基于“医-药-护”预警监控系统的合理安全输液整合管理实践

目的：过度依赖静脉输液给药已经成为我国医疗卫生工作中突出的重要问题之一,不安全和不合理的使用输液会导致严重的不良后果甚至死亡。本研究拟开展合理安全输液整合管理,构建"医-药-护"合理安全输液预警监控系统,并初步探讨了该系统对于输液全过程监管的意义。方法：本研究从整合管理的框架和设计原则、标准体系建设和知识规则库的设立、"医-药-护"三方管理结构整合和功能模块设计等方面,构建了"医-药-护"合理安全输液预警监控系统,建立基于数据平台的评价体系,实现合理安全输液实时干预。结果：该院以静脉输液作为切入点,全面整合了医务、药学、护理及临床科室的管理规则、治理结构和数据资源,实现输液管理系统化。建立、测验并修订了输液知识规则库,建设了医师、药师和护士3个输液数字化工作平台,实现输液实时预警、辅助决策、回顾评价、科学研究等功能,并通过初步应用效果评价进行了验证。结论：本研究率先探讨建立输液标准体系和管理指南、研发输液预警监控系统、组织多学科团队监管输液的全过程。提示涵盖"医-药-护"多学科的整合管理将成为合理用药管理的重要创新探索。

Integration management practice of rational and safe infusion based on the “medicine-pharmacy-nursing” monitor-control and early-warning system

OBJECTIVE Overuse of intravenous infusion has been one of the most important issues in China's medical and health era. Unsafe and inappropriate use of infusion can lead to serious adverse consequences or even death. This study intends to carry out integrated management of rational and safe use of infusion, establish the "medicine-pharmacy-nursing" monitor-control and early-warning system for rational and safe infusion and preliminarily explore the significance of the system for the whole process of infusion supervision. METHODS Based on integrated management framework and design principles, establishment of standard systems and knowledge rule bases, integration of "medicine-pharmacy-nursing" tripartite management structures and functional module design, this study established the "medicine-pharmacy-nursing" monitor-control and early-warning system for rational and safe infusion. Through the development of evaluation system based on the data platform, this study realized rational and safe infusion real-time intervention. RESULTS Taking intravenous infusion as the cut-in point, the hospital fully integrated the management rules, governance structure and data resources of medical, pharmacy, nursing and clinical departments to achieve systematic management. The infusion monitoring system established a preliminary infusion management rule and knowledge base, and conducted a rule test and revision. The system has established three infusion-related digitized working platforms for physician, pharmacist and nurse to achieve functions of real-time early warning and intervention, auxiliary decision making on selection of devices, retrospective assessment and scientific research. And it had been verified by preliminary application evaluation. CONCLUSION This study takes the lead in exploring the whole process of establishing infusion standard system and management guideline, developing infusion warning monitoring system and organizing multidisciplinary team to supervise infusion. It is suggested that the integration of multiple disciplines, including clinical medicine, pharmaceutical sciences, and nursing will be an important innovation in the management of rational drug use.