The Sterile Processing Department (Central Supply, or Sterile Supply as it is also known), comprises that service within the hospital in which medical/surgical supplies and equipment, both sterile and nonsterile, are cleaned, prepared, processed, stored, and issued for patient care. It is a Service, with in the hospital, catering for the sterile supplies to all departments , both to specialized units, general wards and OPDs.

Until the 1940s, medical/surgical supplies were, for the most part, processed and maintained in the departments and patient care areas in which they were to be used. Under this system, there was considerable duplication of effort and equipment, and it was difficult to maintain consistently high standards for sterilization technique and product quality throughout the health care facility.

As the number and variety of surgical procedures grew and the types of medical devices, equipment, and supplies proliferated, it became apparent that a centralized processing was needed for efficiency, economy, and patient safety. The work of scientists W.B. Underwood and J.J Perkins (3) was instrumental in encouraging health care facilities to establish a separate and distinct department, the Sterile Processing Department, with specialized expertise and direct responsibility for providing clean and sterile medical/surgical supplies and equipment to patient care areas.

Functions

The Central Sterile Supply Department (CSSD) plays a crucial role in ensuring patient safety and infection control within healthcare facilities. Its primary functions include:

1. Sterilization of Medical Equipment: CSSD is responsible for sterilizing and disinfecting all medical instruments, devices, and equipment used throughout the hospital or healthcare facility. This includes surgical instruments, trays, linens, and other reusable medical items.
2. Inventory Management: CSSD manages the inventory of sterile supplies, ensuring that healthcare providers have access to the necessary equipment and materials for patient care. This involves tracking stock levels, ordering supplies, and maintaining appropriate storage conditions.
3. Quality Control and Assurance: CSSD implements quality control measures to ensure that sterilization processes meet regulatory standards and guidelines. This includes monitoring sterilization equipment, performing regular testing of sterilization cycles, and maintaining accurate records of sterilization activities.
4. Infection Control: CSSD plays a critical role in preventing healthcare-associated infections by ensuring that medical equipment and instruments are properly sterilized and free from pathogens. By maintaining strict sterilization protocols, CSSD helps minimize the risk of cross-contamination and infection transmission within healthcare settings.
5. Education and Training: CSSD staff are trained in proper sterilization techniques, infection control practices, and safety protocols. They may also provide education and training to healthcare providers on the proper handling and care of sterile supplies and equipment.
6. Instrument Processing and Assembly: CSSD staff are responsible for cleaning, inspecting, assembling, and packaging surgical instruments and trays for use in surgical procedures. This ensures that surgical instruments are prepared and organized according to the specific needs of each procedure.
7. Equipment Maintenance and Repair: CSSD may be responsible for maintaining and repairing sterilization equipment and instruments to ensure optimal performance and reliability.

The Central Sterile Supply Department plays a vital role in maintaining the safety and effectiveness of medical equipment, preventing infections, and supporting high-quality patient care within healthcare facilities.

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PLANNING of CSSD

1. The materials/ items from contaminated and sterile areas should not get mixed.
2. There should be physical barrier between clean and dirty areas.
3. The floor should be smooth, impervious, non skid and robust.
4. Relative humidity should be maintained at 45±5 %
5. The clean area should be maintained at positive pressures.
6. The minimum ventilation rate should be 6-10 air changes / hour.
7. The work area should be made of marble / granite/stainless steel.
8. The sterilization must be planned for autoclaving by steam as well as by gas.

In most healthcare facilities, the Central Sterile Supply Department (CSSD) plays a key role in providing the items required to deliver quality patient care. A well planned, well managed and well staffed CSSD can ensure an infection free environment of hospital and save
valuable life and money.

Decontamination Process

Decontamination is the physical or chemical process that renders an inanimate object that may be contaminated with harmful microbial life safe for further handling. The objective of decontamination is to protect the preparation and package workers who come in contact with medical devices after the decontamination process from contracting diseases caused by microorganisms on those devices.

