The medical infusion solution concept verification, together with the nine companies, completed the performance test of RFID hardware and the prototype of the infusion liquid RFID system. The Taichung Hospital of Traditional Chinese Medicine was formerly known as Taiwan Provincial Taichung Hospital. It has 560 beds and an average annual hospitalization of 14300. It is one of the 28 hospitals affiliated to the Department of Health. In 2006, it began to provide cancer patients with chemotherapy infusion solution (formerly outsourcing), and established Taiwan's first central laboratory system, which was also awarded the National Quality Awards Organization Group Award.
Status statement and issue analysis
At present, in the preparation process of injecting drugs, the pharmacy staff prints the dispensing form, dissolves and mixes or dilutes according to the listed drugs, manually checks them, records the dose of the dispensed drugs, fills in the sticker label, and manually fills in the label. The drug preparation and receipt of the drug and the drug in and out of the inventory card, for the chemotherapy drug also need to record the preparation process time, the steps required are cumbersome and error-prone.
Therefore, the record of each chemotherapy injection preparation process, such as: drug name, dosage, dispensing completion time, dispensing pharmacist, patient and application time, can not be effectively obtained from the infusion solution container marking system. , reducing the aging time of the pharmacists and nursing staff.
Executive practice
Confirmation of verification case
1. Application scoping
Initial validation of medical infusion solutions, covering TPN (full intravenous infusion of nutrients) and chemotherapy injections. When further communication with the responsible pharmacist, the chemotherapy injection is locked. Because TPN is mostly prepared with a good solution at the factory, the pharmacist only needs to add the drug to the special nutritional formula, which is far less harmful than chemotherapy. Chemotherapy drugs have a high risk (because they will cause corrosive effects on human skin), and the high-priced, modulation process requires highly specialized technical characteristics. According to the identification and verification of the chemotherapeutic drugs from the pharmacy warehouse, the pharmacist adjusts the sterilized deployment room of the chemist, informs the ward to send the personnel, and finally goes to the nurse in the ward to apply the process, in the most important check-up check-in level, using RFID automatically Capture label information, compare and sign, and completely record the dispensing process of syringe drugs, and automatically send warning notices.
2. Case feasibility * Estimation
I just discussed the modulation of the chemotherapy infusion solution with the hospital pharmacist. I want to use the RFID to carry out the syringe control. When comparing and confirming the drug barcode, the pharmacist thinks it is very necessary, in addition to reducing the proportion of the wrong medicine. Implement the actions of medical personnel to follow the standard operating procedures for dispensing and administration. Moreover, the RFID automatically captures the label data, automatically completes the use of the drug and the syringe modulation, and saves a lot of manual filling and sign-off operations.
3. Execution architecture
After the verification team first communicated with the relevant competent authorities of the Department of Health (Science and Technology Development Group, Hospital Management Committee), the Taichung Chinese Medicine Hospital was selected as the main use test unit. After the company briefing session was held in May, the verification contents were confirmed. The participating companies (5 RFID hardware, 3 software, and one testing center) worked together to conduct a proof-of-concept test for medical infusion fluid RFID applications. The empirical test execution architecture is as follows:
Analytical verification requirements
1. Verify the situation analysis
The process of medical infusion fluid RFID application operation is mainly divided into preparation stage, deployment stage, and notification delivery.
2, verification needs confirmation
(1) This verification is mainly for the red bag of the syringe 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 reading. effect. Because the chemotherapy drug is corrosive, the verification process can not be replaced with the actual drug, replaced by physiological saline.
(2) It is limited by the narrow space of the chemotherapy deployment room. Therefore, it is important to select a reader with a built-in antenna and a small-sized RFID printer.
(3) Because the drug has not been labeled with RFID, and even the barcode has not been applied, the concept verification first plans the use of the barcode label of the bottle, and combines the RFID employee ID card and the patient RFID bracelet to explore the integration of barcode and RFID. Application, the verification system is mainly used to establish the use system of the syringe required for the patient's chemotherapy medication, completely record the modulation status of the syringe, and immediately send a warning message.
3. Verification of indicators
This proof of concept requires the following verification metrics when selecting the appropriate label and reader:
(1) The dispensing time of the dispensing order is shortened from 0.2 minutes/partially to 0.2 minutes/automatic induction
(2) Nursing staff check verification efficiency is shortened from 3 minutes/piece to 0.5 minutes/piece
(3) Notification of the use of the telephone notification from the pharmacist to the system automatic notification
(4) 100% identification when reading a single label
Implementation verification
Phase 1 basic performance test
In the first stage, a total of 6 kinds of HF sticker labels were tested, and 5 kinds of labels were used. There are 7 readers (3 are USB interfaces, 2 are Bluetooth transmission, 1 is PDA, and the above reader antenna is 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 is, the larger the sensing distance is reduced, and the reduction is about 15~50%.
Currently tested readers, the built-in inductive antenna size is not very large (mostly 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 did not affect the RFID sensing distance.
