Nhau

Mubvunzo: Norepinephrine mushonga unowanikwa zvakanyanya unopinzwa netsinga (IV) semushonga unopinzwa nguva dzose. Mushonga unowanzo shandiswa kuti ropa rirambe rakakwana riine simba uye riine simba rekuisa ropa munhengo dzevanhu vakuru nevana vane hypotension yakanyanya kana kuvhunduka kunoramba kuripo pasinei nekuwedzerwa kwemvura mumuviri. Kunyangwe zvikanganiso zvidiki mukuwedzera simba kana dose, pamwe nekunonoka kurapwa, zvinogona kukonzera migumisiro ine njodzi. Multicenter Health System ichangobva kutumira ISMP mhedzisiro yekuongorora kwezvikonzero zvakafanana (CCA) yezvikanganiso zana nematanhatu zve norepinephrine zvakaitika muna 2020 na2021. Kuongorora zviitiko zvakawanda neCCA kunobvumira masangano kuunganidza zvikonzero zvakajairika uye kushaya simba kwehurongwa. Data kubva kuchirongwa chekushuma chesangano uye mapombi e infusion akangwara akashandiswa kuona zvikanganiso zvinogona kuitika.
ISMP yakagamuchira mishumo gumi nematanhatu ine chekuita ne noradrenaline muna 2020 na2021 kuburikidza ne ISMP National Medication Error Reporting Program (ISMP MERP). Chikamu chimwe muzvitatu chemishumo iyi chakataura nezvenjodzi dzine chekuita nemazita akafanana, mavara, kana kurongedza, asi hapana zvikanganiso zvakataurwa. Takaburitsa mishumo yezvikanganiso zvinomwe zvevarwere ve norepinephrine: zvikanganiso zvina zvekuyerwa kwemushonga (Kubvumbi 16, 2020; Nyamavhuvhu 26, 2021; Kukadzi 24, 2022); zvikanganiso chimwe chekusakwana kwehuwandu hwemushonga; zvikanganiso chimwe chekusakwana kwe titration yemushonga; kukanganiswa kwe norepinephrine netsaona. Mishumo yese gumi nematanhatu yeISMP yakawedzerwa kuCCA multicenter health system (n=106) uye mhedzisiro yakaunganidzwa (N=122) yedanho rega rega rekushandisa mushonga inoratidzwa pazasi. Chikanganiso chakataurwa chinosanganisirwa kupa muenzaniso wezvimwe zvikonzero zvakajairika.
Kunyora mushonga. Takaona zvinhu zvinoverengeka zvinokonzera zvikanganiso zvekupa mushonga, zvinosanganisira kushandiswa kwemirairo isina kufanira, kunyora norepinephrine pasina kushandisa mirairo, uye zvinangwa zvisina kujeka kana kuti zvisizvo (kunyanya kana mirairo isina kushandiswa). Dzimwe nguva zvirevo zvekupa mushonga zvakatemwa zvakanyanya kana kuti hazvishande (semuenzaniso, kuwedzera kwakanyorwa kwakakura zvakanyanya), zvichiita kuti zviomere vanamukoti kutevedzera mirairo iyi pavanenge vachitarisa BP yemurwere. Mune zvimwe zviitiko, vanachiremba vanogona kunyora madhigirii anotorwa kubva pakurema kana kuti asina kurema, asi izvi dzimwe nguva zvinovhiringika. Kunyora mushonga uku kunowedzera mukana wekuti vanachiremba vepasi pese vatadze, kusanganisira zvikanganiso zvekuronga pombi, sezvo sarudzo mbiri dzekupa mushonga dziripo muraibhurari yepombi. Pamusoro pezvo, kunonoka kwakataurwa kunoda kujekeswa kweodha apo mirairo yekupa mushonga yaisanganisira mirairo yekupima uremu uye isina kurema.