Steps in the Decontamination Process

• Transport – Used supplies and equipment should be collected and taken to the Decontamination Area in the Sterile Processing Department in a way that avoids contamination of personnel or any area of the hospital. Equipment should be covered and supplies should be moved in covered carts, closed totes or containers, or closed plastic bags.
• Attire – Personnel working in the decontamination area should wear protective clothing, which includes a scrub uniform covered by a moisture-resistant barrier, shoe covers, rubber or plastic gloves, and a hair covering. During manual cleaning processes, when splashing can occur, safety goggles and a face mask should be worn.
• Sorting – sorting begins at the point of use. Handling of contaminated items should be minimized unless the user of the device is already wearing full personal protective attire, such as following care in the operating room. In areas where workers are wearing no or minimal protective attire, sorting should consist only of removing disposable sharps and discarding other single-use items.
• Soaking – this is necessary only if you have lumens or other complex designs that are filled with debris or if the devices are very bloody and cannot be rinsed or wiped at the point of use.
• Detergent – should be compatible with the materials in the device and suited for the type of soil. Consult the recommendations from the device manufacturer.
• Equipment – many types of cleaning equipment are available, the most commonly used are:
  • Washer/decontaminator – the washer/decontaminator is used to clean heat-tolerant items. The cycle consists of several washes and rinses, followed by a steam sterilization cycle appropriate for the types of items contained in the load. Although subjected to a cycle designed to sterilize clean items, items processed in a washer/decontaminator should not be assumed to be sterile at the end of the process. The reason for this is that items enter the washer/decontaminator with an unknown, but probably very high, level of microbial contamination, which the sterilization cycle may not be able to completely destroy.
  • Ultrasonic – the ultrasonic washer is used to remove fine soil from surgical instruments after manual cleaning and before sterilization. The equipment works by converting high-frequency sound waves into mechanical vibrations that free soil from the surface of instruments. The high-frequency energy causes microscopic bubbles to form on the surface of the instruments and as the bubbles implode, minute vacuum areas are created, drawing out the tiniest particles of debris from the crevices of the instruments. This process is called cavitation.
  • Inspection – after cleaning, all instruments should undergo inspection before being packaged for reuse or storage. Box locks, serrations, and crevices should be critically inspected for cleanliness.Instruments with cutting edges such as scissors, rongeurs, chisels, curettes, etc., should be checked for sharpness. There should be no dull spots, chips, or dents.Hinged instruments such as clamps and forceps should be checked for stiffness and alignment of jaws and teeth. Tips should be properly aligned, jaws should meet perfectly, and joints should move easily. Ratchets should close easily and hold firmly. Any instruments with pins or screws should be inspected to make sure they are intact. Plated instruments should be checked to make sure there are no chips, worn spots, or sharp edges. Worn spots can rust during autoclaving. Chipped plating can harbor soil and damage tissue and rubber gloves. If any problems are noticed during the inspection process, these instruments should be either cleaned again, or sent for repair depending on the problem observed.

Sterilization Process

Bacterial spores are the most resistant of all living organisms because of their capacity to withstand external destructive agents. Although the physical or chemical process by which all pathogenic and nonpathogenic microorganisms, including spores, are destroyed is not absolute, supplies and equipment are considered sterile when necessary conditions have been met during a sterilization process. Several methods of sterilization are commonly used in healthcare settings, each with its own advantages and limitations.

