Application of FMEA model and 6S management method in reducing dispensing errors in PIVAS of children’s hospitals / 中国药房

OBJECTIVE To reduce dispensing errors in pharmacy intravenous admixture service （PIVAS） of children’s hospitals. METHODS The risk of dispensing procedures in our PIVAS was identified by applying failure mode and effect analysis （FMEA） model. Potential failure modes that might lead to dispensing errors in each link were determined， and failure causes were analyzed. The severity， incidence and detection degree of potential failure modes were quantitatively scored， and their risk priority number （RPN） was calculated to screen failure modes that needed to be improved in priority； the corresponding improvement measures were developed by 6S management method from six aspects， namely， finishing （seiri）， rectifying （seiton）， sweeping （seiso）， sanitation （seiketsu）， literacy （shitsuke） and safety. The effect of intervention before and after rectification was evaluated. RESULTS Based on the RPN， 32 potential failure modes were selected， of which a total of 18 critical failure modes that needed to be improved in priority. After implementing corresponding measures according to 6S management method， the RPN of 18 critical failure modes decreased. The total RPN decreased from 497 to 142 with a decrease rate of 71.43%. The error rates of 15 critical failure modes were significantly lower than before implementation （P＜0.05）. CONCLUSIONS Applying FMEA model and 6S management method to the risk control of all aspects of PIVAS workflow can effectively reduce the risk of PIVAS dispensing errors and ensure the safety of children’s intravenous medication.

Exploration of pharmaceutical service model in multidisciplinary diagnosis and treatment of rare diseases in children / 中国药房

OBJECTIVE To explore the pharmaceutical service model in multidisciplinary diagnosis and treatment （MDT） of rare diseases in children. METHODS Clinical pharmacists of West China Second University Hospital （hereinafter referred to as “our hospital”） participated in the process of MDT of children’s rare diseases. Clinical pharmacists took part in the entire diagnosis and treatment process of children and established the MDT pharmaceutical service model of children’s rare diseases by formulating drug treatment plans based on evidence-based practice， improving the accessibility of drugs， pharmaceutical monitoring and drug treatment management. RESULTS From January 2021 to April 2022， clinical pharmacists of our hospital had participated in a total of 39 cases of rare diseases MDT in children， including 21 hospitalized children with rare diseases and 18 outpatient com children with rare diseases， involving a total of 23 rare diseases. Clinical pharmacists completed 45 pharmaceutical zhanglingli@scu.edu.cn rounds and 26 pharmaceutical consultations for rare diseases inpatients， 25 outpatients’ MDT and 5 pharmaceutical outpatient service for outpatients with rare diseases， 38 medication educations for inpatients and outpatients with rare diseases and 25 follow-up services for out-of-hospital patients. There were 24 cases （61.54%） of off-label drug use， involving 13 rare diseases and 16 therapeutic drugs， among which off-label drug use registration of 11 drugs had been completed or was in progress. The temporary purchase evaluations of 3 drugs had been completed； 268 cases of medical insurance drug and high-value drug prescription had been reviewed. CONCLUSIONS Our hospital have primarily established a loop pharmaceutical service model of MDT for children with rare diseases， which covers inpatients and outpatients. The model improves the availability and standardization of clinical application of therapeutic drugs， and diagnosis and treatment level for children with rare diseases in our hospital.

Recommendations for prescription review of antipyretic-analgesics in symptomatic treatment of children with fever / 中华实用儿科临床杂志

Antipyretic-analgesics are currently one of the most prescribed drugs in children.The clinical application of antipyretic-analgesics for children in our country still have irrational phenomenon, which affects the therapeutic effect and even poses hidden dangers to the safety of children.In this paper, suggestions were put forward from the indications, dosage form/route, dosage suitability, pathophysiological characteristics of children with individual differences and drug interactions in the symptomatic treatment of febrile children, so as to provide reference for the general pharmacists when conducting prescription review.

