CN103902791A - Clinic safe and reasonable drug use decision supporting method - Google Patents
Clinic safe and reasonable drug use decision supporting method Download PDFInfo
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Abstract
The invention belongs to a clinic drug use management system, and particularly relates to a clinic safe and reasonable drug use decision supporting method. The clinic drug use management system at least comprises a clinic reasonable drug use standard database, information input equipment and a doctor advice decision unit, wherein when the pathological information of a patient is input to the doctor advice decision unit through the patient information input equipment, the doctor advice decision unit compares and discriminates the pathological information of the patient with the pathological information of common clinical diseases and high-incidence diseases stored in the clinic reasonable drug use standard database, drug use standard doctor advice information is displayed through the doctor advice decision unit, the drug use standard doctor advice information displayed by the doctor advice decision unit is further screened through the information input equipment, and the screened drug use standard doctor advice information is further compared and discriminated by the doctor advice decision unit through a safe drug use monitoring database, and confirmed doctor advice is obtained through the doctor advice decision unit and provided to the patient. The clinic safe and reasonable drug use decision supporting method can rapidly, economically and effectively monitor disordering, attempt and experience trends of clinic drug use.
Description
Technical field
The invention belongs to clinical application management system, particularly clinical safety rational use of medicines decision support method.
Background technology
In China, the system reform of in-depth medical and health is one and involves a wide range of knowledge, the systems engineering that difficulty is large.On the one hand, China's medical resource " difficulty and high cost of getting medical, the high cost of getting medical treatment " in short supply, existing epileptic 10,000,000 people of China, also have every year 400000 new patients, but in fact the people more than 40% never carried out treatment, and what about 35% people accepted is irregular treatment; On the other hand, government and the common people are but checking for " excessively diagnosis and treatment, drug abuse ", have 40% to infect for preventing in the various big hospital of the antibacterials whole nation, and wherein half misapplication, is often only abuse of antibiotics economic loss and just reaches more than 1,000,000,000 yuan.SFDA medicine assessment centers 2007 in Beijing, the treatment of 26 the investigation children of hospitals watery diarrheas in Wuhan, Chongqing, Guangzhou, medication reasonably only has 5.4%; The drug therapy of pneumonia is processed suitable also only has 12.3%.Because medication is lack of standardization, patient produces the also increasing year by year of event of bad reaction, processes such dispute and has also expended a lot of time and efforts of hospital simultaneously.
The problem causing for above-mentioned present situation, stops surprising waste that excessive diagnosis and treatment cause and significant damage and the hidden danger to national health, and country still lacks science, quick, economic, effective regulatory measure.Therefore, drug safety software embeds HIS(hospital information management system with control form), in electronic prescription (doctor's advice) link, to the multiple prescription that exists overdose, contraindication, incompatibility, interaction or wrong input etc. to damage patient, set up a set of drug safety monitoring system, real-time alerting, prompting, avoid the generation of phytotoxicity accident, improve the medicine quality of hospital, prevent medication accident and dispute, ensure patient's drug safety, become the common recognition of domestic hospitals information monitoring system.The domestic rational use of medicines monitoring system (PrescriptionAutomaticScreeningSystem that now developed, PASS), clinical safety rational use of medicines decision support system (DSS) (Drug Rational Use Guideline System, DRUGS), Drug Counseling and drug safety monitoring system (leading to greatly pharmaceutical information technology company limited), newly organized clinical application reference, the softwares such as doctor's Maitong (Beijing gold leaf Tian Sheng Science and Technology Ltd.) are in clinical use, but above rational use of medicines system all causes and can not solve current clinical application disordering, trialization, the treatment present situation of empirical.
Summary of the invention
The object of this invention is to provide the clinical safety rational use of medicines decision support method that a kind of energy is quick, economic, effectively supervise clinical application disordering, trialization, empirical.
The object of the present invention is achieved like this, clinical safety rational use of medicines decision support method, it is characterized in that: which comprises at least clinical rational drug use normative database, information input equipment, doctor's advice decision package, crossing patient information input equipment when patient's pathology information exchange is input to after doctor's advice decision package, doctor's advice decision package compares the pathological information of the common clinical storing in patient's pathological information and clinical rational drug use normative database and high morbidity, after examination, showing medication standard doctor's advice information by doctor's advice decision package, medication standard doctor's advice information doctor's advice decision package being shown by information input equipment is further screened, medication standard doctor's advice information after screening again by doctor's advice decision package 10 by safe medication monitor database is further compared, screen, obtained the doctor's advice of a confirmation by doctor's advice decision package, offer patient.