Here are some of the most common methods:

1. Steam Sterilization (Autoclaving):
   • Steam sterilization is one of the most widely used and effective methods of sterilization in healthcare facilities.
   • It involves exposing items to high-pressure saturated steam at temperatures typically ranging from 121°C to 134°C (250°F to 273°F) for a specified period, usually around 15-30 minutes.
   • Steam sterilization effectively kills microorganisms by denaturing their proteins and disrupting their cell membranes.
   • It is suitable for a wide range of materials, including surgical instruments, medical devices, and heat-resistant plastics.
2. Ethylene Oxide (ETO) Sterilization:
   • Ethylene oxide sterilization is a low-temperature sterilization method commonly used for heat-sensitive medical devices and equipment.
   • It involves exposing items to a mixture of ethylene oxide gas and other gases in a sealed chamber at controlled humidity and temperature conditions.
   • Ethylene oxide penetrates packaging materials and kills microorganisms by disrupting their DNA and protein synthesis.
   • The process typically requires several hours to complete and involves aeration to remove residual gas and ensure safety before items can be used.
3. Hydrogen Peroxide Gas Plasma Sterilization:
   • Hydrogen peroxide gas plasma sterilization is another low-temperature sterilization method suitable for heat-sensitive instruments and equipment.
   • It involves exposing items to hydrogen peroxide gas in a vacuum chamber, where the gas is energized into a plasma state to enhance its sterilizing effectiveness.
   • The process typically takes about 45-60 minutes and is followed by aeration to remove residual gas and by-products.
4. Dry Heat Sterilization:
   • Dry heat sterilization involves exposing items to high temperatures ranging from 160°C to 190°C (320°F to 375°F) for an extended period, typically 1 to 2 hours.
   • It is suitable for items that are sensitive to moisture, such as powders, oils, and certain types of glassware.
   • Dry heat sterilization kills microorganisms by oxidative destruction of cellular components.
   • However, it may not be suitable for all materials and may require longer exposure times compared to steam sterilization.
5. Radiation Sterilization (Gamma Radiation, Electron Beam):
   • Radiation sterilization involves exposing items to ionizing radiation, such as gamma rays or electron beams, to kill microorganisms.
   • It is commonly used for sterilizing disposable medical supplies, such as syringes, gloves, and sutures.
   • Radiation sterilization does not require high temperatures and does not leave behind residues, making it suitable for heat-sensitive and plastic materials.

Each sterilization method has its own advantages, limitations, and compatibility with different types of materials and equipment. Healthcare facilities must carefully select the appropriate sterilization method based on the specific requirements of the items being sterilized and the needs of the facility. Additionally, proper validation, monitoring, and quality control are essential to ensure the effectiveness and safety of the sterilization process.

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In rural settings, where access to healthcare services may be limited, pharmacists often take on expanded roles to meet the unique needs of the population they serve. In this comprehensive explanation, we will delve into the multifaceted responsibilities of pharmacists in rural public hospitals, highlighting their contributions to patient care, medication management, public health initiatives, and community outreach.

1. Patient Care:

Medication Therapy Management (MTM):

Pharmacists in rural public hospitals provide comprehensive medication therapy management services to patients. This includes assessing medication regimens, identifying and resolving medication-related problems, and optimizing therapy to improve patient outcomes. Pharmacists collaborate with physicians and other healthcare providers to ensure that patients receive appropriate and safe medication therapy.

Medication Reconciliation:

Pharmacists play a key role in medication reconciliation, especially during transitions of care such as admission, discharge, and transfer. In rural hospitals where continuity of care may be challenging, pharmacists ensure accurate medication histories, reconcile discrepancies, and minimize the risk of medication errors.

Patient Education:

Pharmacists educate patients and caregivers about their medications, including proper administration, potential side effects, and precautions. In rural areas where access to healthcare resources may be limited, patient education becomes even more critical to empower individuals to manage their health effectively.

2. Medication Management:

Procurement and Inventory Management:

Pharmacists are responsible for procuring medications, ensuring adequate inventory levels, and managing medication distribution systems within the hospital. In rural settings where access to pharmaceutical supplies may be limited, pharmacists must optimize inventory management to prevent stockouts and ensure continuity of care.

Compounding and Dispensing:

Pharmacists compound and dispense medications accurately and efficiently, adhering to regulatory standards and best practices. In rural hospitals where specialized medications may be less readily available, pharmacists may need to compound medications to meet the unique needs of patients.

