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BACKGROUND: Pharmacy intravenous admixture service (PIVAS) center has emerged as an important department of hospitals as it can improve occupational protection and ensure the safety and effectiveness of intravenous infusions. However, there is little research on the standardized capability and risk evaluation of PIVAS by using modern information technology. In this research, we established Regional Pharmacy Intravenous Admixture Services Data Reporting and Analysis Platform (RPDRAP) to improve quality control ability for PIVAS management. RPDRAP including evaluation matrix for quality control monitoring. The construction of platform is based on guidelines for the Construction and Management of PIVAS and management specifications of PIVAS in China. METHODS: RPDRAP was established in 2018. This platform comprises a data collection system and a data analysis system. The data collection system consists of 67 data items. Data collection relied on online platforms through data acquisition module. The collected data were analyzed using a model with 20 indicators within the data analysis system. Fifteen hospitals, public comprehensive healthcare facilities with more than 500 beds, participated in the platform's application evaluation. RESULTS: The study revealed significant differences in PIVAS total score, supervisors, and workload between 2020 and 2022. The platform's application results demonstrated improvements in personnel management, work efficiency, and infection control within these PIVAS. Although statistical significance was observed in only 8 out of the 25 items, most of the scores showed an increase, with a small portion remaining unchanged and no decline in scores. CONCLUSIONS: This platform can be recommended for PIVAS homogeneous and regional efficient management. The use of this platform not only improves the quality control ability of PIVAS but also enables the management department to quickly grasp the current situation and characteristics of each PIVAS through standardized data collection and analysis.
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Serviço de Farmácia Hospitalar , Farmácia , Humanos , Projetos de Pesquisa , Administração Intravenosa , Controle de QualidadeRESUMO
Background: This study sought to analyze the leakage rate, economic loss caused by leakage, leakage reasons, and usage of upright polypropylene infusion bags and non-polyvinyl chloride (PVC) infusion bags, two types of closed intravenous infusion containers used in pharmacy intravenous admixture service (PIVAS), to improve the product quality of drug infusion packaging materials, reduce drug and clinical economic losses, and reduce the safety hazards of medication. Method: A real-world study was used to collect statistics for these infusion containers. The study was conducted in 21 hospitals in China from September to December 2022. Upright polypropylene infusion bags or non-PVC infusion bags in PIVAS of these 21 hospitals were chosen as the research material. Results: In total, 2,349,899 upright polypropylene infusion bags and 3,301,722 non-PVC infusion bags were collected. Eleven cases of upright polypropylene infusion bag leakage occurred (with a the leakage rate of 0.05‱), and 394 cases of non-PVC infusion bag leakage occurred (with a leakage rate of 1.19‱). The leakage rate of non-PVC infusion bags was significantly higher than that of upright polypropylene infusion bags (p < 0.01). The main reason for leakage in upright polypropylene infusion bags was sharp objects such as glass fragments or aluminum caps piercing the bag. The main reason for leakage in non-PVC infusion bags was squeezing, stacking, and uneven arrangement that causes folding of edges. For non-PVC bags, additional reasons for leakage included leakage at the nozzle joint, excessive manual or machine throwing force, and excessive dosage. The economic loss of upright polypropylene infusion bags was 1,116.56 CNY. The economic loss of non-PVC infusion bags was 32,210.86 CNY. Conclusion: Based on real-world study data on the leakage of upright polypropylene infusion bags and non-PVC infusion bags in multicenter PIVAS, it can be concluded that the leakage rates of upright polypropylene infusion bags are significantly lower than those of non-PVC infusion bags in PIVAS, and the economic losses due to upright polypropylene infusion bags are lower than those due to non-PVC infusion bags in PIVAS. Therefore, we can infer that upright polypropylene infusion bags are superior to non-PVC infusion bags.