Described medication standard doctor's advice information, be the steps include: by safe medication monitor database is further compared, screened by doctor's advice decision package
The first step: whether the medicine in medication standard doctor's advice information has interaction, does not carry out lower step, has phase inversion interaction output information;
Second step: whether the medicine in medication standard doctor's advice information exists taboo, does not carry out lower step, has the taboo of turning information;
The 3rd step: whether the medicine in medication standard doctor's advice information the outer compatibility of body, does not carry out lower step, the outer compatibility information of turning;
The 4th step: whether the medicine in medication standard doctor's advice information exists repeated drug taking, does not carry out lower step, has the output of the repeated drug taking of turning information;
The 5th step: whether have route of administration in medication standard doctor's advice information, have and carry out lower step, do not have, be given to out route information prompting;
The 6th step: whether, be not carry out lower step, be if being special population in medication standard doctor's advice information, turns medicine monitoring examination procedure;
The 7th step: whether have allergic drug in medication standard doctor's advice information, do not carry out lower step, have, turn over sensitizing drug information indicating;
The 8th step: whether the medication standard doctor's advice information dosage of drug is excessive, suitable, carries out lower step, improper, turns the excessive information indicating of pharmaceutical quantities;
The 9th step: whether be drug induced disease in medication standard doctor's advice information, or not do not carry out lower step; To turn drug induced disease information indicating;
The tenth step: contrast with medical insurance medication information, when inconsistent with medical insurance medication information, show on doctor's advice decision package computer interface; In medication standard doctor's advice information, whether be drug induced disease, or not do not carry out lower step; To turn drug induced disease information indicating;
The 11 step: the price in the medicine of medication standardize information is retrieved, and price is greater than the price in medication standard, provides information indicating.
When described patient's pathology packets of information is drawn together the adverse events information of historical medication standardize information Chinese traditional medicine generation, doctor's advice decision package will be added up automatically, be stored in adverse reaction monitoring database, by doctor's advice decision package when safe medication monitor database is further compared, is screened medication standard doctor's advice information, abnormal signal monitoring means can provide feedback information to doctor's advice decision package, further adjusts doctor's advice by doctor's advice decision package.
When the described patient's pathological information that is input to doctor's advice decision package by input equipment comprises in historical medication standardize information antibacterials statistical information, antibacterials clinical practice, drug-fast bacteria related data, operative incision infects and uses antibacterials correlation analysis, and the clinical practice and the people that analyze antibacterials are stored in adverse reaction monitoring database for the correspondence results of hospital infection records.
Described drug interaction is by drugs compared interaction data bank, finds unreasonable coupling medicine; Described medicine contraindication disease is by calling " taboo " in diagnosing patient and package insert, finds to violate contraindication medicining condition after contrast; Described vitro Drug compatibility is by calling pharmaceutical incompatibility table corresponding doctor's advice information, finds incompatibility can occur; Described repeated drug taking is by examining doctor's advice information in database, and corresponding drug ingedient table, thereby finds to repeat composition; Described route of administration is to call medicine method of administration table, and contrasts with doctor's advice method of administration, thereby finds and point out wrong method of administration.
Described allergic drug is the irritated information of comparing patient's allergic state and medicine used by database, thereby finds allergic drug may occur; Described individual administration is to contrast doctor's advice information and individuation drug use storehouse by database, and ejects personalized medicine prompting frame, inspection and the observation project that when prompting is used this type of, should carry out.
Described dosage monitoring examination is in the time preserving or call " dosage examination ", by database, dosage in dosage in doctor's advice information and drug dose table is compared, and finds to exceed maximum dose medicine, and warns.
Described drug induced disease early warning is in the time using the drug induced disease that may cause of recording in package insert in doctor's advice, monitors doctor's progress note respective field by database, thereby finds doubtful drug-induced symptom, and warning.
Described clinical drug application separated time, to license management and the prompting of bacterial resistance level be to call antibacterials separated time, use rank, and doctor's advice doctor academic title is assigned in contrast, the use antibacterials thereby restriction doctor bypasses the immediate leadership; By calling specific bacteria resistant rate in LIS system, the corresponding doctor's advice of descending, finds to the super upper limit antibacterials of this bacterial resistance, above situation system automatic spring dialog box is reminded, and while backstage record.
The storage of clinical rational drug use normative database has the clinical application standard of disease, the kind that clinical application is selected foundation " national essential drug catalogue " or had evidence-based medicine EBM to support, medication standard is the clinical common disease based on affecting human health, through domestic and international up-to-date treatment guide and domestic and international RCT article are compared, use for reference, screen formation.
