Release date: 2018-05-31
Blood transfusion is one of the clinically irreplaceable treatments. Ensuring that blood is safe, reasonable, scientific and effective is an important part of evaluating blood transfusion management. Shaanxi Provincial People's Hospital cooperated with a software company to develop closed-loop blood transfusion information management according to the requirements of the "Administrative Blood Management Measures for Medical Institutions", "Clinical Blood Transfusion Technical Specifications", "Three-level Comprehensive Hospital Evaluation Standards Implementation Rules (2012 Edition)" and other documents. The platform relies on this platform to enable medical staff, department quality control team, blood transfusion department, blood transfusion quality management committee and corresponding functional departments to participate in clinical blood quality management work, and achieved good results.
1 main practice
1.1 Conduct quality management throughout the process
Clinical blood begins with the patient's examination and testing, and finally the evaluation and feedback of the effect after transfusion. The clinical blood transfusion process is divided into three parts: before transfusion, during transfusion, and after transfusion.
1.1.1 Quality management before transfusion (1) Pre-transfusion assessment. The clinician selects the patient information, right-clicks the blood application, selects the blood transfusion type, and the blood transfusion target to enter the blood application interface. The blood transfusion application interface sets options such as therapeutic blood transfusion, preoperative blood preparation, and special blood treatment. The applicant is selected to enter according to the situation, and the LIS system is automatically linked to obtain laboratory test indicators and ABO and RH blood types. According to the patient's symptoms and signs and laboratory test results, add the application for blood transfusion components, save the blood transfusion application form and automatically print the informed consent for blood transfusion. At the same time, the blood transfusion department reviews and evaluates the rationality and applicability of blood. In addition to the blood for first aid, those who lack the assessment content cannot proceed to the next step. The blood for first aid is notified to the blood transfusion department by the blood department telephone, blood is collected and/or the information is checked, and the blood is sent and signed, and the blood is first examined. The Blood Transfusion Quality Management Committee will report the blood of first-aid blood in each department and conduct quality control one by one to establish an information filing system. Penalties such as defamation, deduction of performance appraisal scores, and even administrative sanctions are imposed on individuals and departments that repeatedly lie and report false blood for first aid.
(2) Blood transfusion application review. Follow the requirements of the “Administrative Measures for Clinical Blood Use of Medical Institutionsâ€, and review according to the amount of blood used. Less than 800ml is only reviewed by the superior doctor, 800ml ~ 1 600ml need to be reviewed by the director, more than 1600ml need to be examined by the medical department and fill out the "a large number of blood application forms."
(3) Blood sample collection. The clinical nurse enters the blood sample collection interface, clicks to print the unique blood transfusion specimen identification barcode 2, one is attached to the blood transfusion application form, and one is attached to the blood transfusion sample tube. After the blood collection, the blood sample and the blood transfusion application form are sent to the blood transfusion department. . The system records the blood collection time, the operator, the delivery personnel, and the blood transfusion department receiving personnel to ensure traceability.
(4) Blood sample reception. The blood transfusion personnel check the blood sample, check the application form and blood sample information with the blood sample nurse, scan the test tube barcode, check the information again, and receive the specimen and the application form.
(5) Blood type identification with blood. The blood transfusion personnel will automatically enter the information by scanning the blood sample, and automatically upload the result or manually check the entry after checking the result after each operation. In the blood transfusion test, the operator, the reviewer, and the blood type identification match time will be recorded truthfully.
(6) Blood. The system matches the blood bag products (ABO+RH(D)+anti-screening) according to the same type of infusion principle, selects the blood products according to the expiration date, clicks the charge, and prints the blood report. After the cross-matching is completed, if blood transfusion is required, the nurse prints the blood collection list, and the blood transfusion department and the blood-staining personnel jointly check the patient information, blood information, cross-matching blood information and blood bag information, scan the blood bag barcode, and print the blood list. And both parties signed. The system automatically records both sides of the operation and the time of blooding.
1.1.2 Quality management in blood transfusion Blood is transported from blood transfusion department to clinical blood department. It is equipped with special blood transport box, ice bag and thermometer are placed in the box, the temperature is kept at about 4 °C, the temperature inside the box is recorded when leaving the blood transfusion department, and blood transfusion in clinical department The former nurse records the temperature and performs blood run cold chain control. When the blood reaches the ward, the nurse scans the blood bag and the system automatically records the check time and the checker. Before the blood transfusion, the nursing staff performed “three check seven pairsâ€, scanned the patient's wristband and blood bag information, checked the patient's blood matching report, and the three began to transfusion. The nurse records the start time, end time, blood transfusion, and blood transfusion reaction of the blood transfusion. The system automatically records the operator's name, blood transfusion volume and blood transfusion composition. The blood infusion time can be used to control the quality of blood infusion of various components [1]. The nurse conducts a blood transfusion process to monitor the patient's general condition and vital signs such as body temperature, pulse, respiration, and blood pressure. Those who have adverse reactions to blood transfusions will be recorded in time and reminded by the competent physician. The Department of Blood Transfusion and the Quality Control Department randomly check the information of transfusion patients and conduct follow-up sampling.