Medication Safety:

Pharmacists implement medication safety protocols to minimize the risk of medication errors and adverse drug events. This includes medication labeling, storage, and distribution practices to ensure the integrity and safety of medications throughout the hospital.

3. Public Health Initiatives:

Disease Prevention and Management:

Pharmacists contribute to public health initiatives by promoting disease prevention and management strategies within the community. In rural areas where access to primary care services may be limited, pharmacists may provide vaccinations, health screenings, and chronic disease management services to improve population health outcomes.

Health Education and Promotion:

Pharmacists engage in health education and promotion activities to raise awareness about medication safety, adherence, and lifestyle modifications. They collaborate with local healthcare organizations, schools, and community groups to deliver health education programs tailored to the needs of rural populations.

Public Health Emergency Response:

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Pharmacists play a crucial role in public health emergency preparedness and response efforts. In rural areas prone to natural disasters or outbreaks, pharmacists may participate in emergency response teams, dispense medications, and provide essential healthcare services to affected communities.

4. Community Outreach:

Medication Access Programs:

Pharmacists collaborate with community organizations and government agencies to improve medication access for underserved populations. They may participate in medication assistance programs, patient assistance programs, and medication donation initiatives to ensure that patients have access to affordable medications.

Health Screening Events:

Pharmacists organize health screening events and wellness fairs to promote preventive healthcare services within the community. These events may include blood pressure screenings, cholesterol screenings, and medication therapy reviews to identify and address health risks early.

Collaborative Partnerships:

Pharmacists establish collaborative partnerships with local healthcare providers, community leaders, and stakeholders to address healthcare disparities and improve access to quality healthcare services in rural areas. These partnerships facilitate coordinated care delivery and enhance the overall health and well-being of the community.

Conclusion:

In conclusion, pharmacists in rural public hospitals play a multifaceted role in patient care, medication management, public health initiatives, and community outreach efforts. Their contributions are instrumental in improving healthcare access, promoting medication safety, and enhancing patient outcomes in rural communities. By leveraging their clinical expertise, pharmacists serve as integral members of healthcare teams, working tirelessly to meet the evolving healthcare needs of rural populations.

As advocates for patient-centered care and public health, pharmacists play a pivotal role in addressing healthcare disparities and fostering health equity in rural areas.

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Antimicrobial resistance (AMR) refers to the ability of microorganisms, such as bacteria, viruses, fungi, and parasites, to withstand the effects of antimicrobial drugs, including antibiotics, antivirals, antifungals, and antiparasitics. This phenomenon occurs when microbes evolve mechanisms to neutralize the drugs intended to kill them, rendering the medications ineffective.

AMR poses a significant threat to public health worldwide, leading to increased morbidity, mortality, and healthcare costs. The emergence and spread of resistant pathogens complicate the treatment of infectious diseases, rendering previously effective drugs ineffective. This can result in prolonged illness, treatment failures, and the need for more expensive and toxic medications.

Key factors contributing to the rise of antimicrobial resistance include:

1. Overuse and Misuse of Antimicrobials: Excessive and inappropriate use of antimicrobial drugs in human health, animal agriculture, and agriculture contribute to the selection pressure driving the development of resistance.
2. Poor Infection Prevention and Control Practices: Inadequate hygiene, sanitation, and infection control measures in healthcare settings facilitate the spread of resistant pathogens among patients, healthcare workers, and the community.
3. Globalization and Travel: Increased international travel and trade facilitate the rapid spread of resistant microbes across borders, making AMR a global health security concern.
4. Lack of New Antimicrobial Development: The pipeline for new antimicrobial drugs is limited, with few new antibiotics being developed and approved for clinical use. This exacerbates the problem of AMR, as existing drugs become less effective against resistant pathogens.