Advantage of the present invention can be by relatively being embodied with existing technology in table 1:
Table 1 hospital administration supervisory systems software contrast list
* note: not this module XXX have this functional module ★ ★ ★ to have and the more full ★ ★ of function ★ ★ have this functional module and powerful, have a good enforceability ★ ★ ★ ★ ★
In sum, we can find, rational use of medicines monitoring system, Drug Counseling and drug safety monitoring system, newly organized clinical application is with reference to waiting and cure its most important medication audit of Maitong software and supervision just in electronic auditing and the intervention to prescription according to medicine instructions, and for treating empirical in the current medical act of China, freeing, trialization, the present situation of disordering does not have basic intervention effect, and " clinical safety rational use of medicines decision support system (DSS) " is after diagnosis, system provides treatment reference scheme automatically, according to patient's drug therapy situation, automatic early-warning drug therapy mistake, the medicine that automatic-prompting need to be monitored, medicine that may be irritated, automatically examination medicine incompatibility and interaction, is that doctor's clinical treatment behavior is really accomplished " there are laws to abide by, abide by the laws ", promotes medical act standardization, standardization, guarantees medical safety, improves health care efficiency and benefit.
Accompanying drawing explanation
Below in conjunction with specific embodiment, the invention will be further described:
Fig. 1 is specific embodiment of the invention theory diagram.
In figure: 1, rational use of medicines normative database; 2, standardization doctor's advice database; 3, individuation doctor's advice automatic-prompting database; 4, pharmaceutical information dynamic data base; 5, safe medication monitor database; 6, medical insurance medication prompting and management database; 7, abnormal signal monitoring means; 8, adverse reaction monitoring database; 9, information input equipment; 10, doctor's advice decision package; 11, doctor's advice is revised platform; 12, carry out doctor's advice.
Embodiment
Clinical rational drug use standard module (clinical rational drug use normative database) comprising: rational use of medicines normative database 1, standardization doctor's advice database 2, individuation doctor's advice automatic-prompting database 3.
The storage of clinical rational drug use normative database has the clinical application standard of nearly 200 diseases, these medication standards are the clinical common diseases based on affecting human health, by veteran clinical front-line expert, domestic and international up-to-date treatment guide and domestic and international RCT article are compared, use for reference, screened, form after medication standard, wherein medication is selected all according to " national essential drug catalogue " or is had the kind of evidence-based medicine EBM support, authoritative expert's examination and recognition are definite forms by domestic.
Standardization doctor's advice database 2 storage has some come to a conclusion clear and definite doctor's advice or the doctor's advice of easily makeing mistakes or need higher level doctor's doctor's advice of examination and approval of checking on, and is set to mandatory doctor's advice.Such as: while using mitomycin, doctor's advice can its solvent of automatic spring be salt solution, and has avoided doctor to misapply syrup as solvent; For another example, while using ifosfamide, except solvent is salt solution, while bringing into use ifosfamide, use 6 hours, use 12 hours, should give the doctor's advice of sulphur ethyl sulfonic acid sodium, system also can be listed it in doctor's advice automatically, has so just avoided doctor owing to forgeing or doctor did not just know it is so to use and be only reasonably originally.
Individuation doctor's advice automatic-prompting database 3 storage has that clinical treatment window is narrow or toxicity is large, need close observation to monitor at any time the information of medicine.When doctor to this type of medicine under when doctor's advice, database can eye-catching dialog box of automatic spring, reminds doctor to do necessary Laboratory Monitoring and the observation of the state of an illness.In the time that Laboratory Monitoring Index exceedes specified standard, corresponding medicine is in doctor's advice, have obvious prompting, such as font can become eye-catching redness etc., cause the generation of Adverse drug events to avoid doctor's careless omission, for another example, use digoxin to a hypokalemic patient, such doctor's advice can cause warning or a suggestion of mending potassium to patient.
Clinical rational drug use standard module, be used for storing common clinical and high morbidity medication standard, medication standard is by existing common clinical and high morbidity are obtained by comparison, examination and statistics, cross patient information input equipment 9 when patient's pathology information exchange and be input to after doctor's advice decision package 10, doctor's advice decision package 10 compares the pathological information of patient's pathological information and common clinical and high morbidity; When patient's pathological information is in pathological information storehouse, will be presented at doctor's advice decision package 10 computer interfaces at medication standardize information corresponding to patient's pathological information corresponding to clinical rational drug use normative database.
