Nā Lāʻau Lapaʻau Makaʻala Kiʻekiʻe ma nā Lawelawe Haukapila
Pendahuluan
ʻO ka palekana o ka mea maʻi kahi kumu nui o ka mālama ʻana i ka haukapila. ʻO kekahi o nā wahi pilikia loa, ʻo ia ka hoʻokele lāʻau lapaʻau, ʻoiai ka hui o nā lāʻau lapaʻau i ʻike ʻia he mau lāʻau lapaʻau makaʻala kiʻekiʻe. ʻO nā lāʻau lapaʻau makaʻala kiʻekiʻe nā lāʻau lapaʻau e lawe mai ana i kahi pilikia nui o ka hōʻeha nui a i ʻole ka make inā loaʻa nā hewa, inā paha i ke kuhikuhi ʻana, ka hoʻomākaukau ʻana, ka mālama ʻana, a i ʻole ka lawelawe ʻana iā lākou. ʻO nā hewa liʻiliʻi e like me ka nui hewa, ka mea maʻi hewa, ke ala lawelawe hewa, a i ʻole ka noʻonoʻo hewa hiki ke loaʻa nā hopena koʻikoʻi. No laila, rumah sakit pono e loaʻa kahi ʻōnaehana ikaika e kaohi ai i nā pilikia o kēia mau lāʻau.
Ka Wehewehena a me nā ʻAno o nā Lāʻau Lapaʻau Makaʻala Kiʻekiʻe
ʻOiai he lāʻau lapaʻau makaʻala kiʻekiʻe, ʻaʻole ia he manaʻo he ʻoi aku ka nui o ka hiki ke hana i nā hewa, akā i ka wā e hana ʻia ai nā hewa, ʻoi aku ka koʻikoʻi o nā hopena ma mua o nā lāʻau lapaʻau ʻē aʻe. ʻO nā ʻano o nā lāʻau lapaʻau makaʻala kiʻekiʻe:
1. He haiki ka nui o ka lāʻau lapaʻau (narrow therapeutic index), no laila hiki i nā ʻokoʻa liʻiliʻi ma waena o ka nui kūpono a me ka nui ʻawahia ke lilo i mea weliweli.
2. Pono nā helu ʻana o ka nui paʻakikī, no ka laʻana ma muli o ke kaumaha o ke kino a i ʻole ka hana o nā puʻupaʻa.
3. Loaʻa nā ʻano like ʻole a i ʻole nā ʻano lāʻau like no laila hiki ke hui pū ʻia.
4. Hoʻohana ʻia i nā poʻe maʻi koʻikoʻi me nā kūlana paʻa ʻole, e like me ka ICU, ER, a i ʻole ka lumi hana.
5. Pono ka nānā pono ʻana i nā hopena lapaʻau/keʻena hoʻokolohua a me nā palena.
Nā Laʻana o nā Lāʻau Lapaʻau Makaʻala Kiʻekiʻe ma nā Halemai
Hiki ke ʻokoʻa nā papa inoa lāʻau lapaʻau makaʻala kiʻekiʻe mai kēlā haukapila a i kēia haukapila, akā ma ke ʻano laulā e pili ana i nā ʻōlelo aʻoaʻo mai nā hui e like me ka Institute for Safe Medication Practices (ISMP) a me nā lula a me nā kulekele aupuni. ʻO kekahi o nā hui lāʻau lapaʻau makaʻala kiʻekiʻe i ʻike pinepine ʻia:
1. ʻO Insulin
He lāʻau lapaʻau makaʻala nui ka insulin no ka mea hiki i ka dosage hewa ke hoʻoulu i ka hypoglycemia koʻikoʻi a i ʻole hyperglycemia, e alakaʻi ana i nā pilikia koʻikoʻi. ʻO nā ʻano like ʻole o nā ʻano (hana wikiwiki, hana lōʻihi), a me nā ʻano like o ka inoa a me ka ʻōpala, hoʻonui pū i ka pilikia.
