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Objective:To explore the block-based charging method for centralized dispensing of neonatal drugs in pharmacy intravenous admixture service (PIVAS), analyze its effect on drug savings and inpatient drug cost, so as to provide the reference for the appropriate charging method of neonatal drugs.Methods:According to the balance quantity and amount of neonatal intravenous drugs that were centrally allocated by the PIVAS of our hospital, refer to the doctor′s orders, the dosage per dose as well as the number of patients per dose were analyzed, then the drug types and plans for block-based charging were formulated. Before and after the implementation of the plan, the monthly average drug balance quantity and amount, the average number of drug charges for the neonates, the average daily drug cost, and the adverse events of related drugs were used as the indicators to be investigated to clarify the implementation effect of the block-based charging mothod.Results:Fourteen medicines were charged by block-based, including 4 antibiotics, 2 ordinary infusion preparations, and 8 parenteral nutrition solution preparations. The monthly average drug balance quantity was reduced from 5 047±541 to 1 856±225, and the monthly average balance amount was reduced from 65 811±10 265 yuan to 20 659±6 002 yuan. The average drug dosage for children in the trial drug was significantly reduced with a decrease range of 39.2% to 90.1%. Both the inpatient daily drug cost of neonatus and the daily average antibacterial drug cost was decreased. During the centralized dispensing of neonatal drugs, no related adverse drug events occurred.Conclusions:The block-based charging method of centralized drug distribution can improve the utilization rate of drugs, reduce drug waste, reduce the cost of inpatient medicines the financial burden on children′s families, which is worthy of further promotion and implementation.
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OBJECTIVE To establish a total quality management system for pharmacy intravenous admixture services （PIVAS）， in order to promote the standardization， accuracy and rationalization of clinical intravenous infusion. METHODS Based on information system in PIVAS， the management system and quality monitoring items of the whole process before， during and after PIVAS infusion preparation were formulated. The quality control and quality improvement were carried out regularly with quality management tools and methods such as PDCA （plan， do， check， process） cycle， quality control circle， and root cause analysis. The main quality control indexes of PIVAS were retrospectively analyzed before （in 2019） and after PDCA cycle management （in 2020 and 2021）. RESULTS The indexes of quality monitoring in the whole process of PIVAS infusion preparation， such as the score of drug quality management， the drug residue qualification rate and the qualified rate of drug content in infusion， were increased from 92 points， 79%， 86.4% in 2019 to 99 points， 92%， 99.8% in 2021， respectively. The indexes of safe and rational drug use， such as the ratio of intravenous irrational medical orders， the rate of drug repercussion， the rate of antibiotics use， and the rate of TCM injection use decreased from 0.98%， 6.1%， 40.55%， 39.70% to 0.23%， 3.2%， 37.18%， 26.00%， respectively. CONCLUSIONS The established total quality management system for PIVAS can improve the quality management level in the infusion preparation process， improve the quality of infusion preparation and promote clinical safe and rational drug use.
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Objective To explore the fluctuation characteristics of long-term doctor's order workload in pharmacy intravenous admixture services (PIVAS) and build a daily workload fluctuation prediction model and provide reference for the adjustment of PIVAS work mode. Methods Daily workload data of long-term doctor’s orders from PIVAS in the East Campus of Zhongshan Hospital affiliated to Fudan University from July 2020 to June 2021 were selected , and the time series analysis method was used to analyze the workload fluctuation characteristics and a prediction model was established. The accuracy of the model was verified by fitting parameters and prediction results. Results The fluctuation of PIVAS long-term doctor's daily workload data had the characteristics of periodicity, short-term slow rise and irregular variation. The Winters multiplier model was used to fit the series with R2 = 0.777, the significance value of Ljung-Box statistic value (P value) was 0.060, and the mean absolute error percentage between the fitted and actual values was 4.45%, indicating that the model fitting accuracy was high. The average relative deviation between the predicted and actual results was 3.81%, indicating that the model prediction was effective. Conclusion The model constructed in this study could be used for the analysis and prediction of long-term doctor's orders workload of PIVAS. However, because the workload of doctor's orders has fluctuations such as periodicity and irregular changes, it is necessary to adjust the working model according to the fluctuation characteristics of the workload and the prediction results to ensure the efficient operation of PIVAS.