Clinical rational drug use standard module is soul or the core of DRUGS system, and other functional modules are all based on this.This module database is on the basis that domestic and international all disease criterion treatment guides are extensively collected, and compares, screens, and eliminates the false and retains the true, and clinical 50% common disease and high morbidity has been write to medication standard at present, and through authenticating authority.This module is intended to make current clinical common disease disordering, empirical, freeing, trial to change relative standard and standard into.Disease treatment guide and standardization prescription are converted into clinical practice, change common people and see same disease, the first of seeing the doctor is spent 10 yuans, and the second of seeing the doctor will be spent the present situation of 1000 yuan.Such as gastric ulcer, according to the clinical treatment guide of gastric ulcer, we have 9 kinds of standard therapeutic regimens selective, no matter doctor's first or doctor's second, according to clinical practice selection scheme, make standard unification, treatment standard, reach the object that improves clinical efficacy, reduces resource medicine waste.This module comprises: rational use of medicines normative database, standardization doctor's advice database and individual administration automatic-prompting database.
Safe medication examination module, further the medicine that clinical rational drug use normative database provides medication standardize information is retrieved as follows and analyzed:
1) medicine of medication standardize information is carried out to drug interaction monitoring examination
In the time preserving or call " drug interaction monitoring examination ", system can be by the drugs compared data bank that interacts, find unreasonable coupling medicine, and the serious warning degree of corresponding definition shows red, yellow warning lamp accordingly in doctor's advice interface in " warning " hurdle, as: assign doctor's advice dilantin sodium, aminophylline, system can preserved after doctor's advice, examination drug interaction data bank simultaneously, find that this group drug combination can interact, the corresponding order of severity gives red light warning simultaneously.
2) medicine of medication standardize information is carried out to medicine contraindication disease monitoring examination
In the time preserving or call " examination of medicine contraindication disease ", by calling " taboo " in diagnosing patient and package insert, after contrast, find to violate contraindication medicining condition; As: diagnosing patient asthma, in doctor's advice, assign brufen, system is by calling taboo in medication instruction book: forbid in asthma patient, and patient diagnosis table, find medicine violation contraindication service condition, and the corresponding order of severity is pointed out with reddish yellow lamp form at doctor's advice interface.
3) medicine of medication standardize information is carried out to vitro Drug compatibility monitoring examination
In the time preserving or call " vitro Drug compatibility monitoring examination ", system, by calling pharmaceutical incompatibility table corresponding doctor's advice information, is found to occur incompatibility and is used, and propose corresponding warning lamp.As: in the time assigning compatibility doctor's advice " calcium gluconate " " magnesium sulfate " in doctor's advice, system, through audit incompatibility information bank, finds that by contrast this medicine is to there being incompatibility, and prompting.
4) medicine of medication standardize information is carried out to repeated drug taking monitoring examination
In the time preserving or call " repeated drug taking monitoring examination ", system can be examined doctor's advice information, and corresponding drug ingedient table, thereby finds to repeat composition, and warns by the order of severity.As: in the time assigning " Vitamin H " " Alpha Vee-12 " in doctor's advice, system is by examination drug ingedient, after contrast, find to have contained cobalamin in water soluble vitamin, system judges that this situation is as repeated drug taking, and gives corresponding prompting.
5) medicine of medication standardize information is carried out to route of administration monitoring examination
In the time preserving or call " repeated drug taking monitoring examination ", system call medicine method of administration table, and contrast with doctor's advice method of administration, thereby find and point out wrong method of administration.As: when assigning " cefuroxime sodium for injection " method of administration for " oral ", system, by drugs compared method of administration information, is found method of administration mistake, and is given corresponding prompting.
6) medicine of medication standardize information is carried out to special population (children, old man, gestation, pregnant woman and hepatic and kidney function obstacle) medication monitoring examination
Preserving or calling " old man's medication examination ", " children examination ", " lactation medication examination ", " pregnant drug examination ", " liver function medication examination ", when " renal function medication examination ", system audit patient age, diease occurrence state also call medicine special population drug use table, by relatively finding special population medication problem, and prompting.As: when assigning " Cefepime Injections " in doctor's advice, system inspect patient age is " 75 years old ", by contrast special population drug use table, finds that this medicine gerontal patient is cautious use of, and gives corresponding prompting.
7) medicine of medication standardize information is carried out to allergic drug monitoring examination
In the time preserving or call " the irritated examination of medicine ", the irritated information of system comparison patient's allergic state and medicine used, thus find allergic drug may occur, and prompting.As: doctor's input " penicillin anaphylaxis " in " diease occurrence state/allergy ", in the time assigning penicillin medicine " penicillin V potassium ", the irritated information of system contrast medicine, and diease occurrence state/irritated information, thus find allergic drug, and give corresponding prompting.
