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JCI standard is the most professional and authoritative certification standard of medical quality and safety system in the world. HRP information system is a systematic hospital resource management platform which integrates the existing hospital information resources and establishes a set of unified, efficient, interconnected and information sharing operation and management of the hospital. In order to meet the requirements of closed-loop management of implantable medical devices in the JCI standard, our hospital has established a set of standards which based on the HRP system platform, including access permission, purchase application, entering and leaving the warehouse, bookkeeping charge, cost accounting and postoperative traceability of implanted medical device management system. HRP system improves the management level of implantable medical devices, and realizes the closed-loop management of the whole process of implantable medical devices.
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Humans , Hospitals , Information Dissemination , Methods , Management Information Systems , Reference Standards , Prostheses and ImplantsABSTRACT
OBJECTIVE： To provide reference for the management of high-alert medicine. METHODS： Based on the requirements of JCI and HIMSS standards， the mode of high-alert medicine management were established， including formulation of high-alert medicine list， identification and storage， prescribing medical order， reviewing medical order， dispensing and application， post-administration monitoring and other key management links. Then the effectiveness analysis was carried out. RESULTS： After implementing high-alert medicine management measures， the qualification rate of high-alert medicine storage increased from 29.28％ to 95.50％ and the incidence of irrational medical order involving high-alert medicine decreased from 3.43％ to 1.99％， with statistical significance （P＜0.01）. The errors of dispensing was reduced from 35 to 0 monthly， high-alert medicine-related adverse events reduced from 18 to 3 monthly， and the safety of high-alert medicine was greatly improved. CONCLUSIONS： Through the establishment of high-alert medicine management model based on JCI and HIMSS standards in our hospital， the management of high-alert medicine is standardized， the risk of drug use is reduced.
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Objective:To establish a calculation model of drug preparation difficulty coefficient for outpatient pharmacy intrave -nous admixture center ( OUIVA) in a children's hospital, and construct the performance model .Methods: All the prescriptions in a week in OUIVA of Shanghai children's medical center were randomly selected .According to the actual difficulty level in the process of outpatient and emergency drug preparation , a basic drug difficulty coefficient and difficulty coefficient addition method was constructed . The difficulty index of every prescription was calculated .All the prescriptions in a week were randomly selected , and according to the difficulty coefficient analysis method , the daily difficulty coefficient of the prescriptions was calculated in order to build a performance model for OUIVA in the hospital .Results:The difficulty coefficient of medicine mainly included four basic difficulty coefficients and nine difficulty addition coefficients .According to the statistics , the average difficulty coefficient of daily prescriptions was (3.83 ± 2.86 )with the highest difficulty coefficient of 35, and the prescription data showed that there was significant difference between outpa -tient and emergency prescriptions and daytime blood tumor prescriptions .Conclusion:A performance model based on the difficulty co-efficient for OUIVA in children ' s hospital is a more scientific reflection to the daily work .
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The laboratory is an indispensable part in a hospital, and it is always providing very important and much support for public third-level grade-A hospital in medical treatment, scientific research and teaching. As one of JCI review points, how to strengthen the laboratory safety and management is one of the important tasks, which cannot be ignored. Our hospital managers try their best to strengthen the supervision at the following nine aspects: Laboratory rules and regulations, environment and management, safety facilities, safe water and electricity, chemical safety, biological safety, radiation safety, safe instruments and equipment, and personal protective measures. Based on above nine aspects, our hospital managers actively take measures to ensure our laboratory safety. Following are the measures: We arrange lectures on laboratory safety in order to improve the personnel laboratory safety awareness. We carry out network examination and popularize knowledge of laboratory safety. We not only have phased examination, but also give positive feedback to laboratory managers. In a word, our challenge is very big, but we harvest a lot of achievements.