Chiremba anokumbira mukoti kuti anyore mushonga we norepinephrine kumurwere ane BP isina kugadzikana. Mukoti akaisa odha yacho sezvakarairwa nachiremba nemuromo: 0.05 mcg/kg/min IV titrated to a target mean arterial pressure (MAP) iri pamusoro pe65 mmHg. Asi mirairo yemushonga wachiremba inosanganisa kuwedzera kwemushonga usingabvi pahuremu nechiyero chepamusoro chehuremu: titrate pamwero we5 mcg/min maminetsi mashanu ega ega kusvika pachiyero chepamusoro che1.5 mcg/kg/min. Pombi yeinfusion yakangwara yesangano haina kukwanisa kuisa mutero we mcg/min kusvika pachiyero chepamusoro chehuremu, mcg/kg/min. Varapi vemishonga vaifanira kutarisa mirairo navanachiremba, izvo zvakaita kuti pave nekunonoka pakupa rubatsiro.
Gadzirira uye govera. Zvikanganiso zvakawanda zvekugadzirira uye dosing zvinokonzerwa nebasa rakawandisa remu pharmacy, rinowedzerwa nevashandi ve pharmacy vanoda huwandu hwakanyanya hwe norepinephrine infusions (32 mg/250 ml) (inowanikwa muma pharmacy e503B asi isingawanikwe munzvimbo dzese). zvinotungamira mukuita mabasa akawanda uye kuneta. Zvimwe zvikonzero zvinowanzo kukonzera zvikanganiso zve dispensing zvinosanganisira noradrenaline labels dzakavigwa mumabhegi asina kusimba uye kusanzwisisa kwevashandi ve pharmacy nezvekukurumidzira kwe dispensing.
Kuiswa pamwe chete kwe norepinephrine ne nicardipine mubhegi re amber dema kwakarasika. Pakuiswa kwe dark infusions, nzira yekupa mishonga yakadhinda mavara maviri, rimwe pabhegi re infusion pacharo uye rimwe kunze kwebhegi re amber. Kuiswa kwe norepinephrine kwakaiswa mupaketi dze amber dzakanyorwa kuti "nicardipine" mushonga usati wagoverwa kuti ushandiswe nevarwere vakasiyana uye zvinopesana. Zvikanganiso hazvina kuonekwa vasati vapihwa mushonga kana kuupihwa. Murwere akarapwa ne nicardipine akapihwa norepinephrine asi hazvina kukonzera kukuvara kwenguva refu.
Kukanganisa kwakajairika kunosanganisira kukanganisa kwemushonga kana kuwanda kwawo, kukanganisa kwemushonga zvisina kururama, uye kukanganisa kwemushonga zvisiri izvo. Zvizhinji zvezvikanganiso izvi zvinokonzerwa nekurongwa kusina kururama kwepombi yeinfusion yakangwara, chimwe chikonzero chiripo nekuda kwekuvapo kwesarudzo yemushonga muraibhurari yemishonga, zvese nehuremu uye pasina; zvikanganiso zvekuchengetedza; kubatana uye kubatanidzwazve kweinfusions dzakakanganiswa kana dzakamiswa kumurwere dzakatanga infusion isiriyo kana kuti hadzina kutara mitsetse uye hadzina kuitevera pakutanga kana kutangazve infusion. Pane chimwe chinhu chakakanganisika mumakamuri ekukurumidzira nemakamuri ekuvhiyira, uye kushandira pamwe kwepombi yakangwara nemagwaro ehutano hwemagetsi (EHR) kwakanga kusina kuwanikwa. Kuwedzerwa kwemvura kwakakonzera kukuvara kwenyama kwakashumwawo.
Mukoti akapa norepinephrine sezvakarairwa pachiyero che0.1 µg/kg/min. Panzvimbo pekugadzira pombi kuti ipe 0.1 mcg/kg/min, mukoti akaronga pombi kuti ipe 0.1 mcg/min. Nekuda kweizvozvo, murwere akagamuchira norepinephrine shoma zvakapetwa ka80 pane yaakarairwa. Apo infusion yakaderedzwa zvishoma nezvishoma ndokusvika pachiyero che1.5 µg/min, mukoti akaona kuti akanga asvika pamuganhu wepamusoro wakatarwa we1.5 µg/kg/min. Nekuti avhareji yeBP yemurwere yakanga ichiri isina kujairika, vasopressor yechipiri yakawedzerwa.