8) medicine of medication standardize information is carried out to individual administration automatic-prompting
In the time assigning the narrow or larger medicine of toxicity for the treatment of window, system contrast doctor's advice information and individuation drug use storehouse, and eject personalized medicine prompting frame, prompting use this type of time inspection and the observation project that should carry out.As: in the time assigning " digoxin ", systematic search individual administration table, judging that this medicine belongs to needs individual administration, thereby jumps out respective dialog frame.
9) medicine of medication standardize information is carried out to dosage monitoring examination
In the time preserving or call " dosage examination ", system, by dosage in dosage in doctor's advice information and drug dose table is compared, is found to exceed maximum dose medicine, and is warned.As: when giving " piperacillin for inj Sulbactam " 8g/ time, system is by contrast package insert Chinese traditional medicine dosage maximum 6g/ time and prescription drug consumption 8g/ time, thereby proposes corresponding warning.
10) medicine of medication standardize information is carried out to drug induced disease early warning
In the time using the drug induced disease that may cause of recording in package insert in doctor's advice, system passes through to monitor doctor's progress note respective field, thereby finds doubtful drug-induced symptom, and warning.As: system finds that there is " hepatic lesion " by scanning progress note, uses " rifampin " by contrast doctor's advice INFORMATION DISCOVERY, and rifampin has the bad reaction of the hepatic lesion of initiation, and system is judged the drug induced disease that may cause as rifampin, and gives red light warning.
11) antimicrobial in the medicine of medication standardize information is carried out clinical drug application separated time, licenses management and the prompting of bacterial resistance level
Call antibacterials separated time, use rank, doctor's advice doctor academic title is assigned in contrast, the use antibacterials thereby restriction doctor bypasses the immediate leadership.By calling specific bacteria resistant rate in LIS system, the corresponding doctor's advice of descending, finds to the super upper limit antibacterials of this bacterial resistance, above situation system automatic spring dialog box is reminded, and while backstage record.As: in doctor's advice, use " Cefradine ", Cefradine resistant rate statistical form in system call LIS system, in the time that Cefradine exceeds 75% for bacillus canalis capsulatus resistant rate, system is jumped out prompting automatically, for doctor's reference.
Domain of Abuse Antibiotics is the main reason that causes antibiotic resistance, has caused huge social danger and resource medicine waste, and in China, 138 grams, year consumption microbiotic, exceedes 10 times, the U.S., the first in the world per capita; Have every year 80000 people directly or indirectly to die from abuse of antibiotics, hospital's abuse of antibiotics is mainly manifested in: over adaptation disease, and overdose, over time limit, the limit of going beyond one's commission is used, and this module is mainly used microbiotic from surgical prophylaxis; Microbiotic classification is used; The aspects such as resistance condition monitoring realize management.Further promote the various antibacterials standard policies of health ministry, General Logistics Department really to implement and carry out, reduce abuse of antibiotics, resistance phenomenon.
Clinical rational drug use normative database comprises: rational use of medicines normative database 1, standardization doctor's advice database 2, individuation doctor's advice automatic-prompting database 3.
Nearly four or five thousand kinds of the medicine that Chinese Hospitals is used at present, up to ten thousand of nomenclature of drug, annual also constantly have new medicine to occur, in this case, clinician accomplishes that safe and reasonable medication is not easy, therefore, this system will omnidistancely assist doctor from medicine usage and dosage, interact, incompatibility, drug induced disease, 15 aspects such as especial patient personalized medicine are examined, and warn by the order of severity, system has the details to the meeting of warning content, doctor is by using this module, evade on the one hand medication errors risk, on the other hand, constantly strengthen medication knowledge, improve drug level.In addition, by this module, medicining condition also can go on record in violation of rules and regulations, supplies regulator as supervision foundation.This module comprises: drug interaction monitoring review database, medicine contraindication disease monitoring review database, vitro Drug compatibility monitoring review database, repeated drug taking monitoring review database, route of administration monitoring review database, special population (children, old man, gestation, pregnant woman and hepatic and kidney function obstacle) medication monitoring review database, allergic drug monitoring review database, individual administration automatic-prompting database, dosage monitoring review database and drug induced disease early warning (similar with drug therapy abnormal signal monitoring function).
Medical insurance medication prompting is used administration module 6 with non-medical insurance medicine, and the price in the medicine of medication standardize information is retrieved, and contrasts with medical insurance medication information, when inconsistent with medical insurance medication information, on doctor's advice decision package computer interface, shows.Effectively avoid medical institutions to be refused to pay the generation of event by medical insurance department.It is the difficult problem in hospital management that medical insurance is for a long time refused to pay always, hospital is every year because super medical insurance medication causes refusing to pay, lose very large, the relevant issues that solution medical insurance is refused to pay are current emphasis urgently to be resolved hurrily, by this module, doctor, opening the medical insurance situation of meeting automatic-prompting medicine in the individual process of doctor's advice and patient's total charge, stops the unnecessary medical insurance bills due of hospital, thereby is that hospital saves writing spending.Mainly corresponding with use management with medical insurance medication prompting.