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Objective To explore the application value of JCI standard and HIMSS 7 grade clinical closed loop system in pathological specimen handover. Methods The First Affiliated Hospital of Xiamen University adopted the traditional way to transfer pathological specimen in 2014, and improved the process under guidance of JCI standard in 2015. Then HIMSS 7 level clinical closed-loop system was applied to pathological handover on the basis of JCI standard guidance in 2017. Comparative analysis was made on the failure rate of the pathological specimen,the average handover time of pathological specimen and the timely rate of pathological frozen reports in the above 3 years. Results A comparison of the failure rate of pathological specimens found the following: That of 2015 was significantly lower than that of 2014 (P <0.05);and that of 2017(Jan. -Sept.) was significantly lower than that of 2015(P<0.01). A comparison of the handover timeliness of frozen digestive endoscopy specimens and a single frozen specimen handover duration found the following:That of 2015 was significantly shorter than that of 2014 (P< 0.01),and that of 2017 (Jan. - Sept.) was significantly shorter than that of 2015 (P < 0.01). A comparison of the timeliness of frozen specimen pathological reports found the following: that of 2015 was significantly better than that of 2014 (P< 0.05),and that of 2017 (Jan. -Sept.) was significantly better than that of 2015 (P< 0.05). Conclusions The guidance of JCI concept has reduced the failure rate of pathological specimen, shortened the average handover during, and improved the timeliness of pathological frozen specimen reports. Under the JCI standard guidance, the HIMSS 7 level clinical closed-loop system was applied to the pathological specimen handover process. This practice could significantly reduce the failure rate of pathological specimen and improve the pathological specimen handover efficiency. Furthermore,it is conducive to full-course tracking and dynamic management of such specimen.
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Objective To observe the impact of improving the compliance of ventilator bundle on morbidity of ventilator-associated pneumonia (VAP) in intensive care unit (ICU) patients undergoing mechanical ventilation (MV) guided by context of Joint Commission International (JCI) settings, and to study the oral care efficacy of suction tube sponge brush. Methods A prospective study was conducted. The patients who needed MV admitted to Department of Critical Care Medicine of the First Affiliated Hospital of Xiamen University from January 2013 to December 2016 were enrolled. In the context of JCI settings, necessary measurements were taken to enhance the compliance of ventilator bundle each year. In 2013, the preventive measures were set up and the education was strengthened. In 2014,the compliance of hand hygiene and bedside elevation was strengthened. In 2015, a control study was conducted to evaluate the effect between the traditional cotton dipped in chlorhexidine and the suction tube sponge brush rinsed with chlorhexidine on oral health impact parameters. The suction tube sponge brush rinsed with chlorhexidine oral care was introduced to improve compliance. In 2016, electronic bundle checklist for daily self-audits was conducted. The annually morbidity of VAP through the software of hospital and ICU was collected and calculated. The annual incidence of VAP was indicated by the VAP cases per 1000 MV days. Based on the VAP incidence rate in 2013 as 1, the VAP incidence-rate ratio (IRR) of each year was calculated. Results During the study period, a total of 2733 patients admitted to the ICU, including 1403 patients undergoing MV. Ninety-four of the 1403 patients with community-acquired pneumonia (CAP), aspiration pneumonia, back elevation ban, incomplete information, and withdrew from the study were excluded. 1399 patients undergoing MV were enrolled in the final analysis, with total MV days of 11012 days, and 94 patients occurred VAP. The annual incidence of VAP was progressively declined from 2013 to 2016, and the VAP cases per 1000 MV days were 17.0, 10.0, 5.9, 3.5 cases, respectively. Based on the VAP incidence rate in 2013, the IRR of VAP from 2014 to 2016 was also progressively declined, which was 0.59 [95% confidence interval (95%CI) = 0.35-0.98], 0.35 (95%CI = 0.18-0.64), and 0.21 (95%CI = 0.09-0.41), with statistical significance (all P 0.05). Conclusion Ventilator bundle can effectively reduce the morbidity of VAP in the context of JCI settings, and the oral care by using suction tube sponge brush and chlorhexidine can effectively improve oral hygiene.