2. Nā lāʻau anticoagulants (e.g. heparin, warfarin, enoxaparin)
Hiki i nā hewa i ka anticoagulation ke alakaʻi i ke kahe koko nui a i ʻole ka thrombosis. Ua ʻike ʻia ʻo Heparin he mea nui ka pilikia ma muli o kona ʻano like ʻole a me ka pono no ka nānā pono ʻana.
3. Nā Opioids (e laʻa me ka morphine, fentanyl, oxycodone)
Hiki i nā opioids ke hoʻoulu i ka hanu kaumaha a me ka make inā hoʻohana nui ʻia a hāʻawi ʻia paha i ka mea maʻi hewa. ʻO ke ala lawelawe hewa a me ka helu ʻana i ka nui o ka lāʻau ke kumu pinepine o nā pilikia.
4. Nā electrolytes i hoʻopaʻa ʻia (e.g. KCl, MgSO4, hypertonic NaCl)
He mea weliweli loa nā electrolytes i hoʻopaʻa ʻia inā lawelawe pono ʻole ʻia, no ka laʻana, ʻo ka potassium chloride i hāʻawi ʻia i ka IV bolus me ka ʻole o ka hoʻoheheʻe ʻia hiki ke hana i nā arrhythmias make.
5. Kemotherapy a me nā lāʻau cytotoxic
He kiʻekiʻe ka ʻawahia o kēia lāʻau lapaʻau a koi pinepine i ka helu ʻana o ka nui o ka lāʻau ma muli o ka ʻili o ke kino. Hiki i nā hewa ke hōʻeha nui i nā ʻōkana.
6. Nā lāʻau hoʻomaha a me nā lāʻau hoʻomaha (e.g. propofol, midazolam)
ʻO ka pilikia o ka pohō hanu, ka hypotension, a me ka nalowale o nā reflexes pale ea e pono ai ke kiaʻi pono ʻia kēia lāʻau lapaʻau.
Nā Wahi Kūpono ʻole i nā Hewa i ka Pōʻaiapuni Hoʻokele Lāʻau Lapaʻau
Hiki ke loaʻa nā hewa lāʻau lapaʻau ma nā pae like ʻole. Me nā lāʻau lapaʻau makaʻala kiʻekiʻe, pono e kāohi pono ʻia kēlā me kēia pae:
1. Ke kuhikuhi ʻana
ʻO nā pilikia maʻamau e komo pū ana me ke koho kūpono ʻole o nā lāʻau lapaʻau, ka nui kūpono ʻole, a i ʻole nā kuhikuhi maopopo ʻole. Hoʻonui ʻia nā pilikia ke hiki ʻole ke heluhelu ʻia ke kākau ʻana, hoʻohana hewa ʻia nā pōkole, a ʻaʻole noʻonoʻo ʻia ka hana o nā puʻupaʻa/akepaʻa.
2. Ka hoʻololi ʻana a me ka hōʻoia ʻana (ka hāʻawi ʻana a me ka hōʻoia ʻana)
Hiki ke loaʻa nā hewa i ke kope ʻana i nā kauoha lāʻau, ke hoʻokomo ʻana iā lākou i loko o ka ʻōnaehana, a i ʻole ka hōʻoia ʻana iā lākou e ka mea kūʻai lāʻau. ʻO nā lepili like a me nā inoa lāʻau like (like ke ʻano a me ke kani like) e hoʻoulu pū i nā hewa.
3. Hoʻomākaukau (hoʻomākaukau/hoʻohuihui)
He mea maʻalahi kēia pae i nā hewa i ka hoʻoheheʻe ʻana, ka helu ʻana i ka nui o ka lāʻau, a me ka hoʻohana ʻana i nā mea hoʻoheheʻe kūpono ʻole. Me nā electrolytes i hoʻopaʻa ʻia a i ʻole nā lāʻau lapaʻau injectable, hiki i nā ʻokoʻa o ka nui ke make.