Zvinhu zviri mudura uye kuchengetwa. Zvikanganiso zvakawanda zvinoitika pakuzadza makabati ekushandisa otomatiki (ADCs) kana kuchinja mavharuvhu e norepinephrine mumakaroti ane makodhi. Chikonzero chikuru chekukanganisa uku kwezviwanikwa ndiko kunyora uye kurongedza kwakafanana. Zvisinei, zvimwe zvikonzero zvakajairika zvakaonekwawo, zvakaita semazinga akaderera e norepinephrine infusions kuADC ayo asina kukwana kusangana nezvinodiwa nechikamu chekutarisira varwere, zvichikonzera kunonoka kwekurapa kana ma pharmacy aifanira kugadzirisa infusions nekuda kwekushomeka. Kukundikana kuongorora barcode yechinhu chega chega che norepinephrine uchichengeta ADC chimwe chikonzero chinowanzoitika chekukanganisa.
Murapi wemishonga akazadza ADC ne32 mg/250 ml ye norepinephrine yakagadzirwa ne pharmacy mudhirowa remugadziri we 4 mg/250 ml premix. Murapi akasangana nekanganiso paakanga achiedza kugamuchira 4 mg/250 ml ye norepinephrine infusion kubva kuADC. Barcode painfusion yega yega haina kuskenwa isati yaiswa muADC. Murapi paakaona kuti paive nebhegi re 32 mg/250 ml chete muADC (rinofanira kunge riri mufiriji yeADC), akakumbira huwandu hwakakodzera. Norepinephrine 4mg/250mL infusion solutions haiwanikwe mu pharmacy nekuda kwekushaikwa kwe 4mg/250mL packs dzakasanganiswa, zvichikonzera kunonoka kwerubatsiro rweinfusion.
Kutarisa varwere zvisiri izvo, kutorwa kwe norepinephrine infusions kunze kwezvinodiwa, uye kusatarisira kuti bhegi rinotevera reinfusion richadiwa riini ndizvo zvinonyanya kukonzera zvikanganiso zvekutarisa.
Murwere ari kufa akarayirwa kuti "usamutsiridze mweya" anobayiwa jekiseni renorepinephrine kuti rigare kwenguva yakareba zvekuti mhuri yake igone kuoneka. Kupinzwa kwenorepinephrine kwakaguma, uye pakanga pasina bhegi rekuwedzera muADC. Mukoti akabva afonera pharmacy ndokukumbira bhegi idzva. Pharmacy haina kuwana nguva yekugadzirira mushonga uyu murwere asati afa ndokuonekana nemhuri yake.
Njodzi. Njodzi dzese dzisina kukonzera kukanganisa dzinotaurwa kuISMP uye dzinosanganisira mazita akafanana kana mazita emishonga. Mishumo mizhinji inoratidza kuti kurongedza uye kunyora mazita ehuwandu hwakasiyana hwe norepinephrine infusions inopihwa ne503B outsourcers zvinoita sekunge zvakafanana.
Mazano ekushandisa mishonga yakachengeteka. Funga nezvemazano anotevera paunenge uchigadzira kana kugadzirisa nzira yechipatara chako yekuderedza zvikanganiso pakushandisa mishonga ye norepinephrine (nemamwe mishonga ye vasopressor) zvakachengeteka:
muganho wehuwandu hwemushonga. Yakajairwa kuti pave nehuwandu hushoma hwemushonga wekurapa varwere vevana uye/kana vakuru. Taura muganho wehuremu hwemushonga wakanyanya kuisirwa hunofanira kuchengeterwa varwere vane miganhu yemvura kana vanoda norepinephrine yakawanda (kuderedza kuchinja kwebhegi).
