Imithi Eqaphile Kakhulu Ezinsizeni Zesibhedlela
I-Pendahuluan
Ukuphepha kwesiguli kuyisisekelo esiyisisekelo sokunakekelwa esibhedlela. Enye yezindawo eziyingozi kakhulu ukuphathwa kwemithi, ikakhulukazi iqembu lemithi eyaziwa ngokuthi imithi eqaphile kakhulu. Imithi eqaphile kakhulu imithi enobungozi obukhulu bokubangela ukulimala okukhulu noma ngisho nokufa uma kwenzeka amaphutha, kungakhathaliseki ukuthi kunqunywa, kulungiselelwa, kugcinweni, noma ekunikezweni kwayo. Amaphutha amancane njengomthamo ongalungile, isiguli esingalungile, indlela yokuphatha engalungile, noma ukuhlushwa okungalungile kungaba nemiphumela emibi kakhulu. Ngakho-ke, izibhedlela zidinga uhlelo oluqinile lokulawula izingozi ezihlobene nale mithi.
Incazelo kanye nezici zezidakamizwa eziqaphile kakhulu
Imithi eqaphile kakhulu ayiholeli emaphutheni kaningi, kodwa uma kwenzeka amaphutha, imiphumela ivame ukuba mibi kakhulu kuneminye imithi. Izici zemithi eqaphile kakhulu zifaka:
1. Inomthamo omncane wokwelapha (inkomba yokwelapha encane), ukuze umehluko omncane phakathi komthamo osebenzayo nomthamo onobuthi ube yingozi.
2. Kudinga ukubalwa kwemithamo eyinkimbinkimbi, isibonelo ngokusekelwe esisindweni somzimba noma ekusebenzeni kwezinso.
3. Zinezinga elihlukahlukene noma izinhlobo zomthamo ezifanayo ngakho-ke zivame ukuhlanganiswa.
4. Isetshenziswa ezigulini ezibucayi ezinezimo ezingazinzile, njengase-ICU, ER, noma egumbini lokuhlinza.
5. Kudinga ukuqapha eduze imiphumela yezokwelapha/elabhoratri kanye nemingcele.
Izibonelo Zemithi Ejwayelekile Exwayisa Kakhulu Ezibhedlela
Uhlu lwemithi eqaphile kakhulu lungahluka kuye ngesibhedlela, kodwa ngokuvamile lubhekisela ezincomweni ezivela ezinhlanganweni ezifana ne-Institute for Safe Medication Practices (ISMP) kanye nemithethonqubo nezinqubomgomo zikazwelonke. Amanye amaqembu emithi eqaphile kakhulu avame ukuhlangana nawo afaka:
1. I-insulini
I-insulini iwumuthi oqaphile kakhulu ngoba ukukala okungalungile kungabangela ukwehla okukhulu kwe-hypoglycemia noma i-hyperglycemia, okuholela ezinkingeni ezinkulu. Ukwehluka kwezinhlobo (ezisebenza ngokushesha, ezisebenza isikhathi eside), kanye nokufana ngegama kanye nokupakishwa, nakho kwandisa ingozi.
2. Ama-anticoagulant (isib. i-heparin, i-warfarin, i-enoxaparin)
Amaphutha ekuvimbeleni ukujiya kwegazi angaholela ekuphumeni kwegazi okukhulu noma ekushayweni kwegazi okukhulu. I-Heparin yaziwa ukuthi inengozi enkulu ngenxa yokuguquguquka kwamazinga ayo kanye nesidingo sokuqapha eduze.
3. Ama-opioid (isib. i-morphine, i-fentanyl, i-oxycodone)
Ama-opioid angabangela ukucindezeleka kokuphefumula nokufa uma esetshenziswa ngokweqile noma enikezwa isiguli esingalungile. Indlela engalungile yokuphatha kanye nokubalwa komthamo ngokuvamile kuyimbangela yezinkinga.
4. Ama-electrolyte agxilile (isib. i-KCl, i-MgSO4, i-NaCl eningi)
Ama-electrolyte agxilile ayingozi kakhulu uma enikezwa ngendlela engafanele, isibonelo i-potassium chloride enikezwe i-IV bolus ngaphandle kokuxuba ingabangela ukungasebenzi kahle kwe-rhythmias okubulalayo.