4. Hoʻokele
Aia pinepine nā kahu maʻi ma nā laina mua i kēia pae. ʻO nā hewa i nā "kuleana 5" (pololei ka mea maʻi, ka lāʻau lapaʻau, ka nui o ka lāʻau, ka manawa, a me ke ala) ke kumu nui pinepine, me ka pamu infusion hewa a i ʻole ka nui o ka infusion.
5. Nānā ʻana
Pono nā lāʻau lapaʻau makaʻala kiʻekiʻe e loiloi i nā hopena lapaʻau a me nā hopena ʻaoʻao. Me ka nānā ʻole ʻia, hiki ke nalo nā hōʻailona mua o nā pilikia.
Hoʻolālā Kāohi a me ka Palekana Pōpilikia
I mea e hōʻemi ai i ka pilikia, pono nā haukapila e hoʻohana i kahi ʻano hana ʻōnaehana, ma mua o ka hilinaʻi wale ʻana i nā hana palekana pilikino. ʻO nā hoʻolālā i manaʻo ʻia:
1. Ka hoʻoholo ʻana i ka papa inoa lāʻau lapaʻau makaʻala kiʻekiʻe o ka haukapila
Pono nā haukapila e mālama i kahi papa inoa kūhelu i hoʻopou hou ʻia ma muli o nā ʻano hoʻohana a me nā hanana. Pono e hoʻolaha ʻia kēia papa inoa i nā kauka, nā kahu maʻi, nā kauka lāʻau lapaʻau, a me nā limahana mālama ola kino ʻē aʻe.
2. Ke kūlana a me ka palena o nā ʻokoʻa
ʻO ka hōʻemi ʻana i nā ʻano like ʻole o nā ʻano nui a me nā ʻano lāʻau i loaʻa e hōʻemi i ka pilikia o nā hewa. No ka laʻana, ʻo ka hāʻawi wale ʻana i kekahi mau ʻano nui o ka heparin a i ʻole KCl e like me ke kulekele.
3. Ka lepili kūikawā a me nā ʻōlelo aʻo maopopo
Pono e lepili ʻia nā lāʻau lapaʻau makaʻala kiʻekiʻe me kahi lepili e like me "HIGH ALERT" a waiho ʻia ma kahi wahi mālama i koho ʻia. He mea maikaʻi nō hoʻi ka hoʻohana ʻana i nā leka Tall Man no nā lāʻau lapaʻau me nā inoa like.
4. Nānā pālua kūʻokoʻa
No kekahi mau lāʻau lapaʻau, e like me ka insulin, heparin, chemotherapy, a me nā electrolytes i hoʻohuihui ʻia, hiki i ka nānā pālua ʻana e ʻelua mau limahana akamai ke pale i nā hewa. Pono ka nānā pālua ʻana e kūʻokoʻa maoli, ʻaʻole wale he ʻano maʻamau.
5. ʻenehana kākoʻo palekana
Hiki i nā ʻōnaehana kauoha uila (Computerized Physician Order Entry/CPOE), ke kākoʻo hoʻoholo lapaʻau, ka hoʻokele lāʻau lapaʻau barcode (BCMA), a me nā pamu infusion akamai ke hōʻemi i ka pilikia o ka mea maʻi hewa, ka mahele hewa, a me ka helu infusion hewa.
6. Palekana a kaʻawale ka waihona
ʻAʻole pono e mālama manuahi ʻia nā electrolytes i hoʻopaʻa ʻia, e like me KCl, ma nā keʻena maʻamau. ʻO ka mālama kikowaena ʻia ma ka hale kūʻai lāʻau lapaʻau a i ʻole me ke komo i kāohi ʻia e hōʻemi i ka manawa kūpono o ka lawelawe hewa ʻana.