Implementing effective measures within hospitals is essential to minimize the emergence and spread of antimicrobial resistance. In this comprehensive guide, we will explore various measures that hospitals can take to combat antimicrobial resistance, organized into different categories:

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1. Antimicrobial Stewardship Programs (ASP):Antimicrobial stewardship programs are systematic approaches to promoting the appropriate use of antimicrobials in hospitals. Key components of ASPs include:
   • Forming multidisciplinary teams comprising infectious disease specialists, pharmacists, microbiologists, and clinicians to oversee antimicrobial use.
   • Implementing guidelines and protocols for antimicrobial prescribing based on local antibiograms, susceptibility patterns, and clinical evidence.
   • Conducting regular audits and feedback sessions to monitor antimicrobial use practices.
   • Providing education and training to healthcare professionals regarding appropriate antimicrobial prescribing and resistance mechanisms.
2. Infection Prevention and Control (IPC):Infection prevention and control measures are critical for minimizing the transmission of resistant pathogens within healthcare settings. Key IPC strategies include:
   • Hand hygiene promotion among healthcare workers and visitors through education and provision of hand sanitizers.
   • Implementing contact precautions for patients colonized or infected with multidrug-resistant organisms (MDROs).
   • Environmental cleaning and disinfection protocols to reduce the reservoir of pathogens in hospital settings.
   • Implementing screening programs to detect colonization with MDROs upon admission and during hospitalization.
   • Isolation of patients with confirmed or suspected MDRO infections to prevent cross-transmission.
3. Diagnostic Stewardship:Rational use of diagnostic tests can help optimize antimicrobial prescribing and minimize unnecessary antibiotic use. Diagnostic stewardship measures include:
   • Utilizing rapid diagnostic tests to identify pathogens and their antimicrobial susceptibilities, enabling targeted therapy.
   • Implementing algorithms and clinical decision support systems to guide appropriate diagnostic test ordering.
   • Encouraging judicious use of biomarkers (e.g., procalcitonin) to differentiate bacterial infections from viral infections and reduce unnecessary antibiotic use.
4. Surveillance and Epidemiology:Surveillance of antimicrobial resistance patterns and infectious diseases can help hospitals identify emerging threats and implement targeted interventions. Key surveillance measures include:
   • Establishing robust surveillance systems to monitor antimicrobial resistance trends among common pathogens.
   • Participating in regional, national, and international surveillance networks to share data and best practices.
   • Performing molecular typing and genomic analysis of resistant pathogens to track transmission dynamics and identify outbreaks.
5. Antimicrobial Use and Formulary Restrictions:Hospitals can implement policies to regulate the use of broad-spectrum antibiotics and restrict access to high-risk antimicrobials. Key strategies include:
   • Implementing pre-authorization requirements for restricted antimicrobials, requiring approval from infectious disease specialists or antimicrobial stewardship teams.
   • Establishing antimicrobial formularies and tiered prescribing guidelines to promote the use of narrow-spectrum agents whenever possible.
   • Implementing dose optimization protocols to ensure appropriate dosing and duration of antimicrobial therapy based on patient characteristics and infection severity.
6. Education and Awareness:Education and awareness campaigns are crucial for fostering a culture of antimicrobial stewardship among healthcare professionals, patients, and the community. Key initiatives include:
   • Providing ongoing education and training on antimicrobial resistance, stewardship principles, and infection prevention to healthcare staff.
   • Engaging patients and families in discussions about antimicrobial use, the importance of completing prescribed courses of antibiotics, and the risks of antimicrobial resistance.
   • Collaborating with community stakeholders, including primary care providers, long-term care facilities, and public health agencies, to promote coordinated antimicrobial stewardship efforts.
7. Research and Innovation:Research and innovation are essential for developing new antimicrobial agents, diagnostic technologies, and treatment strategies to combat antimicrobial resistance. Key areas of focus include:
   • Supporting research initiatives to identify novel antimicrobial compounds, alternative treatment modalities, and non-antibiotic approaches to infectious diseases.
   • Investing in the development of rapid diagnostic tests, point-of-care technologies, and surveillance platforms to facilitate early detection and containment of resistant pathogens.
   • Promoting interdisciplinary collaboration and partnerships between academia, industry, and government agencies to address gaps in antimicrobial research and development.