1.1.3 Quality management after transfusion Mainly involved in the evaluation of blood transfusion efficacy and blood bag management.
Efficacy evaluation of blood transfusion is mainly divided into two categories: intraoperative blood evaluation, postoperative and medical treatment blood evaluation. The assessment level is determined by the clinician and/or anesthesiologist and is classified as valid and ineffective. The clinician completed the evaluation of the efficacy after transfusion within 72 hours after transfusion, and evaluated the improvement based on clinical symptoms and signs and the results of blood routine and hemagglutination index [2]. The quality control department and the blood transfusion department can check the blood transfusion process at any time.
Blood bag management is mainly the destruction of blood bags. The nurse retrieves the blood bag as required, and the operator fills in the recycling registration form and transfers the blood. According to the hospital infection management requirements, the blood bag will be returned to the medical waste recycling office.
1.2 Analysis and evaluation
1.2.1 Clinical blood evaluation platform can realize the statistical analysis function of clinical blood, including blood storage and distribution, blood volume, clinical department blood, single disease blood, physician blood volume, physician surgery blood, blood transfusion The ratio of patients with non-transfusion, adverse reactions of transfusion, clinical blood details.
The quality control personnel of the department are required to report and analyze the adverse reactions of blood transfusion every month, and the results are recorded in the “Quality and Safety Record Book of the Departmentâ€. The blood transfusion department publishes the top 10 departments and individuals with the total amount of blood every month, and publishes it in the "Medical Management Monthly". At the same time, the blood transfusion patient information can be taken at any time through the platform, and the doctor's blood transfusion pointer control and blood transfusion effectiveness evaluation can be viewed.
1.2.2 blood transfusion medical record reviews blood transfusion medical record reviews including blood transfusion medical record home page, pre-transfusion assessment form, blood transfusion informed consent, blood transfusion application form, distribution (hair) blood report, blood transfusion process record, adverse reaction record, blood transfusion efficacy evaluation and other aspects . The clinical blood transfusion management system can be statistically evaluated and ranked according to department, personnel, adverse reaction report, blood transfusion process record, blood transfusion assessment, etc.
At the same time, the quality control staff of the department needs to control 2 blood transfusion medical records in the department every month, and the results are recorded in the "Quality and Safety Record Book of the Department". The Quality Control Section reviews a certain number of archived blood transfusion medical records each month.
2 effects
2.1 Comparison of the process before and after the platform
2.1.1 Before blood transfusion Before the use of the platform, the clinical use of blood submitted a manual application form, there are incomplete filling of the project, the doctor's handwriting can not be identified, the delay of submission, etc., need to be checked by the blood transfusion department, the error rate is high. After the platform is used, the project can not be used for the next step; the blood is forcibly pre-transfusion assessment, and the HIS and LIS systems are automatically linked to facilitate the blood transfusion department and the quality management department to conduct blood transfusion rationality evaluation; In the system to complete blood transfusion review, quality control.
2.1.2 In the blood transfusion It is possible to accurately record and analyze the various components with blood infusion start and stop time, and systematically collect patient information of a certain blood product in a certain period of time in the whole hospital, realizing real-time monitoring of clinical blood.
2.1.3 After transfusion The evaluation of transfusion efficacy is more convenient, and the post-transfusion check item reminder is set up, and the LIS system is linked. As part of the post-transfusion assessment, transfusion adverse reactions can be viewed at any time and processed in a timely manner to reduce the risk of blood safety. Blood transfusion records can be printed on the platform with one click to prevent missing key documents.
2.1.4 Other aspects All aspects of clinical blood use are recorded by operators and operation time, which is convenient for problem traceability and quality full process control. The platform can complete the management of blood in and out of the library, blood transfusion reagents and consumables, blood transfusion experiment methods, and blood transfusion project charges. It is possible to store and extract blood statistics at any time, and contribute greatly to the development of planning, implementation, inspection, and feedback to improve the quality of blood transfusion management.
2.2 Data comparison before and after platform use
2.2.1 Blood consumption in 2016: For example, 55 049 patients were discharged from January to June 2016, with a total blood volume of 54 395 U; 56 142 patients were discharged from July to December 2016, with a total blood volume of 50. 268U. The number of discharged patients increased by 1.99%, but the total blood consumption decreased by 7.59%.