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OBJECTIVE To analyze the status quo of performance appraisal of pharmacy intravenous admixture services （PIVAS） in China based on literature analysis， and provide reference for the implementation of performance management of PIVAS in China. METHODS Retrieved from domestic and foreign databases such as CNKI， VIP， Wanfang， PubMed， Embase， the Cochrane Library and CBM， the literature on the status quo evaluation of performance appraisal of PIVAS in China was included from the inception to Sept. 2022. The descriptive analysis was carried out on performance appraisal measures， performance appraisal indicators， performance appraisal achievement， etc. RESULTS Twelve pieces of literature were included， involving 8 before-and-after controlled studies and 4 experience sharing. The performance appraisal subjects of 10 pieces of literature were all staff and those of 2 pieces of literature were nurses. The measures of PIVAS performance appraisal were roughly the same， mainly involving contents and indicators of workload， work quality （including errors）， clinical service satisfaction， labor discipline， department contribution， personal comprehensive evaluation， and so on， but the main accounting proportion was different. Performance appraisal indicators mainly included the rate of medical order review， dispensing rate， check rate， delivery rate， finished product review rate， etc. The performance appraisal achievement mainly included the improvement of work efficiency， the improvement of work quality， the reduction of error rate， and the improvement of clinical satisfaction and employee satisfaction. CONCLUSIONS By building performance appraisal system and adopting corresponding performance management measures of PIVAS， it can improve the work efficiency and quality， reduce the error rate， ensure the safety of patients’ medication， and promote the standardized management of PIVAS in China.
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Objective To investigate the practice effect of situational simulation teaching in emergency ability training for Pharmacy Intravenous Admixture Services (PIVAS) staff.Methods A total of 93 pharmacists and nurses who worked in PIVAS of Children's Hospital of Chongqing Medical University from February 2014 to December 2016 were selected as subjects,and emergency ability training was performed using situational simulation teaching.SPSS 18.0 was used for data analysis,and the paired t-test was used to analyze the scores of professional theory,emergency operation skills,and self-assessment questionnaire before and after training.Results After training,the trainees had significant increases in the mean scores of professional theory [(95.33 ± 1.13) vs.(73.89±4.13),P＜0.01],emergency operation skills [(97.98 ± 1.04) vs.(78.79 ± 3.51),P＜0.01],and self-assessment questionnaire [(91.92 ± 1.51) vs.(73.60 ± 4.77),P＜0.01].Conclusion The use of situational simulation teaching stimulates the leaming interest of PIVAS staff and improves their emergency processing abilities,and therefore,it can promote timely and safe medication for children.
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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.
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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.
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OBJECTIVE： To improve the quality of antitumor drug dispensing in pharmacy intravenous admixture services （PIVAS）， reduce dispensing error and occupational exposure to dispensers by antitumor drugs. METHODS： The composition and functions of automatic injection dispensing system were introduced， and the system was applied in antitumor drug dispensing in PIVAS. Various work indexes were compared 1 month before and after the application of the system. RESULTS： The system included information processing software， equipment control software and drug dispensing machine hardware， and had functions such as automatic counting of medicines， automatic entry into basket， automatic drug dispensing and automatic printing of labels. After applying automatic injection dispensing system， the operation of infusion label printing， basket dividing and dispensing in dispensing process was changed from manual to automatic. It could save human resources， as for each label， the average time of drug dispensing decreased from （33.00±3.31） s to （15.55±1.41） s while no mistakes and damaged label was found. CONCLUSIONS： The application of automatic injection dispensing system achieves automatic operation of antitumor drug dispensing in PIVAS， reduce dispensing error reduces staff’s exposure to antitumor drugs and occupational exposure.