The patient's pathological information that is input to doctor's advice decision package by input equipment comprises historical medication standardize information Chinese traditional medicine adverse events, and a rational use of medicines supervision module will be added up automatically, be stored in medication standardize information storehouse.Give a clue for analyzing clinical Irrational Use of Drugs, for standard clinical rational drug use provides foundation.Realize automatic monitoring and the identification of adverse drug events.
Hospital infection supervision module, the various situations of the clinical use antibacterials of Real-Time Monitoring, the clinical practice of quick statistics antibacterials, drug-fast bacteria related data, all kinds of operative incisions infect and use antibacterials correlation analysis, make the clinical practice of antibacterials in the corresponding relation of hospital infection, become known controlled.
Information Island module: 1. standard care guide; 2. package insert; 3. clinical rational drug use standard; 4. individual administration; 5. medical laws and regulations; 6. clinical medicine handbook; 7. clinical examination normal value and meaning; 8. antibacterials clinical practice governing principle; 9. the conventional computing formula of medical science; 10. pregnant drug safety classification.
Provide the example of the concrete application of the present invention below:
Illustrate (take COPD patient as example)
When patient is admitted to hospital with clinical manifestations such as chronic cough, expectoration and (or) expiratory dyspnea, and there is incomplete reversible airflow limitation, be diagnosed as chronic obstructive pulmonary disease (COPD), patient COPD acute exacerbation after being admitted to hospital, flow limitation further worsens (30%≤FEV
1<50% predicted value), the aggravation of breathing hard, it is III level (severe COPD) that doctor further diagnoses patient.When doctor is by patient's pathological information and COPD(III level) typing doctor's advice decision package 10(computing machine) after, computing machine proposes 2 sets of plan after first being compared, screened by the rational use of medicines normative database 1 in clinical rational drug use standard module and standardization doctor's advice database 2 automatically, example hydrochloric acid ambroxol injection 30mg can appear in scheme with 5% glucose injection simultaneously, and rational use of medicines normative database 1 is defined as scheme one after can automatically examining scheme:
Prednisone sheet 30～40mg, oral, 1/ day; 7～10d
+
+
In addition, the individuation doctor's advice automatic-prompting database 3 in clinical rational drug use standard module can, automatically to selected project checking, not pointed out while finding no the medicine that need to treat monitoring.
Through the comparison of clinical rational drug use standard module, screen definite doctor's advice and enter, safe medication monitor database 5 can carry out a following safety monitoring:
The steps include:
The first step: whether the medicine in medication standard doctor's advice information has interaction, does not carry out lower step, has phase inversion interaction output information;
Second step: whether the medicine in medication standard doctor's advice information exists taboo, does not carry out lower step, has the taboo of turning information;
The 3rd step: whether the medicine in medication standard doctor's advice information the outer compatibility of body, does not carry out lower step, the outer compatibility information of turning;
The 4th step: whether the medicine in medication standard doctor's advice information exists repeated drug taking, does not carry out lower step, has the output of the repeated drug taking of turning information;
The 5th step: whether have route of administration in medication standard doctor's advice information, have and carry out lower step, do not have, be given to out route information prompting;
The 6th step: whether, be not carry out lower step, be if being special population in medication standard doctor's advice information, turns medicine monitoring examination procedure;
The 7th step: whether have allergic drug in medication standard doctor's advice information, do not carry out lower step, have, turn over sensitizing drug information indicating;
The 8th step: whether the medication standard doctor's advice information dosage of drug is excessive, suitable, carries out lower step, improper, turns the excessive information indicating of pharmaceutical quantities;
The 9th step: whether be drug induced disease in medication standard doctor's advice information, or not do not carry out lower step; To turn drug induced disease information indicating;
The tenth step: contrast with medical insurance medication information, when inconsistent with medical insurance medication information, show on doctor's advice decision package computer interface; In medication standard doctor's advice information, whether be drug induced disease, or not do not carry out lower step; To turn drug induced disease information indicating;
The 11 step: the price in the medicine of medication standardize information is retrieved, and price is greater than the price in medication standard, provides information indicating.
Do not pinpoint the problems and will not point out, medical insurance medication prompting and management database 6 can prompting said medicine be medical insurance medication or non-medical insurance medication and expenses for medicine overrun condition.