Sarudza nzira imwe chete yekupinzwa mushonga. Gadzirisai mishonga ye norepinephrine zvichienderana nehuremu hwemuviri (mcg/kg/min) kana isina (mcg/min) kuderedza njodzi yekukanganisa. Sangano reAmerican Society of Health System Pharmacists (ASHP) Safety Standards Initiative4 rinokurudzira kushandiswa kwe norepinephrine dosage units mu micrograms/kg/minute. Zvimwe zvipatara zvinogona kupinzwa mushonga mu micrograms paminiti zvichienderana nezvinodiwa nachiremba - zvese zvinogamuchirwa, asi sarudzo mbiri dzekupinzwa mushonga hadzitenderwi.
Inoda kunyorerwa mishonga zvichienderana ne template yakajairwa yekuraira. Inoda kunyorerwa mushonga we norepinephrine uchishandisa template yakajairwa yekuraira ine minda inodiwa yehuwandu hwaunoda, chinangwa chekuyera titration (semuenzaniso, SBP, systolic blood pressure), ma parameter e titration (semuenzaniso, dose yekutanga, huwandu hwedose, unit yekuwedzera, uye frequency ye dose) kumusoro kana pasi), nzira yekupa mushonga uye dose yepamusoro isingafanirwe kudarika uye / kana chiremba anouya anofanira kufonerwa. Nguva yekutendeuka inofanira kunge iri "stat" kuti maodha aya atore nzvimbo yekutanga mumutsara we pharmacy.
Deredza mirairo yemuromo. Deredza mirairo yemuromo kune njodzi chaiyo kana kana chiremba asingakwanise kupinda kana kunyora odha nemagetsi. Vanachiremba vanofanirwa kuzvigadzirira vega kunze kwekunge paine zvikonzero zvinoita kuti zvisadaro.
Tenga mishonga yakagadzirwa kare kana iripo. Shandisa huwandu hwemishonga ye norepinephrine yakasanganiswa kare kubva kuvagadziri uye/kana mishonga yakagadzirwa nevatengesi vemamwe mapato (senge 503B) kuderedza nguva yekugadzirira mishonga ye pharmacy, kuderedza kunonoka kwekurapwa, uye kudzivirira zvikanganiso zvekugadzira mishonga ye pharmacy.
Siyanisa huwandu hwakasiyana hwemishonga nekuita kuti ionekwe zvakasiyana usati washandisa mushonga wacho.
Ipai mwero weADC wakakwana. Tengai ADC uye ipai mishonga yakakwana ye norepinephrine kuti ienderane nezvinodiwa nemurwere. Tarisai mashandisirwo emushonga uye gadzirisai mwero wakajairika sezvinodiwa.
Gadzira maitiro ekugadzirisa zvinhu zvakawanda uye/kana kuwedzera huwandu hwezvinhu kana zvichidiwa. Nekuti zvinogona kutora nguva kusanganisa huwandu husina kudzoserwa, ma pharmacy anogona kushandisa nzira dzakasiyana-siyana dzekuisa pakutanga kugadzirira nekutumira zvinhu nenguva, kusanganisira kuisa mushonga uye/kana kudzvanya kana magaba asina chinhu mukati memaawa, zvichikonzerwa nenzvimbo yekuchengetedza kana zviziviso zveemail zvichifanirwa kugadzirirwa.
Pakeji/chirongo chega chega chinoskeniwa. Kuti udzivise zvikanganiso panguva yekugadzirira, kugovera, kana kuchengetera, skani bhasikiti pabhegi rega rega re norepinephrine infusion kana chirongo kuti uonekwe usati wagadzira, kugovera, kana kuchengetera muADC. Mabhakodhi anogona kushandiswa chete pamarebheru akabatanidzwa zvakananga papakeji.
Tarisa pane label iri pabhegi. Kana bhegi risina kusimba zvakanyanya richishandiswa panguva yekuongorora nguva dzose, mushonga we norepinephrine unofanira kubviswa kubva mubhegi kwenguva pfupi kuti uongororwe. Neimwe nzira, isa bhegi rekudzivirira rakareruka pamusoro pemushonga usati waongororwa woriisa mubhegi nekukurumidza mushure mekuongorora.