5. Ukwelashwa ngamakhemikhali kanye nemithi enobuthi
Lo muthi unobuthi obukhulu futhi uvame ukudinga ukubalwa komthamo ngokusekelwe endaweni yomzimba. Amaphutha angabangela umonakalo omkhulu ezithweni zomzimba.
6. Imithi yokubulala izinzwa kanye neyokudambisa (isib. i-propofol, i-midazolam)
Ingozi yokucindezeleka kokuphefumula, ukwehla komfutho wegazi, kanye nokulahlekelwa yizinzwa zomoya ezivikelayo kwenza lo muthi udinga ukubhekwa ngokucophelela.
Amaphuzu Avame Ukuba Namaphutha Emjikelezweni Wokuphathwa Kwemithi
Amaphutha emithi angenzeka ngezigaba ezahlukene. Ngemithi eqaphile kakhulu, isigaba ngasinye kumele silawulwe ngokuqinile:
1. Ukunikeza umuthi
Izinkinga ezivamile zifaka phakathi ukukhethwa kwemithi okungafanele, umthamo ongafanele, noma imiyalelo engacacile. Izingozi ziyanda lapho ukubhala kungafundeki, izifinyezo zisetshenziswa ngendlela engafanele, futhi umsebenzi wezinso/wesibindi ungacatshangelwa.
2. Ukubhalwa phansi nokuqinisekiswa (ukukhipha nokuqinisekisa)
Amaphutha angenzeka lapho kukopishwa imithi kadokotela, kufakwe ohlelweni, noma kuqinisekiswa ngusokhemisi. Amalebula afanayo namagama emithi afanayo (afanayo nafanayo) nawo adala amaphutha.
3. Ukulungiselela (ukulungiselela/ukuhlanganisa)
Lesi sigaba sivame ukuba namaphutha ekuxubeni, ekubalweni kwemithamo, nasekusetshenzisweni kwezinyibilikisi ezingafanele. Ngama-electrolyte agxilile noma imithi ejovwayo, umehluko ekugxilweni ungabulala.
4. Ukuphatha
Abahlengikazi bavame ukuba semgqeni ophambili kulesi sigaba. Amaphutha “kumalungelo ama-5” (isiguli esifanele, umuthi, umthamo, isikhathi, kanye nendlela) ngokuvamile ayimbangela eyinhloko, okuhlanganisa iphampu yokumpompa engalungile noma izinga lokumpompa.
5. Ukuqapha
Imithi eqaphile kakhulu idinga ukuhlolwa kwemiphumela yokwelapha kanye nemiphumela emibi. Ngaphandle kokuqapha, izimpawu zokuqala zezinkinga zingaphuthelwa.
Isu Lokuvimbela Nokulawula Ingozi
Ukuze kuncishiswe ingozi, izibhedlela zidinga ukusebenzisa indlela yesistimu, kunokuthembela kuphela ezindleleni zokuzivikela zomuntu ngamunye. Amasu anconywayo afaka:
1. Ukunqunywa kohlu lwemithi yesibhedlela eqaphile kakhulu
Izibhedlela kufanele zigcine uhlu olusemthethweni oluvuselelwa njalo ngokusekelwe kumaphethini okusetshenziswa kanye nezigameko. Lolu hlu kufanele lusatshalaliswe kodokotela, abahlengikazi, osokhemisi, kanye nabanye abasebenzi bezempilo.
2. Ukulinganisa kanye nokukhawulelwa kokwehluka
Ukunciphisa ukuhlukahluka kwamazinga kanye namafomu omthamo atholakalayo kuzonciphisa ingozi yamaphutha. Isibonelo, ukunikeza kuphela amazinga athile e-heparin noma i-KCl ngokwenqubomgomo.
3. Ukulebula okukhethekile kanye nezixwayiso ezicacile
Imithi eqaphile kakhulu kufanele ibhalwe ngokugqamile ilebula efana nethi "HIGH ALERT" bese ibekwa endaweni ebekelwe yona yokugcina. Ukusebenzisa izinhlamvu ze-Tall Man emithini enamagama afanayo nakho kuyazuzisa.
