Is mobile a doctor, a nurse or a message? Why is information moving? What role does mobile medicine play in the information management process in the hospital? I am focusing on this topic today. At present, there is an outbreak of contradictions between doctors and patients. I am a doctor in the hospital. How many people should be involved in the hospital when there are contradictions between doctors and patients? 100 people will cause dangerous factors in medical care, which is more dangerous than diving. It is much more dangerous than chemical manufacturing, so accidents in medical and health care have problems with safety and quality. It can be said that the safety level is very high.
What should we do with IT? Helping hospitals improve the quality of medical safety is the challenge we face in IT. The first point is the continuous improvement of medical quality. The quality of medical care is the core competitiveness that a hospital has been pursuing for a long time. The second point is that medical services are constantly improving. We need to make patients feel good while treating patients. The third is to refine The operation and management of modern hospitals is not only reflected in the fine management of people, finances and materials, but also in the fine management of all aspects.
Closed loop management ensures "five correct" implementationsIs IT the solution to these three aspects? The electronic medical record rating standard is divided into 0-7 levels in addition to the narrow electronic medical record. What is Level 6? Around the safety and quality, all the information in the hospital is recorded, the data is structured, there is CDSS, the clinical assistant decision system, and closed-loop management. In the hospital, the doctor prescribed by the doctor, the patient accepts, the whole process is a closed loop, which requires closed-loop management. This will ensure 5 correct implementations: the right patient, the right time, the right medicine, the right way and the right dose. What effect can this achieve? Basically eliminate some of the errors in medication. HMISS proposed the electronic medical record rating standard five years ago, and it has not changed. The sixth level focuses on safety and quality. I personally think that ensuring safety and quality is the ultimate goal of informatization. Of course, what can be done in the past and up? It is standardization. I think this is the highest development direction of informatization.
1. What is closed loop management?
From the outpatient doctor to open a doctor's order, to the pharmacy to buy medicine, or to take medicine, to confirm the patient's identity, and the complete electronic record of the entire process, you can always check where the problem occurs in each link, such a system is a closed loop management. There are 6 levels in the evaluation standard of HMISS, and the level of safety informatization in such advanced countries in the United States is not too much. Our evaluation last year only reached level 4, maybe we may be higher this year, but I personally think that I have not fully reached level 6.
2. Mobile medical care around safety quality
In the process of improving quality in hospitals, IT is only part of it, not all. We have been emphasizing medical quality and medical safety in hospitals before, and we have imposed these on doctors and nurses. Obviously, this is unfair. Because the doctor and the nurse can only control this link, one point, but the hospital has three levels: 1. The management system level of the hospital, including our supply room, high-quality consumables, low-quality consumables, etc. Are these safe? The structural adjustments here are not something that every doctor and nurse can do. It must be done by the hospital. Therefore, the hospital's IT has played a very important role here. It is as important as water, electricity, gas and warmth protection. It is a thing to be done at the hospital level. 2. The process, the cooperation between each doctor and the nearest medical room in the whole medical process is not completed by one person, but is done by a process team. Therefore, there are some rules and regulations to ensure that everyone can do things. It is right. 3. Improving quality is measurable and measurable. Many hospitals have been talking about the quality of our medical care today is better than in the past, but all things should be measurable, which can reflect the performance of our IT. Role, then we have to come up with a number, how much medical quality we have improved.
Why does Peking University People's Hospital (hereinafter referred to as “People's Hospitalâ€) carry out mobile medical treatment? First of all, it is around safety and quality. I think there are three levels: 1. I think it solves a problem of full tracking and full traceability. It is to close the ring, the last step of the patient taking medicine does not enter the information system, so this mainly means that we close the ring. 2. Practically correct personal corrections. Because of the emergence of mobile medical care, we have achieved one of the most important problems. At every key point on the entire ring, we can check all the data of patients, for the treatment of patients, to patients. The drug can be matched by identity, is it appropriate and correct to avoid all errors. 3. Because we track and trace each key point, we can do scientific statistics and analysis to analyze whether the quality of the whole medical treatment has been improved. What adverse events have been corrected by us, let's come again. Improve our clinical quality. Therefore, the relationship between mobile medical and clinical is mainly the three levels.
Our original informatization is about the system of the hospital office. The big one is the desktop-based system. Our informationization can only be as close to our office, out of the office, and there is no informationization from the office to the patient's bed. So, I proposed to complete the last 20 meters of the clinical hospital, how to complete the last 20 meters of clinical information in the hospital? Always put informationization to the bed. How did our mistakes happen before? We look at a data from the US statistics, the manual analysis of drug accidents - traditionally without the support of IT, the doctors and patients disputes caused by patients taking the wrong medicine, 39% is the doctor's wrong medicine There are various reasons, including the wrong dose, the wrong drug selection, the lack of knowledge of the patient's allergic reaction, and 12% of it is generated by the nurse. Since some doctors' signatures are not performed on the nurse as a correct signature, there is still time. The mistakes, as well as the incomplete order of the drugs, or other problems, that is, in the process of transcription, the nurses transcribed the doctor's orders to produce errors. The other 11% was wrong when the pharmacy was distributed, and the other 38% was the error that the nurse gave to the patient. Today's most critical aspect of the mobile medical system is to eliminate all these mistakes, rather than let the nurse hold a tablet.
