智能化建设在细胞毒性药物集中调配中的应用与实践

Application and Practice of Intelligent Technology of Cytotoxic Drugs in Pharmacy Intravenous Admixture Services

关键词:  静脉用药调配中心  智能化建设  细胞毒性药物  智能化医嘱审核  智能贴签机  智能配液机器人

Key words:  pharmacy intravenous admixture service  intelligent technology  cytotoxic drugs  intelligent medical order review system  intelligent labeling machine  automatic compounding robot

摘要:

目的 总结静脉用药集中调配中心(pharmacy intravenous admixture services，PIVAS)在集中调配细胞毒性药物各环节中的智能化建设情况和成效，为其他PIVAS细胞毒性药物集中调配工作提供参考。方法 介绍华中科技大学同济医学院附属协和医院PIVAS智能化建设情况，统计在建立智能医嘱审核系统后，细胞毒性药物不合理医嘱的比例及干预率；比较应用智能贴签设备与人工操作在工作效率和工作差错等方面的差异；比较智能配液机器人与人工操作在冲配速度、残液量、调配差错率等指标的差异，以此评价智能化建设在细胞毒性药物集中调配中的应用成效。结果 智能医嘱审核系统上线前后3个月，不合理医嘱干预成功率由88.64%逐步提高到目前的100%。智能贴签机贴签效率[(15.50±1.20)张·min^-1]优于人工贴签[(10.11±0.39)张·min^-1]，且统计时间内贴签机每千袋出现0.41次差错，相对于人工(每千袋出现0.79次)差错更少。智能配液机器人配置效率[(0.23±0.04)袋·min^-1]不及人工[(0.49±0.07)袋·min^-1]，但是在统计时间内，配液机器人每百袋出现0.30次差错，相对于人工(每百袋出现0.56次)差错更少。在残液量指标方面，西林瓶包装药品：智能配液机器人[(0.21±0.06)mL·支^-1]优于人工配置组[(0.46±0.23)mL·支^-1]；安瓿瓶包装药品：智能配液机器人[(0.08±0.02)mL·支^-1]略优于人工配置组[(0.09±0.04)mL·支^-1]，但无统计学差异。结论 通过细胞毒性药物集中调配工作的流程再造，依托PIVAS智能医嘱审核系统、智能贴签设备及智能配液机器人等智能系统，提高工作效率，减少工作差错，提高了成品输液质量，对保证输液安全具有重要意义，但在工作效率上，智能化设备部分指标仍不及人工操作，需要进一步改进完善。

Abstract:

OBJECTIVE To summarize the application of intelligent technology and equipment in the working process reengineering of cytotoxic drug in pharmacy intravenous admixture services(PIVAS), and the performance is also evaluated to provide the reference to other hospital. METHODS The application and practice of intelligent technology and equipment in PIVAS of Union Hospital, Tongji Medical College, Huazhong University of Science and Technology were introduced. Ratio of cytotoxic drug irrational medical order after intelligent medical order review system establishing was calculated. Work efficiency and errors were compared between intelligent labeling machine and manual operation to evaluate the application effect of the equipment. Admixing speed, residual liquid and working error were used to evaluate the performance of intelligent automatic compounding robot. RESULTS The successful intervention rate of irrational medical order were gradually increased from 88.64% to 100% in three months, before and after the establishment of intelligent medical order review system. The labeling speed of intelligent labeling machine group and manual labeling group were (15.50±1.20)bag·min^-1 and (10.11±0.39)bag·min^-1 with significant difference, respectively. Less labeling errors were observed of machine group (0.41/1 000 bags) than manual labeling group(0.79/1 000 bags). Infusion compounding speed of manual compounding group was significantly higher than that of intelligent compounding robot group, were (0.49±0.07)bag·min^-1 and (0.23±0.04)bag·min^-1, respectively. However, the errors of the compounding robot group(0.30/100 bags) were less than those of the manual compounding group(0.56/100 bags). Residual liquid volume of vials and ampoules medicine compounding were also observed, the results showed that the compounding robot group[(0.21±0.06)mL·vial^-1] were prior to the manual compounding group[(0.46±0.23)mL·vial^-1] of vials medicine compounding, and residual liquid volume of ampoules medicine of manual compounding group[(0.09±0.04)mL·vial^-1] were slightly higher than the compounding robot group[(0.08±0.02)mL·vial^-1] without significant difference. CONCLUSION The working process of cytotoxic drug in PIVAS is significantly improved by establishing intelligent medical order review system and intelligent equipment. Qualify of finished infusions and working efficiency are improved and working error is reduced, which are important for PIVAS. Furthermore, the infusion compounding speed of intelligent compounding robot is slower than manual group, need to be improved in the further study.