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OBJECTIVE:To improve work efficiency and quality of pharmacy intravenous admixture services(PIVAS). METHODS:The information system of PIVAS in our hospital was optimized. The effects of the system were evaluated by comparing indexes 6 months before and after optimization. RESULTS:Compared with before optimization,the function of automatic repeated medical order checking was added to reduce the workload of manual prescription checking in respect of medical order checking;various batch generation rules were set up to reduce the number of adjusted batch by hand in respect of batch arrangement;label number and signature function were added to realize the information traceability function in respect of label printing and signature;rapid inquiry of transfusion state was realized by using two dimensional code scanning technology in respect of preparation scanning. When the daily workload increased and the staff did not increase,the number of daily manual checked medical orders were 956 before optimization and 257 after optimization;the time of daily labeling and dispensing were 180 min before optimization and 135 min after optimization;the number of monthly delivery error were 3.6 before optimization and 2.5 after optimization. CONCLUSIONS:Optimized function of information system can improve the work efficiency and work quality of PIVAS.
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OBJECTIVE:To provide reference for improving drug dispensing speed of pharmacy intravenous admixture services (PIVAS).METHODS:The reasons for slow drug dispensing in PIVAS of our hospital were analyzed,quality control circle (QCC) activity was conducted according to ten steps as subject selection,plan formulation,current situation control,goal setting,goal analysis,countermeasure formulation,countermeasure implementation and review,effect confirmation,standardization,review and improvement.The effect of QCC activity was evaluated by drug dispensing speed and the rate of drug dispensing error.RESULTS:Main reasons for slow drug dispensing in PIVAS in our hospital included not fixed position of the infusion bag,insufficient pre-dispensing drug basket,not unified method of sticking doctor's order labels,not eye-catching drag position identification,unreasonable drug shelf position.Drug dispensing speed increased from 2.99 bag/person/min to 4.90 bag/person/min,and the target yield rate was 95％ through displacing injection according to the doctor's order,re-making the drug shelf logo,preparing adequate pre-dispensing basket in advance,sticking the prescription tag of medical order standardly,etc.The rate of drug dispensing error decreased from 0.005％ to 0.002％ after improving and optimizing drug dispensing procedure.CONCLUSIONS:The application of QCC activity,improvement and optimization of drug dispensing procedure in PIVAS in our hospital not only improve drug dispensing speed in PIVAS,but also reduce the rate of drug dispensing error.
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Eight sub-databases of pharmacological information on rational use of medicines were designed and established. These sub-databases cover dosing frequency, therapeutic drug priority to auxiliary medication, infusion shelf-life after admixture, incompatibility of two continuous infusion in the vein infusion tube, chronopharmacology, drug interaction involved in administration sequence , venous irritative drugs and preventive medicine. Once the standing order delivery to PIVAS involves any of these sub-databases, the system will prompt in turn " Auxiliary" , " Time limit" , " Taboo" , " Chronopharmacology" , " Interaction" , " Irritative" and " Preventive (therapeutic)" , starting from therapeutic drug priority to auxiliary medication. Pharmacists would make a reasonable sequence of the corresponding infusion and label the administration sequence on the infusion tag according to the prompt.Compared to the circumstance prior to this system, the wards with the infusion sequence labeling and equipped with intelligent prompt increased from 2 to 43; the percentage of such inpatients increased from 0.50% to 66.33%; the percentage of medical orders increased from 0.72% to 78.94%. The time spent by pharmacists for the same workload reduced from 73.44 h per day to 1.94 h per day. The times of flushing infusion tube reduced from 34.42 to 1.49 per ward and per day. The cost of flushing infusion tubes reduced by a big margin. PIVAS has established a method of regulating infusion administration sequence by an intelligent prompt system, based on improved safety and effectiveness of medication.