Continue to carry out the former doctor's advice of former doctor's advice 12(by not pinpointing the problems after above monitoring).After patient's medication, whether adverse reaction monitoring database 8 can automatic analysis patient there is bad reaction, and points out the bad reaction that may occur.Abnormal signal monitor database 7 also can be analyzed accordingly and whether have new bad reaction, while discovery, do not keep a record, if find, patient's feedback information can enter doctor's advice and revise the automatic record of platform 11 once, it is branches in doctor's advice decision package 10 (computing machine) that doctor's advice is revised platform 11, can analyze any medicine and in application, occur bad reaction, in the time having numerous bad reactions all to point to some medicines, can realize giving warning in advance of bad reaction.
Finally treat the state of an illness after 7 days and do not alleviate (will not have following scheme if cure).System also can be revised platform 11 by doctor's advice result is carried out to record, and in the time that doctor applies this doctor's advice again, system can be done corresponding prompting.
Do not alleviate because treating patient's state of an illness after 7 days, phlegm is cultivated return klebsiella pneumoniae infections, and rational use of medicines normative database 1 is pointed out Normalized Treatment doctor's advice, and standardization doctor's advice database 2 can automatic-prompting solvents.
Theophylline glucose injection 200mg drip-feed 1/d
Because of theophylline in treatment narrow range, individuation doctor's advice automatic-prompting database 3 can need to monitor blood concentration during prompting application theophylline, must not exceed 20 μ g/ml.
Patient suffers from hypertension simultaneously, apply propranolol hydrochloride tablets, 0.2g, 3/d, oral, can prompting there is drug interaction in " the drug interaction monitoring review database " in " safety monitoring database ", when theophylline and propranolol coupling, can make the blood concentration of theophylline raise, toxicity increases, and bad reaction increases the weight of, and therefore system prompt doctor should avoid two kinds of drug combinations.Propranolol is changed to metoprolol by doctor.
Because having used antibacterials Sulbactam/Cefoperazones (1:1) safety monitoring database " in " antibacterials clinical practice and drug-fast bacteria monitoring " can be according to phlegm cultivation results; whether automatically monitor klebsiella pneumoniae responsive to cefoperazone/Sulbactam; if sensitivity do not point out, can automatic-prompting if insensitive.
Because patient's laboratory examination serum serum creatinine is 500 μ mol/L, " special population medication monitoring review database " in safe medication monitor database 5 can prompting patient be moderate renal insufficiency, needs to adjust Sulbactam/Cefoperazone dosage to be 1g, 2/ day.Medical insurance medication prompting and management database 6 can prompting said medicine be medical insurance medication or non-medical insurance medication and expenses for medicine overrun condition.
The final doctor's advice of carrying out is:
Theophylline glucose injection 200mg drip-feed 1/d
Metoprolol tartrate tablets 100mg2/d is oral
According to patient record after medication, find that fatigue, dizziness, sleep-disorder appear in patient, the malaise symptoms such as ache all over, the first three items adverse drug reaction that adverse reaction monitoring database 8 can prompting patients occurs may be relevant to metoprolol.But the reaction of ache and any medicine are irrelevant from head to foot, may above several medicines be used in conjunction and cause." abnormal signal monitor database " analyzes patient's medicine relevant to adverse reactions of patients, and can report bad reaction.Final patient takes a turn for the better, and system can, by situation after patient's medication and new bad reaction record, be pointed out when other patients apply this doctor's advice afterwards in the lump.Pharmaceutical information dynamic data base 4 can be pointed out up-to-date country's medical treatment and the relevant laws and regulations of pharmaceutical administration accordingly.
Claims (9)
1. clinical safety rational use of medicines decision support method, it is characterized in that: which comprises at least clinical rational drug use normative database, information input equipment (9), doctor's advice decision package (10), crossing patient information input equipment (9) when patient's pathology information exchange is input to after doctor's advice decision package (10), doctor's advice decision package (10) compares the pathological information of the common clinical storing in patient's pathological information and clinical rational drug use normative database and high morbidity, after examination, showing medication standard doctor's advice information by doctor's advice decision package (10), medication standard doctor's advice information doctor's advice decision package (10) being shown by information input equipment (9) is further screened, medication standard doctor's advice information after screening again by doctor's advice decision package (10) by safe medication monitor database is further compared, screen, obtained the doctor's advice of a confirmation by doctor's advice decision package (10), offer patient.