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Background: Antimicrobial agents' wastage is a huge problem, especially for pediatric patients, resulting in excessive drug expenditure and increasing the economic burden on patients' families. Moreover, the cost of disposing of antimicrobial agents' waste and the risk of environmental and occupational exposure also increased. This study aimed to explore the cost-effectiveness of the vial-sharing strategy combined with the daily-rate charge mode for pediatric inpatients to provide a strategy for reducing patients' expenditures, saving medical costs, and reducing drug proportion. Methods: This retrospective study was conducted at Pharmacy Intravenous Admixture Service (PIVAS), Shenzhen Children's Hospital, Guangdong Province, China, in 2022. Data on prescription drugs were collected from the PIVAS system. Ten antimicrobial drugs with a frequency of prescriptions no less than twice once daily were selected, and the drug costs, drug weight, and drug saved were further analyzed according to the combination of real-time vial sharing strategy and daily-rate charge mode. Traditional single vial charge mode without vial sharing was set as a control strategy. The actual expenditure of the hospital was also calculated and analyzed. Results: During 2022, ¥ 4,122,099 (34.4%) was saved for inpatients by applying a vial-sharing strategy on ten antibacterial agents, and more than 46,343,750 mg (24.6%) of drugs were totally saved. The top 5 drugs saved by the real-time vial-sharing strategy were cefoperazone-sulbactam, vancomycin, amoxicillin-sulbactam, ceftazidime, and meropenem. Taken the price into consideration, the top five payment-saved drugs were vancomycin (¥ 1,522,385), meropenem (¥ 1,311,475), cefoperazone-sulbactam (¥ 736,697), imipenem-cilastatin (¥ 406,092), and amoxicillin-sulbactam (¥ 51,394). Moreover, the account balance of the hospital was up to ¥ 426,499. Conclusion: The real-time vial sharing strategy combined with the daily-rate charge mode greatly reduces drug wastage and patients' payments. It may be useful for hospitals with PIVAS to achieve vial-sharing while protecting the best interest of inpatients.
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Objective To establish a rational drug use model of PIVAS and promote the rational drug use in clinical practices by enhancing the quality of prescription review by pharmacists. Methods The PIVAS physician orders received from 2014 to 2021 were extracted through the hospital information management (HIS) system. The types of irrational physician orders were statistically analyzed, the improvements were made by the method of quality control circle (QCC). Results The model of PIVAS rational drug use formed a standardized process. The proficiency of physician order review was improved. From 2014 to 2021, the number and proportion of unreasonable physician orders in PIVAS decreased year by year. Every type of unreasonable physician orders was improved year by year. Conclusion The professional and technical levels of pharmacist for physician order review at our hospital were improved by the model of PIVAS rational drug use. The quality of pharmaceutical service was significantly improved which ensured the safety of patients' medication.
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The traditional intravenous infusion configuration in medical institutions has the shortcomings of long time and low efficiency， and it is difficult to ensure that the dispensed liquid medicine is not contaminated. At the same time， medical staff may be exposed to risks such as cytotoxic drugs due to lack of protection. To solve the defects and deficiencies in intravenous infusion configuration， the “Dolphin 7” pharmacy intravenous compounding robots are introduced in our hospital， cluster management platform is constructed based on data middle platform service exchange system； mini-intelligent PIVAS module is designed and constructed. The mode can reduce the workload of medical staff， save medical construction and labor costs， also help to promote and deepen the construction of intelligent hospitals.