The plastic light-proof bag not only affects the induction of the RFID tag outside the bag, but also the inside of the bag.
When the notification is received, the external tablet antenna (about A4 size) is used. The standard ISO card size label can sense 30cm away, so it can be used to sense multiple dark bags.
Small labels have poor adhesion (perhaps because the 3cc cylinder surface is too curved or the label material is too hard), and the label will be edge-lifted and separated from the syringe after standing for a while.
Second stage situational test
(1) Situational testing
The situational test is carried out by reading the label at different moving speeds on the conveyor belt, simulating the situation in which the pharmacist or nurse performs the syringe or red bag sensing reading. 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 detect the label and make a “click†sound during the dynamic test, 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 a tag, it is recommended to leave the identification item in front of the reader and confirm the ID display before proceeding to the next reading.
(2) Verification system
At the same time as the second phase of the situational test, the infusion fluid RFID verification system was also developed, and six subsystems were completed, including:
1. Confirmation of medication;
2. Chemotherapy RFID label printing operations;
3. Drug matching confirmation operation;
4. Syringe bagging operation;
5. Notify the use of the delivery operation;
6. The ward is administered.
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 sense the login system and enter the corresponding system screen.
B. RFID tag read and write printing
According to the HIS verification system, the amount of the syringe for modulating the medicine is generated, and the RFID tag sticker is produced by the ZebraR2844-Z RFID label printer. The exact code of the RFID tag contains the name of the drug, the total dose, the serial number of the syringe/the total number of syringes, the medical record number, and the date of the adjustment.
The exact code of the RFID tag contains the name of the drug, the total dose, the serial number of the syringe/the total number of syringes, the medical record number, and the date of the adjustment.
When the pharmacist prepares to complete each syringe, the syringe RFID tag is sensed and confirmed. At this time, the deployment completion time (system time) is written in the RFID tag.
The syringe is scanned in front of the dark bag (red bag) and the RFID tag of the syringe is checked against the RFID tag that will be placed.
C. RFID drug delivery
The storage area antenna senses the light-shielding bag RFID tag, and automatically sends a short message to notify the corresponding ward care station personnel to perform the collection operation.
The drug delivery personnel or the nurses who use the beatings, use the RFID employee card to sense, record the employee code and the time of receipt in the RFID tag and HIS system.
D. RFID system warning
The pharmacist scans the barcode of the outer box with a barcode scanner and checks with the HIS system drug project. If it does not match, it needs immediate warning.
The pharmacist prepares to place the red bag in the storage area, the RFID antenna senses the RFID tag, and the system immediately informs the nursing station to send the person to display the adjustment completion message.
The pharmacist or nurse can check the drug item, dose, patient, and expiration date by scanning the RFID tag and system. If it does not match, it needs immediate warning.
The pharmacist reads the check before taking the medicine. If the effect is expired, it needs immediate warning.
Nurses can view the effects of drugs, precautions, and other health information by reading RFID tags.
E. RFID drug delivery
Requisition process
Personnel login: The recipient uses the RFID employee card to sense the login system.
Use the check: Inductive red bag tag information, check the red bag to be used, if the red bag is short or the expiration date is near, instant notification will be sent.
.Receipt record: After confirming that the red bag is completed without error, write the recipient's information and the date of receipt.
Nursing medication process
Personnel login: The nurse uses the RFID employee card to sense the login system.
Drug check: The nurse scans the patient's wrist RFID tag, brings out the information about the chemotherapy medication needed to be applied, and then senses each syringe label and checks the drug project.
Clinical Education: Nurses can read RFID tags, click on drugs to display related effects, apply precautions, and other health information.
3. The third stage on-site import test
The on-site introduction test was carried out in the chemotherapy deployment room on the next floor of the Taichung Hospital (the on-site introduction observation was held on 11/18), and the space in the chemotherapy deployment room was limited, and the reading device was light and portable. Especially in the operation of the sterile room, try not to let the dispensing pharmacist take the reader to sense the syringe label, but fix the reader on the table, and let the syringe approach and sense the record. For the small screen of UMPC, the original design verification system is adjusted, the font and data fields are enlarged, so that the operator can easily read important data. When designing the interface, the keyboard is not used for inputting, but the screen is selected. The way.
conclusion and suggestion
Verification tests confirm the management benefits of RFID technology in the application of chemotherapy infusion solutions (identification of syringes and red bags). In addition to integrating RFID and bar code technology, as a phased solution, it simplifies the manual and paper record processing mode and reduces the risk of loss. In the standard process of checking the infusion solution, by sending the warning immediately, the probability of drug error can be reduced; and the infusion fluid operation and the management of the infusion can be strengthened to improve the operation efficiency; and the drug graphic database is connected to ensure the operation. Correct medication, strengthen the energy of health education. Only limited by manpower and material resources, this concept verification only involves technical feasibility and preliminary benefit discussion. 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 have to invest in design. To produce an antenna with excellent readability and stability; hardware manufacturers can also enhance the reading device with integrated bar code and RFID to provide a more complete and high performance solution.
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