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Objective To analyze the effect of clinical pharmacists involving in JCI clinical care program certification-AMI(CCPC-AMI) on the compliance rates of clinical drug treatment guideline and the awareness rates of patient medication health education in cardiovascular.Methods Selected cases of acute myocardial infarction(AMI) from March to August in 2015 was as the former group,from September 2015 to March 2016 as the latter group in their hospital,then comparative analysis of two groups was done by statistical method.Results After clinical pharmacists involved in CCPC-AMI,the compliance rates of AMI clinical drug treatment guidelines (after the AMI diagnosis, the 10min was given aspirin, intensified statin therapy and dose selection, the use of ACEI/ARB before discharge and the use of beta blocker before discharge) were increased from 92.7% 67.9%,60.7%,51.8% to 98.1%,85.2%,94.4%,90.7%.The awareness rates of patient medication health education (awareness of safe medication, awareness of self-management, awareness of follow-up knowledge) were all increased to 100% from 75.0%,57.1%,82.1% before participation.Conclusion Clinical pharmacists who carried out pharmaceutical care,has played a critical role in quality control of AMI single disease through the preparing of CCPC-AMI evaluation.
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OBJECTIVE:To revise the accreditation standards of the national clinical pharmacy key specialty,promote the nor-malization and standardization of clinical pharmacy services and improve the service level of clinical pharmacy in our country. METHODS:Based on JCI international hospital accreditation ideas,suggestions for Clinical Pharmacy State Clinical Key Program Construction Score Standard for trial implementation (900 points) published by former Ministry of Health in 2012,were put for-ward. RESULTS & CONCLUSIONS:For the problems that there were lack of pharmacy service institutional management,process control and quality management standards,some classification programs were not clear,and did not fully reflect the clinical phar-macy service quality and work effect evaluation requirements,corresponding revisions were proposed in terms of basic conditions, information management,clinical pharmacy work management system,etc. The revised standard pays more attention and refines the quality system construction in system,standard,process,quality control,effect evaluation,which can promote the enhance-ment of our clinical pharmacy service levels,normalization and standardization of clinical pharmacy services.
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Management of hospital water supply facilities is key to its logistics management.This paper cited the domestic water supply facilities management as an example, and summed up practical experiences in both JCI certification and review along with the hospital′s fine management of water facilities.On such basis, it described such aspects as the establishment of management system, operation standards and work flow, implementation of preventive maintenance, renovation, emergency protection, inspection supervision, file management and staff training.These efforts provide reference for how to establish the fine management mode of water supply facilities.
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OBJECTIVE:To provide reference for further refinement and improvement of pharmaceutical administration in hospital accreditation standards in China.METHODS:According to Joint Commission International Accreditation Standards for Hospitals (6th edition) [called "JCI standards (6th edition)" for short] and Implementation Rules of Level 3 General Hospital Accreditation Standards in China (2011 edition) [called "Implementation Rules of Standards (2011 edition)" for short],the similarities and differences of pharmaceutical administration were studied and compared;the advantages and disadvantages of Implementation Rules of Standards (2011 edition) were analyzed to put forward some suggestions on this basis.RESULTS:The number of the items,standards and key points of pharmaceutical administration in JCI standards (6th edition) were 8,22,89,respectively.The number of above indexes in Implementation Rules of Standards(2011 edition) were 11,39,280,respectively.The similarities mainly reflected in relevant laws,regulations,rules and regulations to be followed in pharmaceutical administration,personnel requirements,drug procurement,reserve,storage and recall,drug dispensing and preparation,special drugs management,prescription management,antibiotics management,drug use monitoring,ADR reporting,etc.The specific regulation of JCI standards (6th edition) involved drug management system documentation review,drag acquisition at night or after pharmacy closed,drug list examination,comparison of drug use list before admission and the first medical order,etc.The specific regulation of Implementation Rules of Standards (2011 edition) involved the promotion of National Essential Medicine System and the construction of clinical pharmacist system.CONCLUSIONS:In China,Implementation Rules of Standards (2011 edition) have clearly defined the National Essential Medicine System and the construction of clinical pharmacist system,and are more in line with the development requirements of medical and health services in China at the present stage;but there are also some deficiencies compared to JCI standards (6th edition),including the revision update,the management of the patient's own medicine,the safety management of the patient's identity,measurability of the accreditation standards.Implementation Rules of Standards should be further refined and perfected by updating version regularly,strengthening the management of details,increasing measurability of the accreditation standards,strengthening drug management outside the department of pharmacy,enhancing drug supply management,etc.