Investigation and Analysis of the Status Quo and Influence Factors for Scientific Research Training of Pharma- cists（Nurses）in PIVAS of China / 中国药房

OBJECTIVE：To investigate the status quo and influential factors for scientific research training of pharmacists （nurses）in PIVAS of China ，to provide direction and reference for the development of PIVAS. METHODS ：The survey method was used to conduct a questionnaire survey of PIVAS pharmacist （nurses）from 29 tertiary and secondary hospitals in 24 provinces， autonomous regions ， municipalities from eastern ， western and central China through the i nternet by using self-designed questionnaire. The survey period was from Mar. to Apr. 2019. The survey content included the basic information （gender，region， hospital level ，professional and technical title ，education background ，employment nature ）of the survey participants and the status quo of scientific research training （frequency and content of scientific research training ，degree of need for scientific research ， degree of interest in scientific research ，etc.）and status quo of scientific research output （publication and application of the project）. Main influential factors for scientific research training were analyzed. RESULTS ：A total of 504 questionnaires were sent out，and 501 valid questionnaires were collected ，with effective response rate of 99.40％ . Totally 63.1％（316/501）of the respondents had scientific training ，and the frequency of scientific training was mainly less than one time/month （26.1％，131/501） and 1-2 times/month（25.0％，125/501）；72.1％（361/501）of the respondents have medium or above scientific research needs ， 82.4％（413/501）of the respondents have medium or above interest in scientific research ，only 6.0％（30/501）of the respondents had mastered the major scientific research methods ， only 5.4％（27/501）of the respondents thought that their scientific research ability were strong. The pharmaceutical re search - direction was mainly related to clinical rational use of drugs ， song_123@126.com less to precision medicine ，new drug and new dosage form： development， therapeutic drug monitoring research ， 028-85503220。E-mail：linyunzhu99@163.com translational medicine ， etc. Only 16.6％ （83/501） of the respondents had published articles after working in PIVAS ，and 9.0％（45/501）had applied for projects. There were statistical significances in the scientific research training among the respondents with different regions ，professional and technical titles ， educational backgrounds and employment natures （P＜0.05）. CONCLUSIONS ：The scientific research training of PIVAS pharmacist（nurses）in China is inadequate and the research output is low. Main influential factors for scientific research training include region ，professional and technical title ，educational background and employment nature .

Analysis of Hot Spots in the Field of Pharmacy ——Taking China Pharmacy as Example / 中国药房

OBJECTIVE： To explore current hot spots in drug research and application，and provide reference of the draft use standard for pharmacy journal editor. METHODS： Taking China Pharmacy （short for our magazine） as example，all literatures published by our magazine and included by CNKI were searched during inception （Jan. 1990） and Mar. 19th， 2019； top 150 literatures [top 100 non-review literatures （NRA） and top 50 review literatures （RA）] were collected according to comprehensive score of downloaded number and citied number as indicators， and then analyzed in respects of publication year，column of NRA，first author’s work unit， subject words； one literatures which the cited number was largest was analyzed separately. RESULTS： Totally 150 literatures were published between 1993 and 2016， while the literature amount reached the maximum value in 2010 （18 articles）. Among NRA， the most were in the columns of “pharmacy administration” （44 articles， 44.00％）， “TCM and ethnic medicine” （18 articles， 18.00％）， “pharmacists and pharmaceutical care” （14 articles， 14.00％）. Among 150 first authors，73 （48.67％） were from college， 62 （41.33％） were from hospital. Subject words of NRA were “status and development” （20 times）， “active ingredient” （14 times）， “international experience” （9 times）， while those of RA were “pharmacological action” （25 times）， “Chinese herbal medicine” （15 times）， “active ingredient” （12 times）. The Principles and Utilization of Sequential Analysis of DDD System of Drug in Hospitals was cited for 1 426 times， which was much higher than the second one （261 times）. CONCLUSIONS： This study can show the good literatures origin and study direction，provide reference to the hot spots for readers. At the same time， high-frequency cited literatures also suggests that researchers can conduct in-depth analysis of controversial and unclear contents in academic circles.

Status Quo of Cost Estimation and Systematic Review in Pharmacy Intravenous Admixture Services in China / 中国药房

OBJECTIVE： To systematically evaluate the status quo of cost estimation in pharmacy intravenous admixture services （PIVAS）， and to provide cost basis for the construction of PIVAS in China. METHODS： Retrieved from PubMed， Embase， Cochrane library， CBM， CNKI， CSJD and Wanfang database from database establishment to Jan. 2019， the studies about the status quo of cost estimation in PIVAS of China were included. The descriptive analysis was conducted for content and method of cost estimation， infection to hospital. RESULTS： A total of 17 literatures were included， involving 8 before and after control studies， 6 experience sharing studies and 3 reviews. Existing reports showed that the estimation contents and methods of PIVAS cost were roughly the same. The cost included manpower， medical and health materials， fixed asset purchase， depreciation， repair costs， medicine cost and indirect costs. At the same time， the infection to hospital were reported， such as in manpower adopting， formulating detailed management measures and systems， concurrent allocation of the same kind of drugs， shortening infusion preparation and replacement time， in order to save manpower cost. CONCLUSIONS： PIVAS cost calculation method is roughly the same in some hospitals， but there is no uniform standard. It is necessary to further improve the PIVAS cost measurement standard and provide a basis for the construction and development of PIVAS in China.