Conclusion

In conclusion, Antimicrobial resistance is a complex problem with many diverse contributing factors. It is major cause of health concerns adding cost to oneself and to the community, directly or indirectly. Prevention is still the best tool to reduce the infection spread and thereby AMR. Along with rational use of existing antimicrobial drugs, development of new effective compounds and new diagnostic technology is the need. Joint efforts from patients, prescribers and individuals to international regulators and policy makers are needed to fight against the globally spreading antimicrobial resistance.

Combating antimicrobial resistance requires a multifaceted approach that encompasses antimicrobial stewardship, infection prevention and control, diagnostic stewardship, surveillance, formulary restrictions, education, and research. By implementing these measures collaboratively, hospitals can mitigate the spread of antimicrobial resistance and safeguard the effectiveness of antimicrobial agents for future generations.

Reference

1. The evolving threat of antimicrobial resistance. Options for action. World Health Organization, 2012
2. Antibiotic Resistance Threats in the United States, US Department of Human and Health Services, Centre for Disease Control and prevention, 23, 2013
3. ECDC/EMEA Joint Technical Report. The bacterial challenge: time to react. European Centre for Disease Prevention and Control, 2009. EMEA. doc. ref. EMEA/576176/2009 [Google Scholar]
4. Methicillin resistant Staphylococcus aureus (MRSA) in India: Prevalence & susceptibility pattern. Indian Network for Surveillance of Antimicrobial Resistance (INSAR) group, India. Indian J Med Res. 2013;137:363–9. [PMC free article] [PubMed] [Google Scholar]

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Here are some common types of home diagnostic kits:

1. Pregnancy Tests: Pregnancy tests detect the presence of human chorionic gonadotropin (hCG) hormone in urine to determine whether a woman is pregnant or not.
2. Blood Glucose Monitors: These kits allow individuals with diabetes to monitor their blood sugar levels by using a small blood sample obtained through a finger prick.
3. Cholesterol Tests: Cholesterol home testing kits measure total cholesterol, HDL (high-density lipoprotein) cholesterol, and sometimes LDL (low-density lipoprotein) cholesterol levels using a small blood sample.
4. Strep Throat Tests: Strep throat kits typically involve throat swabs that detect the presence of Streptococcus bacteria, which causes strep throat.
5. Ovulation Predictor Kits: These kits help women track their ovulation cycle by detecting luteinizing hormone (LH) levels in urine.
6. STD Tests: Some kits allow individuals to screen for sexually transmitted diseases (STDs) such as HIV, chlamydia, gonorrhea, and syphilis by collecting samples at home and sending them to a laboratory for analysis.
7. Allergy Tests: Allergy testing kits help individuals identify potential allergens by analyzing samples of blood, saliva, or hair.
8. COVID-19 Tests: During the COVID-19 pandemic, home test kits became increasingly popular for detecting the presence of the SARS-CoV-2 virus. These kits often involve nasal swabs or saliva samples and may provide results within minutes or require sending samples to a lab for analysis.

Pregnancy Test

Home Pregnancy Test (HPT) kits have become increasingly popular since the first kit was released in the mid-1970s. These kits currently make up the fastest-growing segment of the home-diagnostic testing market. In the United States, approximately 33% of women have used an HPT kit to determine their pregnancy status before seeking professional health care. Most studies have found that women choose to use Pregnancy Test kits because of the speed of obtaining results and the con venience of testing at home.