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Objective To introduce JCI standards into medical consumables management in order to improve the overall management of consumables.Methods Root cause analysis (RCA) method in JCI management standards was used to execute root cause analysis of each key point in medical consumables management.PDCA Cycle was involved in to promote medical consumables management.Results JCI management standardized the path,solved some problems and promoted the level during medical consumables management.Conclusion JCI standards contribute to the standardization and humanization of medical consumables management,and also enhances the patient safety at the same time.
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Objective To introduce JCI standards into medical consumables management in order to improve the overall management of consumables.Methods Root cause analysis (RCA) method in JCI management standards was used to execute root cause analysis of each key point in medical consumables management.PDCA Cycle was involved in to promote medical consumables management.Results JCI management standardized the path,solved some problems and promoted the level during medical consumables management.Conclusion JCI standards contribute to the standardization and humanization of medical consumables management,and also enhances the patient safety at the same time.
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Objective: To establish the standardized management mode for emergent medicines of inpatient area based on JCI. Methods:The expiry verification data of emergent medicines in hospital wards were collected from 2013 to 2015. The number and the amount of emergent medicines expired in the last three months in each calendar month during the three years were analyzed, the exist-ing problems in the management mode were found out and gradually optimized using PDCA cycle. Results:From 2013 to 2015, the re-placement amount of emergent medicines expired in the next month was 3497. 37 yuan. The number of emergent medicines expired in current month was 62. A total of 420 times of emergent medicines didn' t meet the requires of expiry verification from 2013 to 2015. After the check-in form redesign for emergent medicines and the standardization of replacement process, the number of expired medi-cines in the rescue carts was reduced, and the validity and quantity of drugs in all the rescue vehicles could be clearly shown in the new form. Conclusion:The standardization of emergent medicine management model can guarantee the safety of emergent medicines used in patients.
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Objective To protect patients and employees from being polluted and the inferiors,and to build a prototype to enhance the supply chain security of medical consumables according to JCI.Method According to the supply chain security model,adopting corresponding measures of the design of the supply chain management of medical consumables.Result The supply chain security capabilities are enhanced and the risk is reduced in accordance with the quality requirements of JCI.Conclusion The security model applied in the supply chain management of medical consumables can effectively strengthen the security of the supply chain.
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OBJECTIVE:To discuss the application practice of PIVAS standardization in pharmacy intravenous admixture ser-vice(PIVAS)of our hospital. METHODS:Based on JCI,the design concept and management mode of PIVAS were analyzed and summarized from PIVAS design,management,job and medical order time arrangement,staff management,infusion quality or fault emergency plan,etc. RESULTS:After introducing JCI standards,the improvement was conducted in respects of management system and work flow design,purification system and logistics division design,information system design,etc. Working hour was arranged according to the workload or work flow and the actual needs of clinical departments. Medical orders,1 batch per hour,24 batches one day,were delivered to clinical departments according the time point. The positivity of the staff had been improved, and work quantization and performance appraisal had been achieved. Those improvement optimized drug dispensing process, cleared the responsibility of information management and guaranteed the quality of infusion. Work error analysis and summary were monthly conducted;the number of work error decreased from 562 cases before JCI introduction(2013)to 264 cases after JCI intro-duction (2014),decreasing by 112.87% annually. CONCLUSIONS:JCI standard is of significance to the promotion of PIVAS management,work level and quality,and safe and rational use of drugs in the clinic.
