With the active cooperation of the Taichung Hospital of the Department of Health, the proof-of-concept of medical infusion was completed with nine companies to complete the performance test of the RFID hardware and the prototype of the infusion RFID system. The former Taichung Hospital was formerly the Taichung Hospital of Taiwan Province. It has 560 beds and an average annual hospitalization of 14,300. It is one of 28 hospitals affiliated to the Department of Health. In 2006, it began to provide cancer patients with chemotherapy infusion solution service (formerly outsourced operations), and established the first central laboratory system in Taiwan. It was also awarded the National Quality Award Organisation Group Award that year.
Present situation explanation and issue analysis
At present, the preparation process of injectable drugs is printed out by the pharmacy staff. According to the listed drugs, they are dissolved, mixed or diluted, manually checked one by one, and recorded the dosage of the dispensed drug, fill in the sticker label, and fill in manually The drug preparation and signing receipt and the drug entry and exit inventory cards need to record the time of the drug preparation process for the chemotherapy drugs. The required steps are cumbersome and error-prone.
Therefore, the records of the preparation process of each chemotherapy injection, such as: drug name, dose, completion time of preparation, pharmacist, patient and application time, etc., cannot be effectively obtained from the infusion fluid container labeling connection system for administration in time , Reduced the time limit for pharmacists and nursing staff to check the operation.
Implementation
Confirm verification case
1. Definition of application scope
Initially, the scope of verification of the application of medical infusion solutions covered the preparation of TPN (total intravenous nutrition) and chemotherapy injections. After further communication with the responsible pharmacist, the chemotherapy injection was locked. Because TPNs are mostly prepared solutions at the factory, pharmacists only need to add medicines for special nutritional formulas, and their harm is far less than that of chemotherapy drugs. The chemotherapy drugs have a high risk (because it will corrode the human skin), high price, and the process of modulation requires the characteristics of highly professional technology. Regarding the chemotherapy drugs, they are taken from the identification and identification of the pharmacy department. The pharmacist transfers the drugs to the sterile room of the chemotherapy department, informs the ward delivery staff to collect them, and finally arrives at the nurses to apply for the process in the ward. Retrieve label information, compare and sign, and completely record the dispensing process of syringe medicines, and automatically send warning notices.
2. Feasibility of the case * Estimate
When I just discussed the modulation of chemotherapy infusion with hospital pharmacists, I wanted to use RFID for syringe control, and combined with drug barcodes for drug comparison and confirmation, pharmacists thought it was very necessary, in addition to reducing the proportion of wrong medicines, Implement the actions of medical personnel to follow the standard operating procedures for dispensing and administration. Moreover, the use of RFID to automatically retrieve label data automatically completes the use of medicines and syringe modulation registration operations, which can save a lot of manual filling and signing operations.
3. Executive architecture
The verification team first communicated with the relevant department in charge of the Department of Health (Science and Technology Development Group, Hospital Management Committee), and selected the Taichung Hospital as the main test unit for use. After an operator briefing meeting was held in May to explain the contents of the verification, the 9 parties were willing to The participating companies (5 RFID hardware, 3 software, and a testing center) work together to carry out proof-of-concept testing of RFID applications for medical infusions. The empirical test execution structure is as follows:
Analysis and verification requirements
1. Verification situation analysis
The process of medical infusion RFID application operation is mainly divided into three stages: preparation stage, deployment stage, and notification distribution.
2. Confirmation of verification requirements
(1) This verification is mainly aimed at the red bag of the syringe for the chemotherapy and the syringe of the device. It tests the reading rate of various RFID products, clarifies the technical doubts, and tests whether the syringe contains liquid, which may interfere with the reading. effect. Because the chemotherapeutic drugs are corrosive, the actual drug cannot be used in the verification process, and it is replaced with physiological saline.
(2) Limited by the narrow space of the chemotherapy deployment room, the choice is to focus on the reader with the antenna built into the reading device and the small RFID printer.
(3) Because medicines have not been attached with RFID tags or even barcodes, this proof of concept first plans to use the medicine bottle barcode labels, combined with RFID employee ID cards and patient RFID bracelets, to discuss the integration of barcodes and RFID The application and verification system is mainly used to establish the system for the use of syringes required by patients for chemotherapy, to fully record the modulation status of the syringes and send warning messages in real time.
3. Preparation of verification indicators
When selecting a suitable tag and reader for this proof of concept, the following verification indicators need to be achieved:
(1) The time for signing the dispensing form is shortened from 2 minutes / piece manually filled to 0.2 minutes / piece automatic induction
(2) The efficiency of enquiry and verification of nursing staff was shortened from 3 minutes / piece to 0.5 minutes / piece
(3) Notification notification changed from pharmacist telephone notification to system automatic notification
(4) When reading a single tag, it can be identified 100%
Implementation verification prototype
The first stage of basic performance test
In the first stage, a total of 6 types of HF sticker labels, 5 types of labels, and a total of 7 readers (3 for USB interface, 2 for Bluetooth transmission, 1 for PDA, and the above reader antennas are built-in, The other is an RS232 / Ethernet interface, and the antenna is external). The key conclusions are as follows:
When the standard ISO label is attached to the syringe, the larger the label surface, the greater the reduction in the sensing distance, which is about 15-50%.
The size of the built-in induction antenna of the readers tested so far is not very large (mostly the standard ISO card size, or even smaller), so it is less suitable for reading multiple tags at a time.
The physiological saline used in the test does not affect the RFID sensing distance.
The plastic light shielding bag will not affect the induction of the RFID tag outside the bag even if the syringe is inside.
