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Preface
According to the “To err is human” book published by the Institute of Medicine (IOM) of the National Academy of Sciences in 2000, it is estimated that in 1999, the number of deaths due to medical negligence (Adverse Events) in the United States was about 44,000 to Among the 98,000 people, medicines are the most common cause of medical negligence in hospitals. There are about 7,000 deaths caused by medication errors each year, which exceeds the number of deaths caused by car accidents, breast cancer, and even AIDS. It is a serious warning message, and it has also prompted the American medical community to plan to build a safer medical environment within 10 years. It is expected that the medical environment will be “safe”, “effective”, “patient-centered”, and “timely “,” “efficiency” and “medical equality” and other six goals.
In March 2002, the U.S. Food and Drug Administration (FDA) instructed all American pharmaceutical companies to label all drugs delivered to hospitals with barcodes to identify the types of drugs and single-dose drugs. The final regulations were issued in March 2004-requiring all drugs (including prescription drugs and OTC drugs) to be barcoded within 60 days from April 26, 2004, and old drugs must be barcoded within two years to improve Medication is safe.
According to World Health Organization estimates, 10% of global drugs are counterfeit drugs, among which 40% in developing countries may be as high as 40%. Take the United States as an example, including Procrit, Lipitor, Zyprexa, Serostim and Oxycontin. In addition to shaking consumer confidence, it also generates consumption Subsequent disputes, such as litigation issues and subsequent waste of medical resources and increased costs due to poor treatment effects, are difficult to estimate. Therefore, in November 2004, the U.S. Food and Drug Administration (FDA) proposed a feasibility study plan for radio frequency identification technology (RFID) for medicines, aiming at drug labeling, imitation orders, electronic records, and quality, etc., to implement safe medication safety for patients As the core value, it is applied to the overall drug delivery process of drug manufacturers, repackers, relabelers, agents, and retailers.
Since 2003, American health care agencies must cooperate with the American Federation of Appraisal Agencies
(Joint Commission on Accreditation of Healthcare Organization; JCAHO) requirements regarding new patient safety goals. According to JCAHO’s 2006 12 project targets, those directly related to the use of drugs include:
· Improve the accuracy of patient identification
o Whether it is medication, blood transfusion, blood sampling, special clinical examination, and other treatments or performing care, at least two methods of identifying the patient should be used (not including the patient’s room number or bed number)
· Improve the safety of medication
o Check and confirm the list of medicines with similar appearance or similar pronunciation among the medicines used in the hospital at least once a year, and take preventive measures for confusion and errors due to similar appearance or similar pronunciation of medicines.
· Ensure the correctness and integrity of the medications used in the patient’s continuous care
The Department of Health of the Executive Yuan established the Patient Safety Committee in February 1992, and the medical system has also begun to take action. In addition to the importance of relevant government units and medical institutions to patient safety, relevant strategies have been planned to improve the safe environment for patients to seek medical care. Among them, the annual goals and strategies for patient safety in hospitals from 1995 to 1996 include: improving medication safety, implementing infection control in medical institutions, improving the accuracy of surgery, improving the accuracy of patient identification, preventing patients from falling, encouraging notification of abnormal events, and improving communication between handover patients And safety, enhance public participation in patient safety, etc.
Drug Control Application
In recent years, under the implementation of the national health insurance system, the medical division system, and the core value of patient safety, how to make medicines from the original factory manufacture, sell, adjust and deliver medicines to patients in the overall process, can also deliver professional Knowledge, to ensure the safety of the people’s medication, so that patients can obtain the greatest protection and the best pharmaceutical services. In addition to the existing operation methods, reliable RFID identification technology can also be used as an aid. The applicable directions at this stage are as follows:
· Prevent counterfeit drugs from circulating on the market:
For example, Purdue Pharma in the United States is known for its production of prescription drugs, over-the-counter drugs and medical products. The company has successfully integrated the RFID labeling operation with the process of a single medicine bottle packaging production line. The application of RFID technology to the production line products will comply with EPC (Electronic Product Code). ) The standard label is attached to the bottle of OxyContin medicine. In addition, Pfizer Pharmaceutical Factory’s Viagra drug flow tracking and anti-counterfeiting, etc.
· Logistics operation management: In addition to general logistics application and replenishment operations, it can also be applied to:
o Monitoring of environmental conditions for drug delivery and storage
The drug manufacturing has undergone stability tests to confirm its proper storage temperature and shelf storage period. If the transportation and storage environment does not meet the operating requirements, the drug will be invalidated and the medical results will be affected. Through active RFID applications, delivery and environmental conditions can be monitored to ensure the quality of medicines.
o Drug storage and validity management
Applying RFID technology to drug expiration management can reduce manpower, reduce unnecessary inventory waste, and improve the efficiency of logistics operations.