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BACKGROUND: Pharmacy intravenous admixture service (PIVAS) center has emerged as an important department of hospital as it can improve occupational protection and ensure the safety and effectiveness of intravenous infusions. However, medication errors were considered to be a significant challenge in PIVAS, so information-intelligence technologies were introduced to optimize the management of PIVAS. Our article summarized the application of information-intelligence technologies in PIVAS of a large third-class A hospital in China, and provided an example for PIVAS in other hospitals at home and abroad. METHODS: Prescription-reviewing rules containing intravenous medications and infusion solution guideline were recorded in the database of prescription-cheking system. Drugs information were recorded in the PIVAS management system with special identification and warning labels to reduce intravenous infusion errors. Automatic labeling device was used to label the infusion bags, and the quality control program database of intelligent compounding robot for cytotoxic drugs was established ingeniously. Automatic sorting devices were applied for the third batch of finished infusion admixtures, and intelligent logistics robots were used to transport the infusion to the ward. RESULTS: After establishing and implementing of prescription-reviewing rules in the prescription-cheking system database, the number of prescriptions checked by pharmacists increased from 18 to 43 per minute. The success rate of intervention with irrational medical orders increased from 85.89% to 99.06% (P < 0.05). By introducing various intelligent devices, automatic labeling significantly enhanced work efficiency and reduced the error rate (P < 0.001). Furthermore, the use of intelligent intravenous compounding robots significantly reduced the risk of errors (P < 0.001). CONCLUSIONS: The application of information-intelligence technologies in PIVAS can improve work efficiency and reduce error risk. However, some intelligent devices have failed to achieve the expected effect in practical use, and further improvements are needed to meet the demands of PIVAS in the future.
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Serviço de Farmácia Hospitalar , Farmácia , Composição de Medicamentos , Hospitais , Humanos , InteligênciaRESUMO
Background: Cytotoxic drug residues in pharmacy intravenous admixture services (PIVAS) have always been a major problem for pharmaceutical workers and the PIVAS environment,which is not only pollutes the PIVAS environment, but also causes serious harm to the life and health of the staff. This study aimed to establish an ultra-high performance liquid chromatography quadrupole orbitrap high resolution mass spectrometry (UPLC-Q/Orbitrap-HRMS) method for the rapid detection and monitor of 15 cytotoxic drugs. Methods: UPLC-Q/Orbitrap-HRMS method was used to establish a rapid detection method for 15 cytotoxic drugs such as cytarabine, gemcitabine and so on. The daily precision and accuracy of this method were verified by injecting four concentrations of standard solution on the same day, and the same four concentrations of standard solution were injected within three days respectively to verify the daily precision of this method. The signal-to-noise ratio (SNR) of 10:1 was calculated as the limit of quantity. The mixed standard solution of 15 cytotoxic drugs with concentrations of 0.5, 1, 3, 10, 30, 100, 300, and 1,000 ng/mL was configured and detected by this method for linearity and range.The stability of this method was investigated using a mixture of 15 drugs (15MIX) standard solutions at high concentration (300 ng/mL) and low concentration (10 ng/mL) at room temperature for 12 and 24 hours, respectively. A standard solution of each drug, 15MIX and blank solution were taken to verify the exclusivity of the method. Results: The results showed that the method had good specificity, and the intraday precision of all drugs was less than 10% and the intraday precision was less than 15%. At the same time, the standard curve had good linearity, R2 was greater than 0.99, and the limit of quantification of most drugs was about 1 ng/mL. Conclusions: In this study, an UPLC-Q/Orbitrap-HRMS method was established for the rapid detection of 15 cytotoxic drugs, providing technical support for the monitoring of cytotoxic drug residues in PIVAS, which is of great significance for environmental contamination mornitoring as well as occupational exposure alert.
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OBJECTIVE：To pro vide reference for promoting the standardized construction of centralized intravenous drug dispensing mode and the healthy development of PIVAS and improving the rational infusion in China. METHODS ：The establishment and development process of PIVAS in China were reviewed ，the necessity ，current situation and problems to be solved of centralized intravenous drug dispensing mode were analyzed. RESULTS & CONCLUSIONS ：Due to scientific ， advanced，smooth，convenient operation procedure and standardized management ，and reduced occupation exposure ，centralized intravenous drug dispensing mode ，of which the pharmacists were in charge ，had become the inevitable development direction of intravenous drug dispensing in Chinese hospitals. The overall PIVAS construction in China had worked well and played a significant role，not only significantly improved the quality of finished infusion ，promoted rational drug use ，protected the health of nurses and ward （area） environment，but also contributed to the construction and development of the nursing profession ，and also contributed to the improvement of the pharmacy department ’s own management level. However ，the value of PIVAS pharmacist service still needs to be understood.
