1 establishment of intravenous drug distribution center
A hospital 1. 1 PIVAS is located on the sixth floor of the hospital medical technology building, which is convenient for drug transportation and finished product distribution, preparation management and environmental control, and the basic conditions such as water and electricity meet the requirements. Its area is 309m2, and its design is reasonable and its process is smooth. The main functional areas include medicine delivery, medicine storage, medicine filling, information, distribution, dressing and cleaning. Equipped with 6 biosafety cabinets and advanced air purification system. The aseptic workshop has strict isolation measures and disinfection equipment. Entering the workshop must pass through two isolation doors and install air conditioning equipment. After the completion of the project, the purification system will be statically tested by qualified units, and the indicators such as settling bacteria, particles, noise, light, air exchange times, temperature and humidity can be put into use only after they meet the standards. Ensure the cleanliness of the clean room, so as to ensure the safety of clinical medication.
1.2 The management mode of PIVAS in a hospital adopts medicine as the main mode, the pharmacy department is responsible for the daily work management, and the nursing department is responsible for the allocation of nursing staff. At present, there are 5 pharmacists, nurses 13 and 2 workers, serving the hospital 19 ward, providing about 1500 bags of intravenous infusion every day. Pharmacists are mainly responsible for reviewing prescriptions, dispensing drugs, adding drugs, checking and drug management. The duty of nursing staff is to check, prepare and help arrange drugs; Workers need to deliver medicine and clean up in time.
1.3 information system is the basis of realizing intravenous drug preparation. The dean in charge called the relevant personnel of pharmacy department, nursing department, medical department and information department for many times to coordinate their work, unify their understanding and determine the computer program. Computer information system includes prescription transmission, label printing, medicine fee payment, medicine management, consulting service and medicine calendar generation. The contents of the label should include the basic information of patients, drug prescription information, preparation inspection information, etc. , is an important certificate for pharmacists to review drugs and record the preparation process. The information management system should set management authority, improve data statistics function, automatically generate batches and implement the whole process management of configuration. In addition, a compatibility monitoring system will be embedded in the system to monitor the rational use of drugs.
2 workflow design of intravenous drug dispensing center
2. 1 The doctor will prescribe intravenous drugs in accordance with the relevant provisions of the Prescription Management Measures, and the prescription will be entered into the hospital information system by special personnel. Prescriptions can be divided into long-term prescriptions and temporary prescriptions. The ward is responsible for transmitting the long-term prescription that patients need intravenous infusion the next day to PIVAS at the specified time, and the temporary prescription is transmitted to PIVAS according to the relevant regulations and requirements of the hospital.
2.2 After receiving the prescription, PIVAS pharmacists check the prescription information of patients one by one to verify its correctness, rationality and completeness. If the prescription is wrong, communicate with the doctor in time and ask him to adjust and sign. If there is an error in the prescription and the doctor refuses to agree to modify it, he will refuse to allocate it and report it to the relevant departments for coordination.
2.3 Pharmacists' reviewed prescriptions should be printed into prescription labels, which should include the patient's name, ward, bed number, date, prescription composition, automatically generated number, etc. , each process should leave a space for signature or seal, and the label should be attached to the infusion bottle (bag).
2.4 After receiving the auditor's qualified label, pharmacists should carefully check whether the label content is accurate and complete. If there is any error or incompleteness, they should inform the auditor to proofread and correct it. Pharmacists put drugs into containers of different colors in batches according to the sequence of drugs listed in the audit label, according to the nature of drugs and different medication time, and sign or seal the labels, and put them into different configuration rooms according to the different properties of wards and drugs.
2.5 The configuration room is a clean room with cleanliness class of 10000. According to different kinds of drugs, it can be divided into general drugs and total intravenous nutrition drugs allocation room, antibiotics and cytotoxic drugs allocation room. A purification laminar flow platform should be provided between general drugs and total parenteral nutrition drugs, so that the configuration environment can reach 100 level, thus ensuring that drugs are not polluted. Prescriptions containing antibiotics or cytotoxic drugs are mainly prepared in the configuration room between antibiotics and cytotoxic drugs. This room is equipped with a biological safety cabinet, so that the cleanliness level of the environment can reach 100, and it is under negative pressure to prevent the drug from harming the staff. The nurse strictly abides by the principle of aseptic operation, fills the medicine in time and signs or seals the label.
2.6 Send the prepared drugs to the finished product acceptance and packaging area through the delivery window or conveyor belt for acceptance and confirmation again. According to the classification of wards, put them into airtight containers, and attach a list of finished products, which will be sent to each ward by special personnel. The ward nurse receives and checks it, and gives the patient medication after it is correct. Containers containing drugs should be sealed and disinfected regularly to avoid secondary pollution of prepared drugs.