什么是一个“闭环管理环境用药

什么是一个“闭环管理环境用药？”closed loop medication administrator

美国58家医院获HIMSS 7级水平
加州大学圣地亚哥分校医疗系统近期获得了享有盛名HIMSS Analytics 7级水平。HIMSS Analytics是美国医院信息系统协会下属的分析机构，用于追踪全美范围内医院和医疗系统中电子健康档案的进展。HIMSS的评级系统共分为7级，作为顶级水平，7级意味着为患者提供医疗服务的环境不再使用纸质图表，在无纸化环境中运行的医院是卫生系统中的精英群体。在被HIMSS认证的5000多家医院中，只有58家医院获得了7级荣誉。
这是一个广义的术语，它包括几个概念。 Here are a sampling of concepts that "closed loop medication administration" includes:这里有一个概念的抽样“的闭环用药管理”包括：

Goals and objectives - Establishing such an environment is supposed to help solve problems like medication safety (adverse drug events, incorrect prescriptions, antimicrobial over-use) and measuring overall quality.目的和目标 - 建立这样的环境是应该帮助解决问题，如安全用药（药物不良反应事件，不正确的处方，过度使用抗菌）和测量的整体素质。

Workflow transformation - Creating this safer environment is achieved by better documentation of drug orders and administration (before, during, and after patient stay), tracking errors retrospectively, predicting errors, and capturing interventions that are performed against errors over time.工作流程改造 - 创造这更安全的的环境是实现更好的文档（之前，期间和之后，病人留）药物的订单和管理，追溯跟踪误差，预测误差，并捕获，随着时间的推移对错误进行干预。