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Objective To evaluate the effects of information feedback mode on auditing medical orders between pharmacy intravenous admixture services ( PIVAS ) and clinical departments. Methods Sorting and analyzing the work contents, satisfaction, and unreasonable medical order rates before and after auditing medical orders between PIVAS and clinical departments by using the information feedback mode. Results The information feedback mode of auditing medical orders has been well accepted. For example, the satisfaction between clinical departments and PIVAS was increased significantly (P < 0. 05), and unreasonable medical order rate was decreased significantly as well (P < 0. 05). There was a strong correlation between satisfaction and unreasonable medical order rate. Conclusions Establishment of comprehensive information feedback mode for auditing medical order between PIVAS and clinical departments has improved the PIVAS quality of clinical service, and strongly supported the introduction of PIVAS.
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Objective:To explore the application effect of diversified teaching methods in the Pharmacy Intravenous Admixture Services (PIVAS),thus to improve the quality of nursing teaching in PIVAS.Methods:Intemship students from PIVAS in a top three hospital in Xi’an from July to December 2015 and July to December 2016 were randomly divided into control group with 42 cases and experimental group with 40 cases.The control group used conventional teaching method and the experimental group adopted the diversified teaching method.the practical work of the students in the two groups was compared.Results:After intervention,the experimental group had marked improvement in the drug configuration error,the mastery of aseptic technology,the passing rate of theoretical achievement and operational achievement,significantly higher than that of the control group (P ＜ 0.01);the frequency of labels and warehousing errors of the experimental group was significantly lower than that of the control group (P ＜0.01).Conclusion:The application of diversified teaching methods in PIVAS is very important at several dimensions:helping students to be familiar with the work of PIVAS as soon as possible,reducing the occurrence of errors,improving the nursing teaching level of PIVAS and ensuring the quality of dispensing fluid.
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OBJECTIVE:To explore the automated intelligent construction and effect of pharmacy intravenous admixture servic-es(PIVAS)in our hospital. METHODS:The main situation of automated intelligent construction and effect of PIVAS in our hospi-tal was introduced,the time and error rate of related links before(Jul.-Sept. 2016)and after(Oct.-Dec. 2016)the automated intelli-gent construction of PIVAS in our hospital were collected,and its effects were evaluated. RESULTS:Our hospital conducted auto-mated intelligent construction in selecting,labeling,sorting and delivering medicines in PIVAS and established related system and process construction. After automated intelligent construction,time for selecting medicines per medical order was shortened from (6.78±0.87)s to(2.65±0.71)s;time for labeling was shortened from(3.24±0.71)s to(1.41±0.55)s;time for sorting a bag of finished infusion was shortened from (13.37 ± 2.84) s to (5.33 ± 1.72) s;and time for delivering the same amount of infusion shortened from (35.64 ± 4.33) min to (18.12 ± 3.57) min (P<0.05). The error rate of selecting medicines was decreased from (2.35 ± 0.59)‰ to (0.26 ± 0.21)‰;error rate of labeling was decreased from (1.51 ± 0.45)‰ to (0.22 ± 0.10)‰;error rate of misclassifying in a wrong ward was decreased from(3.47±1.02)‰ to(0.17±0.10)‰;and error rate of delivering was decreased from(1.33±0.55)‰ to(0.13±0.11)‰(P<0.05). CONCLUSIONS:The automated intelligent construction in PIVAS of our hos-pital has improved work efficiency,reduced error rate and potential medication risk and improved management level in PIVAS.