4. Ukuhlola okuphindwe kabili okuzimele
Kweminye imithi, njenge-insulin, i-heparin, i-chemotherapy, kanye nama-electrolyte aqinile, ukuhlolwa kabili ngabasebenzi ababili abanekhono kungavimbela amaphutha. Ukuhlolwa kabili kufanele kube okuzimele ngempela, hhayi nje okusemthethweni.
5. Ubuchwepheshe bokusekela ukuphepha
Izinhlelo zikadokotela ze-elekthronikhi (i-Computerized Doctoral Order Entry/CPOE), ukwesekwa kwezinqumo zezokwelapha, ukuphathwa kwemithi yebhakhodi (i-BCMA), kanye namaphampu okufaka umuthi ahlakaniphile kunganciphisa ingozi yesiguli esingalungile, umthamo ongalungile, kanye nesilinganiso sokufaka umuthi esingalungile.
6. Isitoreji esiphephile nesihlukile
Ama-electrolyte agxilile, njenge-KCl, akufanele agcinwe ngokukhululeka emagumbini ajwayelekile. Ukugcinwa okuhlanganisiwe ekhemisi noma ngokufinyelela okulawulwayo kunciphisa amathuba okuphathwa okungalungile.
7. Imfundo nokuqeqeshwa okuqhubekayo
Izinhlelo ezintsha zokuqondisa abasebenzi kanye nokuqeqeshwa njalo ngemithi eqaphile kakhulu kuyadingeka. Izihloko zingafaka ukubalwa kwemithamo, ukuncishiswa, ukusetshenziswa kwephampu yokufaka, kanye nokuphathwa kokusabela okungekuhle.
8. Ukubika izehlakalo ngaphandle kwesiko lokusola (isiko lokusola)
Ukubika cishe ukwehluleka kanye nezenzakalo ezimbi kubalulekile ekufundeni kohlelo. Njengoba kunesiko elingabasoli abantu ngabanye, izibhedlela zingahlaziya izimbangela eziyinhloko futhi zithuthukise izinqubo.
Indima Yabasebenzi Bezempilo Ekuphatheni Imithi Eqaphile Kakhulu
Impumelelo yokulawula ubungozi ayinakuhlukaniswa nokubambisana phakathi kwemisebenzi:
– Indima kadokotela ukuqinisekisa ukuthi izinkomba, imithamo, kanye nemiyalelo icacile futhi acabangele isimo sesiguli.
– Osokhemisi banesibopho sokuqinisekisa imithi kadokotela, ukuqinisekisa ukuthi kukhona amafomula aphephile, ukusiza ngemfundo, kanye nokwenza ukubuyisana kwemithi.
– Abahlengikazi badlala indima ebalulekile ekuphathweni kwemithi kanye nokuqapha iziguli, okuhlanganisa nokuqinisekisa ukusetshenziswa kwezimiso “ezifanele” kanye nokuqaphela izinguquko ezimweni zezokwelapha.
– Abaphathi bezibhedlela badinga ukuhlinzeka ngosekelo mayelana nezinqubomgomo, izinsiza, ukuhlolwa kokuthobela imithetho, kanye nokuqinisa isiko lokuphepha.
Isiphetho
Imithi eqaphile kakhulu iyisici esibalulekile sokwelashwa kweziguli, kodwa inezingozi ezinkulu uma kwenzeka amaphutha. Ezindaweni zesibhedlela, ukuphathwa kwemithi eqaphile kakhulu kumele kwenziwe ngohlelo olujwayelekile, ukuqapha okuqinile, ukuqeqeshwa okuqhubekayo, kanye nokusekelwa kwezobuchwepheshe kanye nesiko lokuphepha. Ngendlela ephelele, kusukela ekunikezeni imithi kuya ekuqapheni, izibhedlela zinganciphisa amaphutha emithi futhi zivikele iziguli emiphumeleni emibi. Ekugcineni, imizamo yokucophelela nokubambisana phakathi kwabo bonke ochwepheshe bezempilo ibalulekile ekuqinisekiseni ukuthi imithi eqaphile kakhulu inikeza izinzuzo ezinhle ngaphandle kokubeka engcupheni ukuphepha kweziguli.