Systematic Evaluation of Current Status of Charges in PIVAS of China / 中国药房

OBJECTIVE： To systematically evaluate current status of charges in pharmacy intravenous admixture services （PIVAS）， and to provide reference for the formulation of China’s pharmacy intravenous admixture services （PIVAS） charging standards. METHODS： Retrieved from PubMed， Embase， Cochrane library， CBM， CNKI， VIP， Wanfang database and related goverment websets， the literatures about current status evaluation of charges in PIVAS of China were collected during the establishment of database to Jan. 2019. Cost estimation， charge standard， influential factors and other indicators were collected， and the results were presented by descriptive analysis. RESULTS： A total of 5 literatures were included， all of which were reviewed. According to the existing literatures， except for Shandong， Guangdong and Yunnan provinces， there were no regional charge standards in other provinces （districts and cities）. The cost estimation methods of PIVAS in these three provinces were basically the same. The cost could be obtained by adding up the business fees， labor fees， fees of medical instruments purchase and use， indirect fees etc. Dispensing charges in PIVAS were 3-5 yuan per piece for general drug， 5 yuan per piece for antibiotics and 8-12 yuan per piece for cancer chemotherapeutics， 20-35 yuan per piece for TPN. The charging level was mainly affected by local prices， PIVAS scale， hardware investment， management and other factors. CONCLUSIONS： There is no unified charging standard for PIVAS in most provinces （districts， cities） of China. The cost estimation methods of the hospitals from the included literatures are basically the same. It is necessary to construct national PIVAS charging standard and cost estimation method， which could provide a basis for formulating the price of medical and health services.

Evidenced-based Evaluation of Personnel Training Mode in Pharmacy Intravenous Admixture Services in China / 中国药房

OBJECTIVE： To systematically evaluate the mode of personnel training in pharmacy intravenous admixture services （PIVAS） in China， and to provide reference for the comprehensive training of pharmacist in PIVAS in China. METHODS： PubMed， Embase， Cochrane Library， CBM， CJFD， VIP and Wanfang database were searched from the establishment of database to Sept. 2018. Studies which evaluated the training mode of PIVAS in China were included， and the results were presented by descriptive analysis in respects of training objects， training objectives， contents and evaluation indicators. RESULTS： A total of 5 literatures were included. The research types were 2 before-after control studies， 2 experience sharing studies and 1 review. 3 subjects were pharmacists， 1 subject was clinical pharmacists， and 1 subject was nurses. The training objectives were comprehensive quality training， clinical rational drug use level， pharmacy personnel training path and professional service ability. The specific training content of the training mode varied greatly， including professional theoretical knowledge， practical operation ability， pre-job training， professional psychological quality， professional ethics and laws and regulations， continuing education learning ability， career development planning and teaching ability. There were great differences in the evaluation indicators of training effectiveness， which were mainly reflected in team execution motivation and creativity， discoveny rate of unreasonable doctor’s advice， work efficiency， service quality， drug treatment level and satisfaction of PIVAS， etc. CONCLUSIONS： There are certain differences in the training objectives， training targets， specific contents and evaluation indicators of the PIVAS pharmacist training model in China. It is necessary to use the evidence- based method to construct the training mode for PIVAS pharmacist to provide support for clinical intravenous drug use.

Practice and Exploration of the Construction of Management System for Off-label Drug Use in Our Hospital / 中国药房

OBJECTIVE： To establish the management system for off-label drug use in a medical institutions， and to standardize the behaviors of off-label drug use and improve the rational drug use. METHODS： Based on evidence-based researches for off-label drug use， management system of off-label drug use was established in our hospital， and off-label drug use management was carried out. The effects of management system were evaluated with the number of records for off-label drug use and pass rate of approval as indexes. RESULTS： Since the year of 2011， the management system for off-label drug use had gradually established and improved in our hospital； the mode of registration and approval for off-label drug use was established by based on a multi-disciplinary team management and quality classification for clinical evidence. Up to 2016， a total of 252 records for off-label use were submitted， among which 159 （accounting for 59.77％） were for pediatrics and 93 （accounting for 34.96％） were for gynecology and obstetrics. Among the submitted records， 181 had passed the examination and approval， and the pass rate was 64.29％. Special prescription comments indicated that the numbers of off-label use medical orders in inpatient medical orders showed a downward trend， and the proportion of recorded medical orders of off-label use had increased from 17.33％ in 2013 to 84.00％ in 2016. CONCLUSIONS： The management system for off-label drug use in medical institutions can effectively improve the clinical understanding of off-label drug use， standardize the behavior of off-label drug use.