3. Mobile care has higher priority than mobile medical
I haven't seen any company in China that can provide a complete medication record, that is, every medicine the doctor drives, when the pharmacist takes it from the medicine rack, which nurse received the medicine, and then gave the medicine. Which patient will let the patient eat it. There is no complete record of this process, and even a process that is very loosely recorded is incomplete. Many hospitals have a medicine machine with a barcode on it, writing the patient's name and how much to eat, but this patient did not check when taking the medicine, so the clinical "three check seven pairs" is greatly reduced in implementation. Even some hospitals don't have a bag that is opened by a drug-packing machine. Is this the drug? Do you know this drug and the drug? So it leads to a lot of medical incidents. In 2009, a very vicious incident occurred in the People's Hospital. Because a patient died due to wrong medicine, it is necessary to solve this mistake no matter how much money we spend. Therefore, I personally think that the priority of mobile care is higher than that of mobile medicine, and this problem should be solved.
Multiple initiatives to ensure effective implementation of mobile careIn July 2010, we started mobile care, including the transfer of operating rooms, the transfer of blood products, the administration of wards, etc. The technology used was PDA-based mobile devices, which used Motorola's mobile devices. Why did we choose this? At the time, some people said that this thing is more expensive than the computer. The People’s Hospital has more than 53,000 discharged patients a year. The amount is very large. I first consider industrial-grade products. How do we use it now? In the hospital, we have two nurses who have PDAs in the hospital for prescription and medicine. In the past, the nurse was asked to "three check seven pairs", but it was very poor. Because of the problem of nurses' matching, there may be no one doing this when some nurses are busy. It is a small nurse to do it. In addition, check with the patient's wristband and bar code, if the system is not successful, the system will automatically alarm. If there is a drug mismatch, a doctor's mismatch, the doctor's order does not exist, and the doctor's order has not yet been executed during the checkup, that is, you should give him the medicine at night, and the cycle is wrong.
In the use of specimens, including many hospitals, we have to do ISO 15189 inspection standards guide, all of our collection standards must be accurate, how to ensure when the blood is taken after the blood is collected, to ensure that the nurses enter, and Can not increase the workload of the nurse, we will automatically complete through the PDA. First of all, to determine whether the patient has this test, is it necessary to do biochemistry? Then check, and record the time of this blood draw.
In the aspect of nursing evaluation, the patient's wristband should be scanned when the patient is inspected. The nurse must scan the patient's bedside card with a PDA infrared. At least this guarantees that the nurse has actually gone to bed. Incoming registration, this is also a problem that has not been solved before mobile care. What is the time of admission? Is it the time for admission to the hospital or the time for the doctor to see the patient? The procedure is the admission time of the financial, not the patient. When I entered the department, I went to the ward nurse to see it. I scanned the patient's wristband. This is the real admission time. It used to be 8:30 and 9:00, and now there are 8:13, 9:00. 9 points and so on.
How to do closed-loop management of the content of disinfection supply? From the beginning of disinfection and cleaning to the whole process of patient use, this package is to be traced, which is very important for medical safety. Which machine is cleaning? Which nurse or worker is playing the bag? Which worker put the sterilized bag in which sterilizer is sterilized? What did I bring today? This is the release. When using it, it is necessary to scan the wristband of the patient when changing the dressing. If the cross-infection of the bag occurs, or if the bag is not disinfected, the wound infection can be traced.
For the nursing record, the focus of the nursing care is to reduce the workload of the nurses. We have structured a large number of nursing records here, and now they are basically selected, and rarely need to write. When you remember the nursing documents, you can scan the patient's wristband, the nurse's mission, the missionary catalogue is here, an orthopedic patient, health education 12345, read it again, each must be ticked, you go to the patient Do the evaluation, he is lazy, you don't know, now you have to read it every time, and then you record another end time. In this case, you record the behavior of each individual and supervise this situation.
If a doctor's order is executed successfully, it can be displayed in real time on the doctor's side. Then is the collection of vital signs, the entry of body temperature, special patients, early warning management, statistical analysis. When I arrived last month, everyone knows that the People’s Hospital has done everything, and it has been used clinically. I have a lot of data, but how can I ensure that every nurse who has not missed every child uses a medical system that can improve quality? So we made another analysis and set some indicators. There are 1700 patients in the hospital. Are each patients doing admission scans? Or are you doing a show? So from April, we asked all nurses to monitor, and each patient should do it. Have done it. The number of people admitted to the hospital every day, see the completion rate, why are these cases not completed? We have to correct the individual, we can find out who has not completed, what is the reason is not completed, if you have no reason is missing, then You have to correct the mistakes. We feedback the monitored results to the nursing department, and the nursing department supervises and manages them. This makes the whole mobile care system effective. Otherwise, the nurses don’t need you, maybe 80% used 20 % is useless, the accident is 20%. After we checked it, we did not reach 100%. Some patients did not scan the ICU, and some entered the operating room. This scan was not performed. There are three reasons: one situation is not in the ward, the other is to rescue the patient, and then it is not possible to check in a crisis situation. I have grasped such a situation. At least you can be realistic.
Regarding health education, after we have finished counting, it is a bit wrong. Our health education is only done when the patient is first admitted to the hospital. It is not done at other times, so the ratio is wrong. General care records are also available, with primary care once a day and secondary care twice a week.
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