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Objective To investigate the fine management in the role of infection control management and the effect evaluation in pharmacy intravenous admixture services. Methods From July 2013 to June 2016, infection control management were reviewed retrospectively in pharmacy intravenous admixture services:routine management (from July 2013 to December 2014) and fine management (from January 2015 to June 2016). The settlement of air bacteria formation rate, hand hygiene compliance and accuracy of drug-care workers, and worker′s hand colonization monitoring data before and after the fine management were compared. Results After the implementation of fine management, the settlement of air bacteria formation rate was reduced from 10.42%(120.0/1152) to 4.45%(51.3/1152); there was significant differences (t=3.417, P<0.01).The hand hygiene compliance of drug-care workers increased from 81.50%(1172/1438) to 95.56%(1314/1375), the difference was statistically significant (χ2=1.353, P<0.01);the accuracy rate increased from 86.09%(1109/1172) to 95.13%(1250/1314), the difference was statistically significant (χ2=60.975, P<0.01); workers′ hands colonies number after fine management decreased than before, and there was significant differences (χ2=41.163, P<0.01). Conclusions The fine management has a higher application value in the infection control management of pharmacy intravenous admixture services, which can reduce the settlement of air bacteria formation rate, workers′ hands colonies number, improve hand hygiene compliance and accuracy of drug-care workers, further standardize the worker′s behavior, provide a more secure configuration environment, and guarantee the quality of drug configuration.
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Objective To investigate the fine management in the role of infection control management and the effect evaluation in pharmacy intravenous admixture services. Methods From July 2013 to June 2016, infection control management were reviewed retrospectively in pharmacy intravenous admixture services:routine management (from July 2013 to December 2014) and fine management (from January 2015 to June 2016). The settlement of air bacteria formation rate, hand hygiene compliance and accuracy of drug-care workers, and worker′s hand colonization monitoring data before and after the fine management were compared. Results After the implementation of fine management, the settlement of air bacteria formation rate was reduced from 10.42%(120.0/1152) to 4.45%(51.3/1152); there was significant differences (t=3.417, P<0.01).The hand hygiene compliance of drug-care workers increased from 81.50%(1172/1438) to 95.56%(1314/1375), the difference was statistically significant (χ2=1.353, P<0.01);the accuracy rate increased from 86.09%(1109/1172) to 95.13%(1250/1314), the difference was statistically significant (χ2=60.975, P<0.01); workers′ hands colonies number after fine management decreased than before, and there was significant differences (χ2=41.163, P<0.01). Conclusions The fine management has a higher application value in the infection control management of pharmacy intravenous admixture services, which can reduce the settlement of air bacteria formation rate, workers′ hands colonies number, improve hand hygiene compliance and accuracy of drug-care workers, further standardize the worker′s behavior, provide a more secure configuration environment, and guarantee the quality of drug configuration.
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With the development of clinical pharmacy in hospital,the demand for pharmacy intravenous admixture services (PIVAS) has been gradually increased.By being built inside the pharmacies,PIVAS of this hospital has created a full range of integrated pharmacy service platform.With independent research and development of information management system,innovative design of the modules and equipments based on the concept of internet of things,and integration of artificial and computerized checking,PIVAS of this hospital has formed a system of prevention and control chain,it has been deepening the connotation of clinical pharmacy services,and providing higher quality pharmacy services to clinical drug using.
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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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In order to improve the staff′s ability to combine professional level and moral quality in pharmacy in-travenous admixture services and implement it in nursing practice, this paper discussed the common ethical issues and its importance in pharmacy intravenous admixture services. It analyzed the problems, found the causes out, put forward the countermeasures, and thus to promote the further development of pharmacy intravenous admixture serv-ices and offer high quality clinical services, avoid medical disputes, and provide safer pharmacy service to patients.
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OBJECTIVE:To study the influence of oscillator on the cleanliness of class 100 clean bench in PIVAS. METH-ODS:Using sedimentated bacteria and the number of dust particle as index,in common drug configuration room,antibiotics con-figuration room and risk drugs configuration room including biological safety cabinet and horizontal laminar flow,the cleanliness of class 100 clean bench were monitored when oscillator was set at clean bench and different positions in work and non-working state. RESULTS & CONCLUSIONS:In working and non-working state of oscillator,there was no difference in sedimentated bacteria and the number of dust particle which was in line with the requirements of 2010 edition of GMP,i.e. the application and location of oscillator didn't influence the cleanliness of class 100 clean bench. From a view of safety,it is suggested to place the oscillator in the left(or right)posterior wall of clean table when biological safety cabinets is used to dispense antibiotic and risk drugs.