2. want the clinical safety rational use of medicines decision support method described in 1 according to right, it is characterized in that: described medication standard doctor's advice information, be the steps include: by safe medication monitor database is further compared, screened by doctor's advice decision package (10)
The first step: whether the medicine in medication standard doctor's advice information has interaction, does not carry out lower step, has phase inversion interaction output information;
Second step: whether the medicine in medication standard doctor's advice information exists taboo, does not carry out lower step, has the taboo of turning information;
The 3rd step: whether the medicine in medication standard doctor's advice information the outer compatibility of body, does not carry out lower step, the outer compatibility information of turning;
The 4th step: whether the medicine in medication standard doctor's advice information exists repeated drug taking, does not carry out lower step, has the output of the repeated drug taking of turning information;
The 5th step: whether have route of administration in medication standard doctor's advice information, have and carry out lower step, do not have, be given to out route information prompting;
The 6th step: whether, be not carry out lower step, be if being special population in medication standard doctor's advice information, turns medicine monitoring examination procedure;
The 7th step: whether have allergic drug in medication standard doctor's advice information, do not carry out lower step, have, turn over sensitizing drug information indicating;
The 8th step: whether the medication standard doctor's advice information dosage of drug is excessive, suitable, carries out lower step, improper, turns the excessive information indicating of pharmaceutical quantities;
The 9th step: whether be drug induced disease in medication standard doctor's advice information, or not do not carry out lower step; To turn drug induced disease information indicating;
The tenth step: contrast with medical insurance medication information, when inconsistent with medical insurance medication information, show on doctor's advice decision package computer interface; In medication standard doctor's advice information, whether be drug induced disease, or not do not carry out lower step; To turn drug induced disease information indicating;
The 11 step: the price in the medicine of medication standardize information is retrieved, and price is greater than the price in medication standard, provides information indicating.
3. want the clinical safety rational use of medicines decision support method described in 1 according to right, it is characterized in that: when described patient's pathology packets of information is drawn together the adverse events information of historical medication standardize information Chinese traditional medicine generation, doctor's advice decision package (10) will be added up automatically, be stored in adverse reaction monitoring database (8), by doctor's advice decision package (10) by safe medication monitor database is further compared medication standard doctor's advice information, when examination, abnormal signal monitoring means (7) can provide feedback information to doctor's advice decision package (10), further adjust doctor's advice by doctor's advice decision package (10).
4. want the clinical safety rational use of medicines decision support method described in 1 according to right, it is characterized in that: when the described patient's pathological information that is input to doctor's advice decision package by input equipment comprises in historical medication standardize information antibacterials statistical information, antibacterials clinical practice, drug-fast bacteria related data, operative incision infects and uses antibacterials correlation analysis, and the clinical practice and the people that analyze antibacterials are stored in adverse reaction monitoring database (8) for the correspondence results of hospital infection records.
5. want the clinical safety rational use of medicines decision support method described in 2 according to right, it is characterized in that: described drug interaction is by drugs compared interaction data bank, finds unreasonable coupling medicine; Described medicine contraindication disease is by calling " taboo " in diagnosing patient and package insert, finds to violate contraindication medicining condition after contrast; Described vitro Drug compatibility is by calling pharmaceutical incompatibility table corresponding doctor's advice information, finds incompatibility can occur; Described repeated drug taking is by examining doctor's advice information in database, and corresponding drug ingedient table, thereby finds to repeat composition; Described route of administration is to call medicine method of administration table, and contrasts with doctor's advice method of administration, thereby finds and point out wrong method of administration.
6. want the clinical safety rational use of medicines decision support method described in 2 according to right, it is characterized in that: described allergic drug is the irritated information of comparing patient's allergic state and medicine used by database, thereby find allergic drug may occur; Described individual administration is to contrast doctor's advice information and individuation drug use storehouse by database, and ejects personalized medicine prompting frame, inspection and the observation project that when prompting is used this type of, should carry out.
7. want the clinical safety rational use of medicines decision support method described in 2 according to right, it is characterized in that: described dosage is by database, dosage in dosage in doctor's advice information and drug dose table to be compared, discovery exceeds maximum dose medicine, and warns.
8. want the clinical safety rational use of medicines decision support method described in 2 according to right, it is characterized in that: described drug induced disease early warning is in the time using the drug induced disease that may cause of recording in package insert in doctor's advice, monitor doctor's progress note respective field by database, thereby find doubtful drug-induced symptom, and warning.
9. want the clinical safety rational use of medicines decision support method described in 1 according to right, it is characterized in that: the storage of clinical rational drug use normative database has the clinical application standard of disease, the kind that clinical application is selected foundation " national essential drug catalogue " or had evidence-based medicine EBM to support, medication standard is the clinical common disease based on affecting human health, through domestic and international up-to-date treatment guide and domestic and international RCT article are compared, use for reference, screen formation.
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