be postoperative preventive medication, whether the operation state is a completed state is judged, and if the operation state is the completed state, whether an antibacterial drug postoperative preventive medication order has been given is continuously judged, and the corresponding operation is performed after the judgment result is obtained; if the operation is not in the finished state, the reminding system detects the current operation or the unfinished state, whether postoperative preventive medication needs to be prescribed or not is determined, the selection of the doctor is judged, if the doctor chooses to continue the postoperative preventive medication, whether an antibacterial postoperative preventive medication order is prescribed or not is continuously judged, corresponding operation is carried out after a judgment result is obtained, and if the doctor chooses not to continue the postoperative preventive medication, the sub-process is finished and the antibacterial medication path selection page is returned.
6. The intelligent management and control system for using antibacterial drugs in perioperative period according to claim 5, wherein continuously judging whether or not a preventive medication order for the antibacterial drugs after operation is given, and performing corresponding operations after a judgment result is obtained specifically comprises: if the postoperative preventive medication advice of the antibacterial drugs is already given, reminding the operation that postoperative preventive medication has already been given, and whether postoperative prolonged preventive medication is given or not, and if the postoperative prolonged preventive medication is selected, further judging whether postoperative prolonged preventive medication is given or not; if the post-operation prolonged preventive medication is not selected, further judging whether the post-operation prolonged preventive medication is the same as the antibacterial medication used for the already-provided post-operation prevention, if the post-operation prolonged preventive medication is the same as the antibacterial medication already provided before, continuously judging whether the previous medical advice is stopped, if the previous medical advice is not stopped, prompting that the post-operation preventive medication of the same antibacterial medication exists, and the medical advice can not be provided any more, ending the sub-process and returning to an electronic medical record medical advice interface; if the previous medical advice is stopped, continuously judging whether the type of the operation incision is in need of preventing the use of antibacterial drugs in principle, and carrying out corresponding operation; if the type of the operation incision is different from the type of the antibacterial drug which is already provided, whether the type of the operation incision needs to use the antibacterial drug in principle or not is continuously judged, and corresponding operation is carried out.
7. The intelligent management and control system for perioperative use of antibacterial drugs according to claim 6, wherein continuously judging whether the type of the surgical incision requires use of antibacterial drugs in principle, and performing corresponding operations specifically comprises: if the ICD code and the incision category combination do not need to use the antibacterial drugs in principle, popping up a reminding frame to show that the operation does not need to use the antibacterial drugs in a perioperative period in principle, and continuously judging whether the doctor chooses to continue to use the antibacterial drugs or not; if the doctor chooses to continue using the antibacterial drugs, an indication table (K-I) for preventing the antibacterial drugs for the operation is popped up, the doctor chooses the indication or clicks to determine to enter the next step after filling in the drug reasons, the background of the system records indication information of the pre-operation preventive drugs, judges whether the antibacterial drugs offered by the doctor are consistent with the drugs recommended by the knowledge base or not, and enters the main flow if the consistent sub-flow is finished; if the antibacterial drug prescribed by the doctor is inconsistent with the drug recommended by the knowledge base, popping up a warning frame inconsistent with the recommended antibacterial drug, providing a recommended drug list, judging whether the doctor selects the recommended drug, if the original drug is still used, popping up an antibacterial drug variety selection table (K-II) by the system, clicking to determine to enter the next step after the doctor selects the reason or fills in the medication reason, recording antibacterial drug variety information by the background of the system, and ending the sub-process to enter the main process; and if the doctor chooses to use the recommended variety, ending the sub-process and entering the main process.
8. The intelligent management and control system for perioperative antibacterial drugs according to claim 1, wherein corresponding operations are performed according to the medication path to select postoperative prolonged prophylaxis, determine whether postoperative preventive medication has been prescribed, further determine whether the postoperative preventive medication order has not been stopped if the postoperative preventive medication has been prescribed, pop up hours for reminding that the operation has been completed if the order has been stopped, and inquire whether the preventive medication needs to be prolonged indeed, and perform further operations; if the stopping advice does not exist, continuously judging whether the used antibacterial drug is the same as the drug variety of the postoperative preventive medication, if so, reminding that the same antibacterial drug is used for the postoperative prophylaxis, please stop the original medication advice first and then start, and returning to the main flow antibacterial drug administration path selection page after the sub-flow is finished; if not, popping up the number of hours for reminding that the operation is completed, and inquiring whether the preventive medicine needs to be prolonged or not to perform further operation.
9. The system as claimed in claim 1, wherein the pop-up prompts the number of hours that the operation has been completed and asks if the preventive medication needs to be extended, and the further operations specifically include: popping up an indication selection table (k-III) of prolonged preventive medication, setting a medical order time after selecting an indication or filling a reason, setting the maximum postoperative preventive medication time allowed by the operation, defaulting the maximum postoperative preventive medication time allowed by the operation to be selected by a doctor, entering an antibacterial drug combined use management sub-process, returning to an EMR (emergency medical record) order page after the sub-process is ended, and popping up an order pre-stop time when the doctor modifies or does not modify the start time of the order, wherein the submitted order has the pre-stop time, only the pre-stop time is allowed to be shortened, and the pre-stop time cannot be deleted or prolonged.
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