· Improve drug safety
In the process of preparing medicines and delivering them to patients, the medical staff confirms the adjustments of the pharmaceutical operation department (such as patient identity, product name, dosage, quantity, double or even triple check of usage, etc.), and nursing staff Patient status, drugs, time, route of administration, injection site, injection rate, etc. work related to patient safety. Although RFID cannot be used in hospital or community pharmaceutical operations in a comprehensive manner, RFID can be used to assist in improving drug safety. Application directions can include:
o Avoid the auxiliary identification of items that are easily confused with the dosage and dosage form of the drug, such as:
§ ADALAT 10MG CAP and ADALAT OROS 30MG CAP
§ CYTOSAR 100MG 5ML VIAL and CYTOSAR 500MG VIAL
§ DEPAKINE 200MG TAB and DEPAKINE CHRONO 500MG TAB
o Auxiliary identification of items with similar drug names, such as:
§ EUCLIDAN 50MG (Indication: Peripheral Vascular Circulation Disorder) and EUGLUCON 5MG (Indication: Diabetes)
§ SOLAXIN 200MG (indication: skeletal muscle relaxant) and SOLIAN 200MG (indication: schizophrenia)
§ SPASMO-EUVERNIL (indication: urinary tract infection) and SPASMONAL 60MG (indication: gastrointestinal and genitourinary tract spasm pain)
o Blood preparation management
Regulations and evaluation require medical institutions to accurately grasp the type, use, and return status of blood preparations ordered for blood transfusion, and to accurately record the flow of patients and keep the batch number of blood used. RFID can be used as an aid to track and manage the entire process from drug manufacturers to hospitalized or home patients, and reduce the amount of manual work.
o Chemotherapy
The chemotherapeutic drugs themselves are extremely toxic. Medical institutions can use RFID to confirm the types of preparations used by patients, record the flow of patient use, and save batch numbers, so as to avoid medication errors and ensure patient medication safety.
o Information query system:
Medical quality is a continuous improvement process. If the hospital information system can be integrated, the patients can take out the medicines after receiving the medicines in the outpatient clinic and self-check them through the scanner, providing patients with an extra guarantee of medication safety. If the hospital information system is connected to the drug database, patients can obtain complete drug information while checking, and even print the required information. It can make up for the lack of drug information on the medicine bag, and it can also educate patients to strengthen their knowledge of medication, which will also positively help the overall service image of the hospital.
Expected benefit
RFID (radio frequency identification) identification technology has become an international development trend. Many medical institutions are actively promoting RFID identification technology to improve the medical safety of patients in medical institutions, increase the efficiency of medical affairs, and improve the overall level of medical services. Its benefits as follows:
· Patients: With the assistance of this system, patients and their families can use medicines in a safer and more careful environment, and realize the core value of patient safety.
· Nursing staff: When administering drugs, use the RFID-assisted operation method to scan into the computer system for reconfirmation, reduce medical problems caused by human negligence, avoid giving wrong drugs, and ensure drug safety.
· Pharmacy personnel: Effectively ensure the correctness of patients’ identity, the correctness of medications (including prescriptions by doctors, pharmacists’ prescriptions, and medications taken by patients, etc.) and the application of effective clinical warning systems in clinical practice to improve medication safety.
· Hospital management department: Through the application of RFID, all prescription medications for inpatients can be confirmed, including various injection route medications, oral medications, external medications, and patient identity, etc., which can be reconfirmed through the computer system during bedside medication to reduce For medical problems caused by human negligence, this function not only increases the safety of medication, but also increases the relationship between doctors and patients, and reduces medical disputes caused by human negligence.
Future demonstration projects promote projects
· Application items
· The plan is to focus on patient safety, use the advantages of RFID tracking and management, and combine the existing outpatient, emergency and inpatient procedures to integrate “patient identity management”, “blood and chemotherapy drug management”, and “blood bag management”. , Used in the identification and management of wards/outpatient clinics, inspection units, operating rooms, intensive care units, etc.
· Expected benefits
· Combining the existing operating procedures, confirming users, accurately recording and tracking the flow direction and abnormal management, improving the medical collaboration of the pharmaceutical department, ward and nursing unit, reducing manual and paper communication and processing, and avoiding the risk of error.
Concluding remarks
The advancement of RFID technology can increase the care of patients by medical institutions. Only when medical institutions introduce this technology, it is recommended to consider the following items:
· It has its limitations when used in daily drug dispensing and patient administration, and cannot completely replace the current operation, but it has special contributions to storage management and drugs that need to be tracked.
· At this stage, the increased cost of technology application needs to be estimated in detail, and whether it can be balanced with the expected increased benefits (such as increased patient medication safety).
· When medical institutions want to apply this technology, it is recommended to integrate patient bracelet identification, drug management, blood bag management, operating room management, examination room process control, instrument management, etc., based on the characteristics of the hospital’s own needs and the overall operation of the hospital. Direction in order to obtain overall economic benefits.
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