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OBJECTIVE：To explore the new management model of Good Clinical Practice （GCP）trial drug dispensing . METHODS：Base on the relevant experience of Pharmacy Intravenous Admixture Services （PIVAS）in daytime chemotherapy center（“daytime PIVAS ”for short ）of our hospital ，the nodes and other matters needing attention were discussed in the workflow of confirmation and development of drug dispensing tasks for clinical trials. RESULTS ：After the successful approval of the new clinical trial ，the supervisor of the sponsor and the principal investigator should first confirm whether the drugs involved in the project needed to be centrally dispensed in the daytime PIVAS ，and then submitted the relevant data to PIVAS for filing. Daytime PIVAS pharmacists could participate in trial drug dispensing of relevant projects only after starting training and authorization. After the doctor issued the medical order for the subjects in the hospital information system ，the research nurse took the drugs out of the GCP pharmacy and handed them to the daytime PIVAS drug receiving window. After receiving the drugs ，the pharmacist would check the dispensing ，and then the preparation pharmacist trained and authorized by the project team would mix and dispense the drugs. The reviewed pharmacist would check and label the prepared infusion. In addition ，daytime PIVAS would regularly summarize the feedback information on the trial drug dispensing and fund management in all links of dispensing process ，so as to improve the standardization of the process. CONCLUSIONS ：Daytime PIVAS for clinical trial drug can arrange batches more rationally，ensure smooth and orderly infusion ，and meet different drug stability requirements ，which can improve trial drug dispensing management and further promote the development of drug clinical trial projects in China.
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BACKGROUND: To investigate the construction situation, costs and charges associated with pharmacy intravenous admixture services (PIVAS) to provide references for the construction and development of PIVAS in mainland China. METHODS: A multi-center cross-sectional survey was conducted via a WeChat Group targeting PIVAS leaders in hospitals to investigate the basic situation of PIVAS, including opening time, area, number of PIVAS, equipment, management mode, PIVAS costs and charges, as well as numbers of beds, open wards, and staff, and analyze differences in PIVAS construction at different provincial and hospital levels. RESULTS: 137 questionnaires were collected from 29 provinces, representing a response rate of 99.3%. Most participants (88.4%) were from Level III Hospitals. The number of years of operations of PIVAS ranged from 1 to 22 (median: 6). PIVAS site area ranged between 100 and 1973 m2; daily average infusion volume was concentrated in the ranges 0-1000 bags (29.9%, 41/137) and 1001-2000 bags (26.3%, 36/137). In terms of PIVAS management mode, the vast majority used separate pharmacy management (65.0%, 89/137). Only 52.6% (72/137) of PIVAS have standardized charges, and 70.1% (96/137) operate at a loss. The median costs of mixed tumor chemotherapy drugs, total parenteral nutrition, general medicine, antibiotics were 20, 35, 4 and 5 RMB, respectively. With the exception of a few features, PIVAS construction does not obviously differ among different regions and hospital levels. CONCLUSIONS: In recent years, PIVAS in China has developed rapidly and become relatively large. The main problems are that most provinces lack standards for charges and PIVAS construction differs among hospitals. Therefore, standards for PIVAS construction and charges should be developed to provide a reference for the future development of PIVAS.
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Composição de Medicamentos/economia , Arquitetura Hospitalar , Serviço de Farmácia Hospitalar , Administração Intravenosa , China , Estudos Transversais , Economia Hospitalar/estatística & dados numéricos , Pesquisas sobre Atenção à Saúde , Número de Leitos em Hospital , Custos HospitalaresRESUMO
PURPOSE: The purpose of this paper is to explore the importance of lean leadership in an implementation in a Chinese hospital, considering a particular focus on the attitudes of nursing professionals while identifying specific cultural or institutional factors in China that might affect the implementation. DESIGN/METHODOLOGY/APPROACH: The authors use Harrison et al.'s (2016) framework to explore the outcomes of a nine-month action research project whereby the authors observed the process and outcomes of implementing lean in a pharmacy intravenous admixture service of a Chinese hospital. FINDINGS: The implementation of lean had positive results, which improved the efficiency of the operation, reduced the work start time and the amount of staff, and improved clinical satisfaction. In the process of implementation, nursing professionals showed a positive attitude toward the implementation and showed no obvious resistance under the positive influence of the head nurse. The combination of Chinese cultural characteristics, nursing culture and strong leadership enabled lean success. ORIGINALITY/VALUE: The unit moved from self-management to a systemized process of using lean concepts and methods, it is an important change for hospital managers.