Research on the Indicators of ADR Reporting by Medical Institutions in China / 中国药房

OBJECTIVE:To evaluate the indicators of ADR reporting by medical institutions in China. METHODS:The indicators of ADR reporting by medical institutions in China were presented primarily by 8 pharmacy experts with focus group interview method. System assessment method was used for evidence-based analysis of primary ADR indicators. Delphi method was used to confirm the requirement,calculation formula,definition,evaluation meaning and reference value of ADR indicators. The reliability was assessed. RESULTS:Primary indicators included the rate of ADR reporting,the rate of qualified ADR,constituent ratio of severe and new ADR. A total of 30 literatures were included(15 documents of management standard,15 literature research)in system evaluation,all of which indicated the necessity and requirement of ADR reporting. But the calculation formula, definition and evaluation meaning of ADR indicators were not mentioned. By investigation with Delphi method,the range of reference value was confirmed as follows that the rate of ADR reporting was≥0.01%;the rate of qualified ADR was≥90%;the constituent ratio of severe and new ADR was≥1%. The evaluation result was reliable. CONCLUSIONS:The indicators of ADR reporting and reference lower limit value can urge medical and health institutions to report ADR actively,improve the quality of ADR reporting and strengthen the attention of medical and health institutions to severe and new ADR.

Systematic Review on the Current Situation of Hierarchical Diagnosis and Treatment in China / 中国药房

OBJECTIVE:To systematically review the current situation and facing problems of hierarchical diagnosis and treat-ment in China,and provide basis for nation health-related decisions. METHODS:Using"hierarchical diagnosis and treatment"as keyword,relevant literatures in CNKI,VIP database,and Wanfang database from building to Jun. 2016 were retrieved. Study for current situation of hierarchical diagnosis and treatment in China was comprehensively collected,and systematical review was con-ducted from aspects of outcome evaluation indicators and facing problems. RESULTS:Totally 23 studies were included,in which, 18 were investigative studies,3 were retrospective/investigative studies,1 was retrospective study,and 1 was randomized con-trolled study. In the outcome evaluation indicators,9 took awareness of hierarchical diagnosis and treatment as review indicators, showing that the public had poor awareness;7 took the current situation as review indicator,showing that the overall current situa-tion was unsatisfactory;3 took human resources as review indicator,showing that human resources in primary medical institutions were not ideal;3 took satisfactory degree as review indicator,showing that the public were generally satisfied with hierarchical di-agnosis;2 took the implementation model as review indicator,showing that the current model had been able to promote hierarchi-cal diagnosis and treatment;2 took medical cost as review indicator,showing that individuals paid higher. In the facing problems, 19 studies suggested the imperfect systems for hierarchical diagnosis and treatment,16 suggested that primary medical treatment was limited in capability,7 suggested that patients still preferred big hospitals to primary medical institutions,and 7 suggested that it lacked publicity. CONCLUSIONS:The current situation of hierarchical diagnosis and treatment is certainly not ideal but still fac-ing many problems in China. Improving the levels in primary institutions,hierarchical diagnosis and treatment system and patients' willingness to primary medical institutions,and increasing its publicity can deeply promote the implementation of hierarchical diag-nosis and treatment and provide objective and valuable reference for health decision-making.

Cytological Study in vitro on Co-delivery of siRNA and Paclitaxel within Solid Lipid Nanoparticles to Overcome Multidrug Resistance in Tumors / 生物医学工程学杂志

Multidrug resistance (MDR) remains the major obstacle to the success of clinical cancer chemotherapy. P-glycoprotein (P-gp), encoded by the MDR1, is an important part with complex mechanisms associated with the MDR. In order to overcome the MDR of tumors, we in the present experimental design incorporated small interfering RNA (siRNA) targeting MDR1 gene and anticancer drug paclitaxel (PTX) into the solid lipid nanoparticles (SLNs) to achieve the combinational therapeutic effects of genetherapy and chemotherapy. In this study, siRNA-PTX-SLNs were successfully prepared. The cytotoxicity of blank SLNs and siRNA-PTX-SLNs in MCF-7 cells and MCF-7/ADR cells were detected by MTT; and the uptake efficiency of PTX in MCF-7/ADR cells were detected via HPLC method; quantitative real-time PCR and flow cytometry were performed to investigate the silencing effect of siRNA-PTX- SLNs on MDR1 gene in MCF-7/ADR cells. The results showed that PTX loaded SLNs could significantly inhibit the growth of tumor cells, and more importantly, the MDR tumor cells treated with siRNA-PTX-SLNs showed the lowest viability. HPLC study showed that SLNs could enhance the cellular uptake for PTX. Meanwhile, siRNA delivered by SLNs significantly decreased the P-gp expression in MDR tumor cells, thus increased the cellular accumulation of rhodamine123 as a P-gp substrate. In conclusion, the MDR1 gene could be silenced by siRNA-PTX-SLNs, which could promote the growth inhibition efficiency of PTX on tumor cells, leading to synergetic effect on MDR tumor therapy.

