The Ministry of Health issued a notice on: how primary medical institutions should carry out intravenous infusion of antimicrobial drugs

The township health centers: At present, some of the primary medical institutions in our county infusion of irrational problems are more prominent, thus leading to increased medical hazards and risks. In order to standardize medical behavior, and effectively strengthen the management of intravenous infusion of primary health care institutions, to ensure that patients are safe, effective, now on the strengthening of primary health care institutions infusion management requirements are as follows, please conscientiously implement. First, to carry out intravenous infusion of township health centers, its personnel engaged in clinical medical services must have a licensed physician or licensed physician assistant qualification, nursing staff must obtain the nursing qualification; village health office of the village doctor must obtain the "village doctor practicing certificate". Second, the health center of the hospital and village health room medical staff to carry out infusion business expertise, infusion of adverse reactions to emergency response capacity skills training, through training, proficiency in commonly used drugs, contraindications, the application of rescue equipment and rescue medicines, infusion reactions and rescue principles and methods, to ensure the safety of infusion. Third, the health center to participate in the training object to carry out infusion business professional knowledge and skills operation assessment, after the assessment of those who are qualified, before allowing the infusion business. Training, assessment work will be included in the annual performance appraisal content, the relevant information must be archived for inspection. Fourth, to carry out intravenous infusion must be equipped with appropriate rescue equipment, drugs and oxygen devices, and to ensure that the equipment intact rate of 100%. The drugs and disposable infusion apparatus used must comply with the provisions of the Drug Administration Law and the Hospital Infection Management Code, and be purchased from regular channels. After the use of disposable infusion apparatus to do timely disinfection and disfigurement, in strict accordance with the "Regulations on the Management of Medical Waste" classification and disposal. V. Strictly grasp the indications for infusion, and strictly follow the principle of "not injecting what can be taken orally, and not injecting what can be injected into the muscle". The application of antibiotics should be in accordance with the Guiding Principles for the Clinical Application of Antibacterial Drugs. Strictly prohibit the abuse of antibiotics, strictly grasp the hormone indications, village health clinics in addition to rescue, prohibit the use of glucocorticosteroids, the scope of medication should be in the "basic drug catalog". Sixth, standardize the writing of medical documents, infusion patients must be issued a prescription for infusion, writing outpatient medical records and outpatient logs, the village health office must use the outpatient registration, detailed, accurate and objective records of clinical symptoms and positive signs, and the content of the prescription and outpatient medical records (outpatient registration) must be consistent. Seventh, the strict implementation of infusion practices, the strict implementation of aseptic operation and three checks and seven pairs, infusion process should be a person responsible for rounds, close observation of the patient's general condition, the occurrence of infusion reactions in a timely manner (Annex: common infusion reaction treatment principles). Eight, each health center to the village health center infusion business situation to carry out a supervision, the focus of the supervision is: whether the practitioners meet the qualifications; medical instruments, the use of drugs is standardized; disinfection and isolation, medical room is in line with the requirements and so on. Does not meet the requirements of the infusion institutions should be rectified, the problem is prominent and remediation efforts, the cancellation of the organization's intravenous infusion business. Nine, increase publicity efforts to correct the poor medication habits of doctors and patients, the primary health care institutions should focus on a period of time, to carry out a variety of situations, easy to understand health education, to tell patients: intravenous infusion is one of the most unsafe way of medication, often infusion will reduce their own immune system and other scientific knowledge, to help patients make a reasonable choice. Annex: common infusion reaction treatment principles March 6, 2012 Report: Municipal Health Bureau Annex: common infusion reaction treatment principles (a) anaphylactic shock 1. Immediately stop the drug, carry out on-site resuscitation, go to the pillow lying down, and pay attention to warmth. 2. Immediately subcutaneous injection of 0.5 mmol/L. 2. Immediately inject 0.1% epinephrine hydrochloride 0.5-1 ml subcutaneously, reduce for children. If the symptoms are not relieved, subcutaneous or intravenous injection of 0.5 ml can be given at intervals of 20-30 minutes until the danger period is over. 3. Improve the symptoms of hypoxia: loosen the collar, open the airway, remove secretions or vomit, keep the airway open, give oxygen inhalation, when the respiration is inhibited, mouth-to-mouth artificial respiration or simple respirator should be carried out immediately to assist respiration and intramuscular injection of respiratory stimulants such as nikoksalmi or santalbumin. If laryngeal edema affects breathing, tracheal intubation or tracheotomy should be prepared immediately. 4. 4. establish intravenous access to maintain arterial blood pressure, if the blood pressure continues to fall, should be timely use of antihypertensive drugs, such as dopamine, etc.. 5. Application of adrenocorticotropic hormone: give dexamethasone 5-10mg IV push or hydrocortisone 200-400mg plus 5%-10% dextrose solution 500ml IV drip as soon as possible. 6. In case of cardiac arrest, immediately perform chest compressions and artificial respiration at the same time. 7. closely observe the patient's consciousness, temperature, pulse, respiration, blood pressure, urine output and other clinical changes, and make a good record of the dynamic condition. When the condition is serious, call 120 emergency center as soon as possible. （Causes: Input of fever-causing substances, impurity of the input solution or drug products, and poor sterilization and preservation. Clinical manifestations: Mostly occur in the infusion of liquid infusion minutes to 1 hour, manifested as chills, chills, followed by fever. In mild cases, the body temperature is about 38℃, and the temperature returns to normal within a few hours after stopping the infusion; in severe cases, the chills start at the beginning, and then the body temperature can be over 40℃, accompanied by nausea, vomiting, headache, rapid pulse and other symptoms. Treatment: 1. slow down the fluid drip or stop the infusion, and give anti-allergic drugs or hormone therapy according to medical advice. 2. 2. Increase the cover when there are chills, and give physical cooling when there is high fever. 3. Report to doctor for symptomatic treatment. 4. Keep the remaining fluid and infusion set and send them to the Drug Testing Laboratory for testing. (iii) Acute pulmonary edema Causes: Infusion is too fast, too much fluid is fed in a short time, which increases the circulating blood volume sharply and overloads the heart. Clinical manifestations: the patient suddenly develops dyspnea, shortness of breath, cough, pink foamy sputum, and in severe cases, sputum gushes out from the mouth and nose, and wet rhonchi can be heard in both lungs. Treatment: 1. immediately stop the infusion, arrange for the patient to sit in a seated position with legs down to reduce venous return and the burden on the heart. 2. pressurize and give oxygen. 2. pressurize oxygen, at the same time give 20-30% alcohol wet oxygen, in order to reduce the surface tension of the foam in the alveoli, so that the foam rupture and dissipate, improve the gas exchange of the lungs, and rapidly reduce the symptoms of hypoxia. 3. according to the condition, give sedatives, vasodilator drugs and cardiac drugs. 4. If necessary, give tourniquet to all four limbs, should call 120 emergency center as soon as possible. (D) Air embolism Causes: The air is not exhausted during infusion, the connection of infusion tube is not tight, and the bottle is not connected in time. Clinical manifestations: Abnormal discomfort in the chest, followed by dyspnea and severe cyanosis, and a loud, persistent "blistering sound" can be heard in the precordial area on auscultation. Treatment: 1. Immediately put the left side of the head low and foot high position. 2. 2. Oxygen inhalation, at the same time call 120 emergency center.