When receiving the infusion medicine, an external flat antenna (approximately A4 size) is used. The standard ISO card size label can be sensed up to 30cm away, so it can be used to sense multiple light-shielding bags.
Small labels have poor adhesion (perhaps due to the curved surface of the 3cc syringe barrel or the label material is too hard). After standing for a period of time, the label will curl up and the syringe will separate.
Second-stage situational testing
(1) Situational testing
The situation test is to use the label to read the test on the conveyor belt at different moving speeds, simulating the situation where the pharmacist or nurse reads the syringe or the red bag inductively. The important findings are as follows:
The sensing distance of the tag in the moving state is generally shorter than the sensing distance under static. The faster the movement speed, the shorter the sensing distance.
One of the readers (using Bluetooth to transmit data) can dynamically detect the label and emit a "beep" sound during dynamic testing, but the test software cannot display the label ID, indicating that the data transmission cycle takes a long time. Therefore, If this reader is used to read tags, it is recommended to put the identification item in front of the reader, confirm the ID display, and then perform the next reading.
(2) Verification system
Simultaneously with the second phase of situational testing, an infusion RFID verification system was also developed, which completed a total of six subsystems, including:
1. Medication confirmation operation;
2. Chemotherapy RFID label printing operation;
3. Drug matching confirmation operation;
4. Syringe bagging operation;
5. Inform the receiving distribution operation;
6. Drug administration in the ward.
The system functions are briefly described as follows:
A. Personnel authority verification
According to the personnel operation authority, the RFID employee card is used to log in to the system and enter the corresponding system screen.
B. RFID tag read-write printing
According to the HIS verification system, the amount of syringes used to modulate the medicine is generated, and the RFID label sticker is generated by the ZebraR2844-ZRFID label printer. The clear code of the RFID tag contains the name of the medicine, the total dose, the syringe serial number / total number of syringes, the medical record number, and the date of adjustment.
The clear code of the RFID tag contains the name of the medicine, the total dose, the syringe serial number / total number of syringes, the medical record number, and the date of adjustment.
When the pharmacist completes the preparation of each syringe, the syringe RFID tag is sensed and confirmed. At this time, the preparation completion time (system time) is written in the RFID tag.
Read the syringe RFID tag before placing the syringe in a light-proof bag (red bag) and check with the red bag RFID tag.
C. RFID drug delivery
The storage area antenna senses the light-proof bag RFID tag, and automatically sends a short message to notify the staff of the corresponding ward nursing station to collect the work.
Pharmacy delivery personnel or nurses using Shida use RFID employee card to detect, record employee code and use time on RFID tag and HIS system.
D. RFID system warning
The pharmacist uses the barcode scanner to scan the bar code of the outer box and check it with the drug project of the HIS system. If it does not match, immediate warning is required.
After the pharmacist completes the preparation, the red bag is placed in the storage area, the RFID antenna senses the RFID tag, and the system immediately informs the nursing station to send the personnel to display the completion of the adjustment message.
The pharmacist or nurse can check the drug items, dosage, patient, and expiration date by scanning the RFID tag and the system. If they do not match, immediate warning is required.
The pharmacist reads and checks before using the medicine. If the medicine expires, an immediate warning is required.
Nurses can read the RFID tag, and the system can check the role of drugs, precautions, and other health education information.
E. RFID drug delivery
Application process
.Personnel login: the user uses the RFID employee card to log in to the system.
Receiving verification: sensing the label message on the red bag, checking the red bag to be used, if there is a shortage of red bags or the validity period is approaching, an instant SMS notification will be sent.
. Receipt record: After confirming that the red bag is completed without error, write in the recipient information and the date of receipt.
Nursing medication process
.Personnel login: Nurses use the RFID employee card to log in to the system.
.Medication check: The nurse scans the patient's wrist RFID tag, brings out the required chemotherapy drug information, and then senses each syringe label to check the medication item.
.Clinical health education: nurses can read the RFID tag, click on the drug to display the relevant role, precautions, and other health education information.
3. The third stage on-site import test
The on-site introduction test was conducted in the chemotherapy deployment room on the ground floor of the Taichung Hospital (the on-site introduction observation observation was held on 11/18), but was limited by the narrow space of the chemotherapy deployment room, and they chose light and convenient reading equipment; Especially in the operation process in the aseptic room, try not to let the dispensing pharmacist hold the reader to sense the syringe label, but fix the reader on the table, let the syringe come closer and sense the record. For the small screen of UMPC, the originally designed verification system is adjusted to enlarge the font and data fields, so that the operator can easily read important data. When designing the interface, as far as possible, no keyboard is required for input actions, but a screen selection. The way.
conclusion and suggestion
The verification test confirmed that RFID technology has management benefits in the application process of chemotherapy infusion solution (identification of syringe and red bag). In addition to integrating RFID and barcode technology, as a staged solution, it simplifies the manual and paper record processing mode and reduces the risk of negligence. In the standard process of checking the infusion solution preparation and receiving, by sending real-time warnings, the probability of medication errors can be reduced; and the infusion solution operation and the management of administration can be strengthened to improve the operation efficiency; in addition, it is linked to the drug graphics database to ensure The medication is correct and strengthens the energy of health education consultation. It is limited to manpower and material resources. This proof of concept is only for technical feasibility and preliminary benefit discussions. In the future, it is still necessary to develop and test RFID tags that can be recycled and reused. In terms of external antennas, domestic manufacturers still need to invest in design. To produce antennas with excellent reading performance and stability; hardware manufacturers can also strengthen existing barcode and RFID integrated reading equipment to provide a more complete and high-performance solution.
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