Emergency Drug Supply Mechanism in Women and Children’s Special Hospital During Earthquake Disaster / 中国药房

OBJECTIVE:To explore an emergency drug supply mechanism for women and children’s special hospital during earthquake disaster. METHODS: The practice of drug supply in our hospital after "5?12" Wenchuan earthquake was analyzed. RESULTS: The daily and post-earthquake medicine supply of the hospital was guaranteed,including the drugs which supply to the medical treatment rescues team in the disaster area;and the principle and approach of emergency drug supply in women and children's special hospital during earthquake disaster has been established. CONCLUSIONS: The emer-gency drug supply in women and children’s special hospital should cover drugs used for wounded women and children in addition to those special drugs used for earthquake injuries. All the links including drug plan,drug purchase,quantity monitoring and drugs needed for rescue should be considered in detail to form a fast and smooth hospital emergency drug supply mechanism.

Scientific Optimizing of Flow of Drug Purchasing in Hospital / 中国药房

OBJECTIVE:To construct a high-efficiency, high-performance, low-cost flow of drug purchasing. METHODS: The defects involved in the current drug purchasing flowsheet prevalent in many hospitals were analyzed and the optimized flowsheet was put into practice by combining the actuality of our hospital. RESULTS & CONCLUSIONS: The traditional drug purchasing modality can not meet the requirement of current hospitals in that it involves large work load and high probability of error, and it is tedious and time-consuming. The establishment of drug catalog database and the online drug purchase by means of instant communication software can help simplify drug purchase flow, lessen work load, enhance work efficiency, and effectuate a high-efficiency, high-performance, low-cost flow of drug purchasing.

Practice of Zero Inventory Principle Management Mode to Achieve Optimized Workflow in Hospital Drug Supply Storeroom / 中国药房

OBJECTIVE: To provide references for the practice of the zero inventory management mode in hospital drug supply storeroom.METHODS: The zero inventory management mode in hospital drug supply storeroom was summarized based on experiences of hospital drug supply storeroom management in our hospital.RESULTS & CONCLUSIONS: After introduction of zero inventory management principle in hospital drug supply storeroom,the drug turnover frequency in our hospital reached 8～9 times every quarter,which has greatly lowered drug storage costs,activated the working capital,and brought down the proportion of drug fund to as low as about 15% of total hospital working capital.Therefore,establishing a reasonable managing mode suitable to hospital condition and applying zero inventory principle in the management of hospital drug supply storeroom are of importance for lowering hospital running cots and enhancing working efficiency.

Preparation and degradation behavior of PELGE nanoparticles / 生物医学工程学杂志

A series of poly (lacticacid-co-glycolicacid)-poly(ethylene glycol) (PLGA-PEG, PELGA) block copolymers and poly (ethylene glycol)-poly (lacticacid-co-glycolicacid)-poly (ethylene-glycol) (PELGE) was synthesized by ring-opening polymerization. PELGA nanoparticles and PELGE nanoparticles were prepared using the emulsion-solvent evaporation technique (O/W). To study the behavior and mechanism of the degradation of PELGA-NP and PELGA-NP, we determined the lactic acids by UV spectrophotometry. The method confirmed that degradation was much faster for polymers with a decrease in the LA content of the polymers or an increase in the PEG content of the polymers.

Approach to Management of Hospital Drug Storehouse Basing on Joint Commission International Accreditation / 中国药房

OBJECTIVE:To strengthen management of hospital drug storehouse.METHODS:According to Joint Commission International (JCI) accreditation,management of drug storehouse was guided through perfecting working system,workflow,qualification confirmation of employees,reasonable management of drug stock and information management,etc.Related investigation and discussion were carried out.RESULTS & CONCLUSIONS:Management of hospital drug storehouse combining with JCI accreditation and quality assurance system of drug storehouse management can improve workflow and management of drug storehouse,guaranteeing efficiency and quality of drug supply.