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Objective To observe the effect of the nutrition management according to the JCI(Joint Commission on Accreditation of Healthcare Organizations)management standard for critically ill pediatric patients with mechanical ventilation.Methods A total of 330 cases with mechanical ventilation were en-rolled in the control group from Hunan Province Children's Hospital PICU between Jan.2012 and Dec.2012, and these pediatric patients were managed with the conventional nutrient management.A total of 359 pediatric patients with mechanical ventilation were admitted to the experimental group from Jan.2013 to Dec.2013 and these patients were managed with nutrient management based on JCI standards.The length of mechanical venti-lation,stay in ICU,stay in hospital were compared between two groups,and the incidence of ventilator-associ-ated pneumonia,abandonment rate and mortality were also compared between experimental group and control group.Results The length of mechanical ventilation in control group[(8.39 ±1.34)days]was longer than that of experimental group[(5.69 ±1.12)days].The length of stay in PICU for control group[(12.32 ± 1.37)days]was more than that in experimental group[(9.42 ±1.53)days].The length of stay in hospital for control group [(15.37 ±2.16 )days]was higher than that of experimental group [(12.63 ±2.29 ) days].The incidence of ventilator-associated pneumonia(9.7%)in control group was higher than that of ex-perimental group,and the giving up or mortality rate in control group(8.48%)was higher than that of exper-imental group(4.35%).And there were significant differences by statistical analysis(P ﹤0.01 ,respective-ly).Conclusion According to the nutritional management in JCI standard,the length of mechanical ventila-tion,stay in PICU and stay in hospital time,the incidence of ventilator-associated pneumonia,and the aban-doned or mortality rate were reduced for critically ill pediatric patients with mechanical ventilation.
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Described in this paper are the JCI accredited domestic hospitals, what should be learned from the JCI accreditation standards by domestic hospital accreditation standards, enlightenments of JCI accreditation standards on improving domestic library service such as establishment of library management systems, provision of network reference service, predictive information service, first-asked responsibility system reference service, library mobile service, and prolongation of library open time.
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OBJECTIVE:To regulate the management of operation drug and promote medication security. METHODS:Based on the relevant principles in the standard of JCI,the practice about establishment of operation pharmacy in our hospital was intro-duced,and it were stated from two aspects which included working mode and effects. RESULTS:The working mode were format-ed by definiting the duties and working flow of pharmacist,anesthetist and liaison man. The establishment of operation pharmacy, which brought operation drugs into the unified management system of our hospital,saved manpower and improved work efficien-cy,refined the management of drugs in all aspects,improved the management of drug safety level,strengthened drug expiration date management,implemented the reporting of adverse drug reactions(event)and collecting of medication(potential)errors. The established mode conformed to the relative standard of JCI including preparation,grant,storage and collection of ADR of drug. CONCLUSIONS:The established drug management of operation pharmacy promotes standardized administration of surgery drug, which guarantees the drug use safety of patients.
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OBJECTIVE:To provide reference for the establishment of prevention and control measures for medication errors. METHODS:Based on JCI standard,51 cases of medication error reported by ADE information platform of our hospital in 2012 were summarized,and analyzed in terms of error type,error time,working life of responsible person,etc. The prevention and con-trol strategies were introduced. RESULTS:Referring to related requirements of JCI standard,medication errors reduced significant-ly during 2013-2014 through personnel training and education,system improvement and process optimization. CONCLUSIONS:Medication errors surveillance and control is important for the promotion of rational use of drugs. JCI standard has played an impor-tant role in monitoring and preventing medication errors.
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Command of the JCI standards and lessons learnt from practice and experience in JCI accreditation preparation,can help identify the gap between the hospitals and JCI standards.These standards can also guide the clinical pathway system,pharmacy intravenous admixture services system and medical business intelligence system.The information system built under such guidance not only makes an effective solution to existing problems,but also proves innovative.All these pave the way for successful JCI accreditation.