2.2.2 Percentage of blood transfusions In the case of an increase in the number of discharged patients, the proportion of blood transfusions from discharged patients decreased from 6.40% in January-June 2016 to 6.07% in July-December 2016. In the case of an increase in the number of surgical patients, the proportion of transfusions in surgical patients decreased from 6.41% in January-June 2016 to 4.07% in July-December 2016.
3 Discussion
Blood transfusion is an independent risk factor for poor prognosis of patients [3], involving departments, personnel, links, and many factors, and its quality is directly related to the health and safety of the people. The clinical blood quality management based on the closed-loop blood transfusion information management platform is characterized by high efficiency, comprehensiveness, convenience and science, and can carry out the whole process of whole blood transfusion before, during and after transfusion. The systematic, perfect, standardized and accurate clinical blood transfusion information management platform provides reliable data for clinical blood safety, reasonable and physician blood evaluation, and meets the requirements of blood rights access management [4]. The next step will be to strengthen quality management around the platform and further expand the platform functions.
3.1 Establish a quality assurance system
The establishment of quality assurance system should start from the laboratory setup, environment, sample and reagent control, indoor quality control and inter-room quality evaluation [5], involving people, machines, materials, methods, rings, etc. should be gradually embedded in the platform. For example, medical personnel establish a blood transfusion personal file, and receive training and assessment records embedded in the platform, including blood records, adverse reactions of blood transfusion, management department's rationality and safety evaluation of blood transfusion. Indoor quality control involves instruments and reagents. The platform has completed the maintenance and inquiry of the reagents used for blood transfusion, but it needs to be further expanded, such as inclusion in the blood transfusion compatibility test project, recording the existing blood specimens, preparation methods, operation procedures, etc., to ensure the reliability, repeatability and safety of the test results. It is also possible to add embedded transfusion management systems and functional divisions, especially to standardize operational procedures, standardize diagnosis and treatment behavior, and ensure evaluation consistency [6].
3.2 Strengthening training
The degree of mastery of blood transfusion indications, contraindications, and adverse reactions to blood transfusions among clinical health care workers is uneven, and little understanding of new concepts of blood transfusion is available. Taking the evaluation of transfusion adverse reaction records as an example, many limitations are described in fever, rash, allergic reaction, non-hemolytic fever response, allergic reaction, allergic reaction, hemolysis reaction, bacterial contamination, circulating overload, bleeding tendency, acid-base balance imbalance Insufficient understanding of transfusion-related acute lung injury, phlebitis, and transmission of infectious diseases [7]. Strengthening training can improve the early detection, early identification and early treatment of adverse blood transfusion events by medical staff. The core of quality management is continuous improvement under interactive feedback. It can use the platform to develop docking mobile APP service to realize real-time information interaction between blood transfusion recipients, blood transfusion executives and blood transfusion managers.
3.3 Strengthen blood transfusion management of key departments, diseases and surgery
According to the feedback data from the platform, the first departments of the hospital use blood department, Department of Hematology, Critical Care Medicine, and Gastroenterology. The top diseases are acute leukemia, upper gastrointestinal bleeding, chronic renal failure (using plasma), and regeneration. Obstructive anemia, severe anemia, the total blood volume for surgery is cesarean section, lobectomy, ascending aorta replacement plus aortic valve replacement, coronary artery bypass, intracranial hematoma removal. Through the management of key departments, diseases and surgery, the blood transfusion management department reduces the total amount of blood transfusion and blood used for surgery in the context of business growth, and improves the safety and rationality of blood transfusion.
references
[1] Tian Zhaoyu. Clinical Blood Transfusion [M]. Beijing: People's Publishing House, 2002: 20-45.
[2] Yu Shuai, Huang Yongwen, Guo Qiang. Optimization and application of clinical blood transfusion intelligent management and evaluation system [J]. Chinese Journal of Blood Transfusion, 2016, 29 (2): 213-216.
[3] Cheng Cong, Liu Shuzhen, Lu Cui, et al. Establishment and application of closed-loop blood transfusion information management system[J].Chinese Journal of Blood Transfusion,2016,23(1):107-110.
[4] Zhou Jun, Chen Qi, Wang Wei, et al. Clinical physicians use blood rights access management [J]. China Health Quality Management, 2016, 23(1) 104-106.
[5] Zhang Xixia. How to do a good job in the quality control of blood transfusion department [J]. Chinese National Folk Medicine, 2011, 20 (23): 38-39.
[6] Wang Fengling, Xing Mo, Sun Wei. Establishment and Application of Concentration Quality Evaluation Mechanism of Blood Transfusion[J]. Hospital Management, 2015, 35(12): 39-41.
[7] Anesthesiology Branch of Chinese Medical Association. Expert consensus on perioperative blood transfusion [J]. Journal of Clinical Anesthesiology, 2009, 25 (3): 189-191.
Source: China Journal of Health Quality
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