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Farmácia , Autogestão , China , Hospitais , Humanos , LiderançaRESUMO
OBJECTIVE：To standardize and optim ize the clinical use of Trastuzumab for injection ，and to provide reference for rational use of drugs in the patients. METHODS ：The pharmacy intravenous admixture service （PIVAS）in our hospital took the lead in communication and coordination with financial ，information，medical insurance departments as well as clinicians and nurses，to set up dispensing ，charging and reimbursement mode by dose of trastuzumab. Under that ，doctors could give orders according to the clinical dosage of patients ；PIVAS dispenses drugs according to the actual dose ；the drugs were shared among patients；the charge and reimbursement of drugs are carried out according to the actual dose of patients. At the same time ，the questionnaire survey was conducted among 60 patients about the medical experience and cost savings before and after the implementation of the mode . RESULTS ：The questionnaire survey showed that in terms of solving the potential safety problems of trastuzumab and the inconvenience of patients ’medical treatment ，the solution rate of the mode was 100％；in terms of improving patients’feeling of seeking medical treatment and helping treatment ，the improvement rate was 100％；in terms of saving patients ’ treatment costs ，most（80％）of the patients thought that it could save less than 500 yuan each time ，and rest of the patients thought that it could save more than 500 yuan each time. CONCLUSIONS ：The mode of dispensing ，charging and reimbursement of Trastuzumab for injection in our hospital has solved the problems of drug waste ，occupational injury and inconvenient preservation in clinical use ，and has played a good role in drug safety ，cost saving and patient convenience.
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OBJECTIVE：To explore the key factors affecting the sustainable development of pharmacy intravenous admixture service（PIVAS），and to provide theoretical basis for the healthy development of PIVAS. METHODS ：Retrieved from PubMed ， CNKI，Wanfang database and VIP ，literatures related to the development of PIVAS. Combining with the actual operation and development of PIVAS in China in recent 20 years，based on actual experience of PIVAS in our hospital in recent 10 years，the key factors affecting the sustainable development of PIVAS were analyzed by retrospective method from five aspects ，i.e. drug management，quality control ，pharmacists’professional quality improvement ，pharmaceutical care extension ，cost and benefit. RESULTS & CONCLUSIONS ：The key elements of PIVAS drug management included drug inventory ，expiration date ，daily inventory，high-warning drug ，drug damage ，slack demand of drug and drug shortage. The key elements of PIVAS quality control included personnel quality control ，environment quality control and quality control of finished infusion. Improving the professional ability and communication service ability of pharmacists were the key factors to improve the professional quality of pharmacists. The establishment and application of medication order review and accurate flushing database based on PIVAS prescription audit system，professional drug consultation and clinical education ，whole pharmaceutical care of cytotoxic drugs and PIVAS adverse drug reaction monitoring were the key elements of pharmaceutical service extension. It can promote the sustainable and healthy development of PIVAS to improve pharmacists ’professional ability and communication ability ，strictly drug management and quality control ，continously extend pharmaceutical care ，improve professional influence and expand social influence and formulate reasonable charging mechanism.
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OBJECTIVE: To investigate the use of PDCA mode for risk assessment and risk management of pharmacy intravenous admixture service. METHODS: A retrospective analysis was made on the errors recorded in the intravenous drug dispensing center from Monday 2019 to March 2019. The types and links of errors were counted and classified, and the causes were analyzed. Targeted preventive measures were implemented from April to June 2019 to observe the incidence of errors before and after prevention in intravenous drug dispensing centers. RESULTS: Through the PDCA cycle management intervention, the main errors in intravenous drug dispensing center are dispensing, labeling, reviewing, checking and issuing. The incidence of errors in each link after prevention is lower than that before prevention, and the difference is statistically significant (P<0.001). CONCLUSION: The PDCA cycle management and risk assessment are conducted. The paper analyzes the types and causes of common errors in intravenous drug dispensing center, so as to formulate corresponding preventive measures, which can reduce the risk factors of errors, reduce the incidence of errors, improve the quality of finished product infusion and the safety of intravenous drug use.