Leveraging technology - Technology can be used to support workflow transformation.利用技术 - 可用于技术支持工作流程的改造。 Bar coded medication, bar code scanners, medication administration records, patient wrist bands, surveillance solutions, and intervention documentation systems all compose the eco-system of solutions that support closed loop medication administration.条码用药，所有的条形码扫描仪，药物管理记录，病人腕带，监控解决方案，和干预的文件系统组成的闭环用药管理解决方案，支持生态系统。
新技术越来越多地被落实到位全国各地的医院，防止用药错误可以自己是一个错误的原因，专家表示，在2011年危重病急救医学协会年度会议。
“We have a high level of technology in my hospital, and we have reduced many different kinds of errors, but now other types of errors have crept in,” said Henry Cohen, PharmD, professor of pharmacy practice at Long Island University and chief pharmacotherapy officer at Kingsbrook Jewish Medical Center, both in New York City.科恩，“亨利说：”我们有一个高水平的技术在我院，我们已经减少了许多不同类型的错误，但现在已经悄悄在其他类型的错误，在长岛大学药学实践药学博士，教授和行政药物在Kingsbrook犹太医学中心，无论是在纽约市的官员。 “Technology is a tremendous advance, and I wouldn't have it any other way, but make no mistake, the technology is not foolproof.” “技术是一个巨大的的进步，我不会有任何其他方式，但不要搞错，技术不是万无一失。”
The ideal technology for preventing medication errors is the closed-loop medication administration methodology, which includes computerized physician order entry (CPOE), in which the prescriber, usually a physician, enters the medication order, the pharmacist validates the medication order and the nurse charts the medication administration using bar-code technology.为防止用药错误的理想技术是闭环用药管理方法，其中包括计算机化的医嘱录入（CPOE），其中的处方，通常医生，进入用药秩序，药剂师验证的用药秩序和护士图表用药管理，使用条码技术。
The medication dispensing process also uses technology, primarily robotic dispensing and/or automated dispensing cabinets.用药配药的过程中也使用的技术，主要是机器人配药和/或自动配药柜。Robotic dispensing to repackage medications using bar-code technology is an almost infallible technology, with an error rate of 0.001%.机器人配药重新包装使用条码技术的药物几乎是一个万无一失的技术错误率0.001％，。 When the same task is done by a pharmacy technician or a pharmacist, the error rate can be as high as 2% to 3%.是由药房或药剂师有经验的技术人员完成相同的任务时，错误率可高达2％至3％高。 “Two percent seems like a small number, but in my hospital, where we dispense about 10,000 medication unit doses a day, that would be 200 medications that might be going up to the floor on any given day that are incorrect,” Dr. Cohen said. “两成好像是一个小数目，但在我院，在那里我们免除每天服药约10,000单位剂量，那将是200的药物可能会在任何一天到地板是不正确的，”科恩博士说。
The primary error that does manage to occur with robotic dispensing is placement of the wrong drug into the prepackaging unit of the robot.管理与机器人配药发生的主要错误是安置到机器人的预打包单位错药。 A prepackaging machine that uses bar-code technology can prevent this.一个预打包的机器，使用条码技术可以防止这一点。 “It is more expensive, but it is also a lot safer,” he said.“这是比较昂贵，但它也安全多了，”他说。
Another useful technology is automated dispensing cabinets.另一个有用的技术是自动化配药柜。These must be pharmacy profiled, Dr. Cohen emphasized. Cohen博士强调，必须药店异形。 “The nurse or anyone who accesses those machines should not be able to get their hands on medication without pharmacy reviewing, validating and approving the order,” he said. “护士或任何人访问这些机器不应该能够得到他们的手没有药房用药审查，验证和批准的顺序，”他说。
In addition, they should be stocked by a pharmacist or pharmacy technician using a scanner aided by guided light technology so that the right drug goes into the right slot inside the machine.此外，他们应放养药剂师或药剂技术员使用一台扫描仪导光技术的帮助下，正确的药物，使机器内部的右侧插槽。
I“When possible, if you have those automated dispensing machines and you can afford the money and the space, guided light technology is the best way to prevent errors. “在可能的情况下，如果你有那些自动配药机，你能负担得起的钱和空间，导光技术是最好的方式，以防止错误。 With guided light technology, the nurse does not just select any drug from a drawer full of drugs, but would select a drug that she is guided to with a light that shows her exactly where it is,” Dr. Cohen said.随着导光技术，护士不只是选择任何一个抽屉药物的药物，但会选择一个，她是光显示她的是它的确切位置，引导药物，科恩博士说。“
Potential Bar-coding Pitfalls 潜在的酒吧编码陷阱
Bar-code technology for nurse administration of medication is a tremendous advance in preventing medication errors, but it, too, has limitations, Dr. Cohen said.科恩博士说，护士用药管理的条形码技术是一个巨大的进步，在预防用药错误，但它也有其局限性。
One problem is unreadable bar codes.其中一个问题是无法读取条形码。 “Unreadable bar codes are still a real problem with bar-code technology. “不可读的条码与条码技术的真正的问题。 In one trial, 22% of 1,605 medications did not have readable bar codes, and 24% of hospitals reported a bar code that is not readable by the scanner.在一项试验中，22％的1605药物没有可读的条形码，并有24％的医院报道不扫描器读取一个条码。 This is an everyday occurrence,” he said.这是一个每天都发生，“他说。 “In addition, there are multiple generic brands of the same drug, which can complicate bar coding.” “此外，也有相同的药物，它可以条形码复杂的多个通用品牌。”
For the entire bar-code system to work, pharmacy needs to enter the bar code every time it purchases a drug.对于整个条码系统工作，药店需要输入的条形码，每次购买毒品。 “All new brands or new lots of a medication must be scanned by pharmacy, but additionally should be scanned by the same scanning device that is used at the bedside by the nurse,” Dr. Cohen suggested. “科恩博士建议，”药店必须扫描所有的新品牌或新的药物很多，但此外应在床边的护士使用相同的扫描设备，扫描。
A lack of hospital-wide wireless bar-code connectivity—where the system fails to work in certain parts of the hospital—failing batteries in the handheld device, and doorways that do not permit entry of the bar-coding device into the room; remotely stored medications, such as refrigerated meds; and loud noises that prevent the nurse from hearing the scanner's warnings and alarms are some of the common obstacles preventing the technology from working properly.一个缺乏全院的无线条码系统无法工作的某些部分医院未能在手持设备的电池，和门道，不会允许进入房间的条码设备进入连通性远程;存储药物，如冷藏MEDS;和大声喧哗，防止听证会扫描仪的警告和报警的护士是一些常见的障碍无法正常工作的技术。

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