7. Hoʻonaʻauao a me ke aʻo mau ʻana
Pono nā papahana hoʻomaʻamaʻa limahana hou a me ke aʻo manawa ma nā lāʻau lapaʻau makaʻala kiʻekiʻe. Hiki i nā kumuhana ke komo pū me ka helu ʻana i ka nui o ka lāʻau, nā dilutions, ka hoʻohana ʻana i ka pamu infusion, a me ka hoʻokele ʻana i nā hopena maikaʻi ʻole.
8. Ka hōʻike ʻana i nā hanana me ka ʻole o kahi moʻomeheu hoʻāhewa (ʻaʻohe moʻomeheu hoʻāhewa)
He mea koʻikoʻi ka hōʻike ʻana i nā mea kokoke i ka hāʻule a me nā hanana ʻino no ke aʻo ʻana i ka ʻōnaehana. Me kahi moʻomeheu ʻaʻole e hoʻāhewa i nā kānaka, hiki i nā haukapila ke kālailai ke kumu kumu a hoʻomaikaʻi i ke kaʻina hana.
Ke Kuleana o nā Limahana Ola Kino i ka Hoʻokele ʻana i nā Lāʻau Lapaʻau Makaʻala Kiʻekiʻe
ʻAʻole hiki ke hoʻokaʻawale ʻia ka holomua o ka kaohi ʻana i ka pilikia mai ka laulima ʻana ma waena o nā ʻoihana:
– ʻO ke kuleana o ke kauka, ʻo ia ke hōʻoia i nā hōʻailona maopopo, nā lāʻau lapaʻau, a me nā kuhikuhi a me ka noʻonoʻo ʻana i ke kūlana o ka mea maʻi.
– Na nā kauka lāʻau lapaʻau ke kuleana no ka hōʻoia ʻana i nā lāʻau lapaʻau, e hōʻoia ana i ka loaʻa ʻana o nā formularies palekana, e kōkua ana i ka hoʻonaʻauao ʻana, a me ka hoʻoponopono ʻana i nā lāʻau lapaʻau.
– He kuleana koʻikoʻi ko nā kahu maʻi i ka lawelawe ʻana i nā lāʻau lapaʻau a me ka nānā ʻana i ka mea maʻi, me ka hōʻoia ʻana i ka hoʻopili ʻia ʻana o nā loina "pololei" a me ka makaʻala i nā loli i nā kūlana lapaʻau.
– Pono ka hoʻokele haukapila e hāʻawi i ke kākoʻo ma ke ʻano o nā kulekele, nā kumuwaiwai, nā loiloi hoʻokō, a me ka hoʻoikaika ʻana i kahi moʻomeheu palekana.
Ka hopena
He ʻāpana koʻikoʻi nā lāʻau lapaʻau makaʻala kiʻekiʻe o ka lāʻau lapaʻau no ka mea maʻi, akā he mau pilikia koʻikoʻi ko lākou inā loaʻa nā hewa. Ma nā wahi haukapila, pono e hoʻokō ʻia ka hoʻokele lāʻau lapaʻau makaʻala kiʻekiʻe ma o kahi ʻōnaehana maʻamau, ka nānā pono ʻana, ke aʻo mau ʻana, a me ke kākoʻo ʻenehana a me kahi moʻomeheu palekana. Me kahi ala piha, mai ke kuhikuhi ʻana a hiki i ka nānā ʻana, hiki i nā haukapila ke hōʻemi i ka nui o nā hewa lāʻau lapaʻau a pale i nā mea maʻi mai nā hopena koʻikoʻi. ʻO ka mea hope loa, ʻo ke akahele a me ka laulima ʻana ma waena o nā loea mālama ola kino āpau ke kī i ka hōʻoia ʻana e hāʻawi nā lāʻau lapaʻau makaʻala kiʻekiʻe i nā pono kūpono me ka ʻole o ka hoʻopilikia ʻana i ka palekana o ka mea maʻi.