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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 .
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ABSTRACT OBJECTIVE：To establish the infusion sequence regulation procedure of PIVAS，and implement individual regulation. METHODS：By combining factors such as liquid volume of each batch，incompatibility between groups and specific solvents of specific drugs，intelligent prompt system and the artificial intelligent regulation system of infusion sequence were successively established to sequence the therapeutic drugs and adjuvant drugs used for the patients with different diagnoses and different purposes in different inpatient areas in a day，so as to realize intelligent control of individual infusion sequence. From Jan. to Sept. in 2017 and from Jan. to Sept. in 2019 as research stages before and after the intelligent control of individualized infusion sequence，the control effect was evaluated with the proportion of reasonable number of infusion priority cases，the proportion of appropriate number of elderly patients’batch liquid volume cases，the proportion of incompatibility cases between separate groups， the number and cost of flushing tubes as index. RESULTS：After regulating infusion sequence individually，the proportion of reasonable infusion priority rose from 5.56％ to 98.72％ ；the proportion of batch liquid quantity appropriate cases in elderly patients rose from 9.58％ to 98.10％；the proportion which separated the incompatibility between groups rose from 41.03％ to 99.12％；the number of washing tube dropped to（0.95±0.43）times/ward/d from（12.95±0.57）times/ward/d；the cost of washing tube could be saved 85 800 yuan/year. CONCLUSIONS：The implementation of individualized infusion sequence regulation promote safe and effective infusion，and provide reference for pharmacists of PIVAS in China to carry out precise pharmaceutical care.
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OBJECTIVE：To introduce the development and application of automatic dosing and mixing system of intravenous infusion in PIVAS of our hospital. METHODS ：Based on the bar code management system in PIVAS ，combined with automatic mixing equipment ，our hospital developed and designed automatic dosing and mixing system of intravenous infusion which could realize real-time scanning and charging of drugs ，setting parameters of mixed dispensing and automatic dosing and mixed dispensing of intravenous infusion. Compared with manual dispensing model ，work efficiency of 5 staff who dispensed Coenzyme complex for injection and Carbazochrome sodium s ulfonate for injection 300 bags each as well as the amount of drug residues in empty bottle were investigated to evaluate the effects of the system. RESULTS ：The system realized automatic mixing of intravenous infusion. In manual dispensing model and automatic dispensing model ，the mixing efficiency of Coenzyme complex for injection were （96.6±10.0）and（195.2±10.7）bag/h（P＜0.001）；mixing efficiency of Carbazochrome sodium sulfonate for injection were （83.8±12.9）and（118.8±6.7）bag/h（P＜0.001）. The amount of residual liquid in Coenzyme complex for injection empty bottle were （0.09±0.02）and（0.11±0.01）mL；Carbazochrome sodium sulfonate for injection empty bottle were （0.08± 0.02）and（0.12±0.01）mL，which were all lower than the internal control requirements that injected solvent volume was no more than 5％ （0.15 mL）. CONCLUSIONS ：The automatic dosing and mixing system of intravenous infusion could improve the efficiency of intravenous infusion dispensing and reduce the labor intensity of the staff .
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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.
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Objective: The construct a pharmacy intravenous admixture service (PIVAS) for changing configuration of intravenous drugs from decentralized configuration to centralized allocation supply so as to guarantee the safety of clinical drugs of hospital. Methods: Through constructed PIVAS, adopted purified air-condition system and established fluid-layers room of different grade to achieve sterile environment for configuration of intravenous drugs. And the centralized allocation should be implemented as the characteristics of different drugs. Results: The PIVAS could reduce the waste of drugs and decrease their cost. At the same time, it guaranteed the safety of clinical medication of hospital on the bases of enhancing work efficiency of clinical nurse and reasonably resolving allocation of human resources. Conclusion: The PIVAS that changes the configuration of intravenous drugs from decentralized configuration to centralized allocation supply can positively and effectively promote the safety of clinical medication and increase work efficiency of nursing and care.
