The continued decline of plasma transfusions in Taiwan: An 11-year population-based study.

BACKGROUND AND OBJECTIVES: In Taiwan, plasma use per capita ranks among the highest in the world. We aimed to describe the trends in usage after the introduction of new hospital accreditation standards that evaluate compliance with institutional plasma transfusion guidelines. MATERIALS AND METHODS: We identified hospitalizations receiving plasma between 2007 and 2017 from the national health insurance database. We estimated plasma transfusions per thousand capita. The risk ratio of transfusion rates among hospitalizations in 2017 compared to 2007 was estimated using logistic regression. RESULTS: The total number of plasma transfusions declined from 964,408 in 2007 to 659,828 in 2017, yielding a rate of 28.00 per thousand capita. The proportion of hospitalizations receiving plasma declined by 38%, from 3.89% (95% confidence interval: 3.86%-3.91%) to 2.62% (2.61%-2.64%). Gastroenterology (16.4%) and general surgery (15.3%) accounted for the largest proportions of plasma usage. Within these two services, liver diseases were the top diagnoses needing plasma use. For hospitalized patients with liver diseases, approximately 40% of plasma units were administered to patients with neither noticeable bleeding nor red blood cells transfusions. Among these patients, almost 50% received plasma with an international normalized ratio trigger of less than 1.50. The use of potential alternative therapies or anticoagulants remained quite low during this period. CONCLUSION: Plasma utilization rates during hospitalizations continuously declined over 11 years. However, inappropriate plasma use remained high, while the use of alternative therapies remained low in services such as gastroenterology. To improve the appropriateness of plasma transfusions, patient blood management should be implemented in the near future.

Comparison and Enlightenment of the Contents of Pharmaceutical Administration in Hospital Accreditation Standards between China and JCI / 中国药房

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.

Effect of JCI accreditation standards on hospital library / 中华医学图书情报杂志

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.