Gadzira gwara. Gadzira gwara (kana nzira) yekuiswa kwe norepinephrine (kana imwe mishonga yakaderedzwa), kusanganisira kuwanda kwakajairika, huwandu hwakachengeteka hwemushonga, kuwedzera kwemushonga, kuwanda kwemushonga (maminitsi), huwandu hwemushonga/huwandu hwemushonga, chiyero chekutanga, uye kutarisa kunodiwa. Kana zvichibvira, batanidza mazano negwara remushonga muMedicines Regulatory Record (MAR).
Shandisa pombi yakangwara. Kuiswa kwese kwe norepinephrine kunoiswa uye kunoderedzwa uchishandisa pombi yakangwara ine Dose Error Reduction System (DERS) inoshanda kuitira kuti DERS igone kuzivisa nyanzvi dzehutano nezvezvikanganiso zvinogona kuitika pakunyora mishonga, kuverenga, kana kuronga mishonga.
Ita Kuti Kushanda Kwazvo Kushande. Kana zvichibvira, shandisa pombi ye infusion inoenderana nemagetsi. Kushanda pamwe chete kunobvumira mapombi kuti azadzwe kare nezvirongwa zve infusion zvakavimbiswa zvakatarwa nachiremba (kunyanya pakutanga kwe titration) uye zvakare kunowedzera ruzivo rwe pharmacy rwekuti yasara mu titrated infusions.
Maka mitsetse uye nyora mapombi. Isa chiratidzo pamutsetse wega wega wekuisa mushonga pamusoro pepombi uye pedyo nenzvimbo yekupinda yemurwere. Pamusoro pezvo, usati watanga kana kuchinja norepinephrine bag kana huwandu hwemushonga, fambisa chubhu nemaoko kubva mumudziyo wemvura kuenda kupombi nemurwere kuti uone kuti pombi/nzira uye nzira yekuisa mushonga ndizvozvo.
Bvuma kuongororwa. Kana mushonga mutsva wamiswa, kuongororwa kwehunyanzvi (semuenzaniso barcode) kunodiwa kuti uone kana mushonga/mushonga wacho uripo, huwandu hwemushonga wacho uye murwere wacho aripo.
Mira kuisirwa mushonga. Kana murwere agadzikana mukati memaawa maviri ekumira kuisirwa mushonga we norepinephrine, funga nezvekuwana gwaro rekumisa kuisirwa mushonga kubva kuna chiremba ari kurapa. Kana mushonga wacho wamiswa, bvisa mushonga wacho kubva kumurwere, wobva waubvisa mupombi, wourasa kuti usapiwe mushonga netsaona. Mushonga wacho unofanirawo kubviswa kubva kumurwere kana mushonga wacho ukamiswa kwemaawa anopfuura maviri.
Gadzira nzira yekubvisa furo remudumbu. Gadzira nzira yekubvisa furo remudumbu renorepinephrine. Vanamukoti vanofanira kuziviswa nezvenzira iyi, kusanganisira kurapwa nephentolamine mesylate uye kudzivirira kudzvanywa kwechando panzvimbo yakakanganiswa, izvo zvinogona kuwedzera kukuvara kwenyama.
Ongorora maitiro ekuti mushonga ushandiswe sei. Tarisa kutevedzera kwevashandi maererano nemazano ekuti mushonga ushandiswe sei, maitiro ekushandisa uye zvakanyorerwa nachiremba, pamwe nemigumisiro yemurwere. Mienzaniso yematanho ekushandisa anosanganisira kutevedzera maganhuro ekuti mushonga ushandiswe sei anodiwa pakurongeka; kunonoka kurapwa; kushandiswa kwemapombi akangwara ane DERS yakabvumira (uye kushanda pamwe chete); tanga mushonga wacho nechiyero chakatarwa; titration zvichienderana nefrequency yakatarwa uye dosing parameters; smart pomp inokuzivisa nezve frequency uye rudzi rwemushonga, magwaro etitration parameters (anofanira kuenderana nekuchinja kwemushonga) uye kukuvara kwemurwere panguva yekurapwa.