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OBJECTIVE:To provide reference for confirming the protective effect of the establishment of PIVAS on antineoplastic drugs(ADs)occupational exposure to nursing staff in clinical departments,and to provide the basis for the formulation of ADs dispensing guideline and occupational exposure protection regulations. METHODS:By questionnaire survey and deriving data of lab examination index,the occurrence of abnormal menstruation,bad birth outcome,alopecia,blood toxicity, liver and renal toxicity in nursing staff of clinical departments with different ADs contact frequencies(non-exposure group as group A,low-exposure group as group B,high-exposure group as group C)were investigated and analyzed in our hospital before and after the establishment of PIVAS. The residual of ADs [methotrexate(MTX)and 5-Fluorouracil(5-FU)] in PIVAS environment were investigated by HPLC. RESULTS:A total of 160 questionnaires were sent out before the establishment of PIVAS,and 151 were effectively collected with effective recovery of 94.38%. After the establishment of PIVAS,150 questionnaires were sent out,and 144 were effectively collected with effective recovery of 96.00%. Questionnaire results showed that the incidence of abnormal menstruation,abnormal menstruation period,dysmenorrhea,spontaneous abortion,infertility and offspring low birth weight,the severity of hair loss in group C were significantly higher than group A,with statistical significance(P<0.05 or P<0.01). The incidence of above 6 conditions in group C were 5.14,6.10,3.81,4.04,6.15,8.08 times higher than in group A.At same time, the incidence of the offspring low birth weight and the severity of hair loss in group B were significantly higher than group A,with statistical significance(P<0.05 or P<0.01);the incidence of the former in group B was 6.21 times higher than in group A.After the establishment of PIVAS,the incidence of abnormal menstruation,abnormal menstruation period,dysmenorrhea,spontaneous abortion,infertility and offspring low birth weight,the severity of hair loss were decreased significantly in group C,with statistical significance(P<0.05). The severity of hair loss in group C was significantly higher than group A,and there was no statistical significance in above indexes,compared with group A(P>0.05). At the same time,there was no statistical significance in the incidence of the offspring low birth weight and the severity of hair loss between group B and A(P>0.05). Results of lab examination index investigation showed that before the establishment of PIVAS,WBC and PLT of group C were significantly lower than group A,and the incidence of abnormal liver function was significantly higher than group A,with statistical significance(P<0.05 or P<0.01). After the establishment PIVAS,WBC,PLT and RBC of group C,and PLT of group B were increased significantly compared to before the establishment PIVAS;the incidence of abnormal liver function in group C was decreased significantly compared to before the establishment PIVAS,with statistical significance(P<0.05 or P<0.01). There was no statistical significance in above indexes between group C and A(P>0.05),and PLT of group B was even significantly higher than group A(P<0.05). Results of investigation of ADs residues in PIVAS environment showed that there were different degrees of MTX and 5-FU residue on the surface of different objects. The residues of ADs from high to low were biological safety cabinet worktops,the floor just below biological safety cabinet,transfer box,transfer window and door handle and infusion bags. CONCLUSIONS:Nursing staff of clinical department with high ADs contact frequency face higher relevant health risks. The establishment of PIVAS can effectively protect the ADs occupational exposure of nursing staff in clinical departments,thereby reducing the above risks.At the same time,there are still different degrees of ADs residues on the surface of different objects in the PIVAS environment,and transshipment out of PIVAS is possible. It is suggested that the awareness of protection against occupational exposure risk caused by ADs residues in PIVAS environment should be improved;unified guideline for ADs dispensing and occupational exposure protection regulations should be formulated as soon as possible,so as to reduce occupational exposure risk associated with ADs for nursing staff in PIVAS and clinical departments.