Another advantage of the Pregnancy Test kit is that the woman is the first person to know that she is pregnant. Since some women prefer to wait until they are sure they are pregnant before visiting their physician, Pregnancy Test kits may lead to an earlier pregnancy diagnosis. An earlier diagnosis provides an opportunity for health care providers to counsel women about pregnancy options and to discour age potentially harmful behaviors, such as smoking and use of alcohol or drugs.

The history of HPT kits parallels the development of laboratory tests for urinary human chorionic gonadotropin (HCG). The first kits used chemical and hemagglutination-inhibition methods,8 but most current kits use HCG-directed monoclonal antibodies. The active ingredients in monoclonal-based kits are the HCG a-chain–specific monoclonal antibodies, the b-chain–specific antibody/enzyme conjugate, the chromogenic substrate solution, and buffer solution. In the presence of urine HCG, the monoclonal antibody binds the hormone and produces a reaction, usually a color change because of the chromogenic substrate and buffer solutions. A reaction should not occur when HCG is absent, because the antibody adheres only to HCG. The accuracy of HPT kits is claimed to be 97% to 99% by the manufacturers.

A home pregnancy test is a simple and convenient tool used by women to determine whether they are pregnant or not. Here’s how a typical home pregnancy test works:

1. Testing Procedure: Home pregnancy tests typically involve urinating on a small absorbent stick or into a cup, or placing a few drops of urine onto a test strip.
2. Detection of hCG: The test strip contains chemicals that react with human chorionic gonadotropin (hCG), a hormone produced by the placenta shortly after a fertilized egg attaches to the uterine lining. If hCG is present in the urine sample, it triggers a reaction that causes the test line to appear.
3. Reading the Results: Most home pregnancy tests provide results within a few minutes. A positive result is indicated by the appearance of a distinct line or a symbol on the test strip. A negative result typically shows only one line or no lines at all. It’s essential to follow the manufacturer’s instructions regarding the interpretation of results and the recommended waiting time.
4. Timing: For the most accurate results, it’s advisable to wait until a few days after a missed period before taking a home pregnancy test. Testing too early may result in a false negative, as the levels of hCG may not be high enough to detect.
5. Accuracy: Home pregnancy tests are generally accurate when used correctly, but false positives and false negatives can occur. Factors such as improper testing technique, expired tests, certain medications, and medical conditions can affect the reliability of the results.

If a home pregnancy test yields a positive result, it’s recommended to follow up with a healthcare provider for confirmation through a blood test or ultrasound. Conversely, if the test is negative but pregnancy symptoms persist, repeating the test after a few days or consulting a healthcare provider may be advisable.

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Home pregnancy tests provide a convenient and private way for women to determine if they are pregnant, but it’s important to use them correctly and interpret the results cautiously.

COVID-19 Tests

COVID-19 diagnostic testing is a critical tool in the global effort to control and manage the spread of the coronavirus disease caused by the SARS-CoV-2 virus. These tests help identify individuals who are infected with the virus, whether they are symptomatic or asymptomatic, allowing for appropriate medical care, isolation, and contact tracing. Here’s an introduction to COVID-19 diagnostic testing

Types of Tests

• PCR Tests (Polymerase Chain Reaction): PCR tests detect the genetic material of the virus. They are highly accurate and considered the gold standard for diagnosing active COVID-19 infections. PCR tests typically involve collecting nasal or throat swab samples, which are then analyzed in a laboratory setting.
• Antigen Tests: Antigen tests detect specific proteins on the surface of the virus. These tests are faster and less expensive than PCR tests but may be slightly less accurate, especially in asymptomatic individuals.
• Antibody Tests (Serology Tests): Antibody tests detect antibodies produced by the immune system in response to a past infection with the virus. They are not used for diagnosing active infections but can indicate whether someone has been previously exposed to the virus.

Testing Process

• Sample Collection: For PCR and antigen tests, samples are usually collected via nasal swabs or throat swabs. Some tests may also use saliva samples. For antibody tests, a blood sample is collected via a finger prick or venipuncture.
• Analysis: PCR tests require specialized laboratory equipment and trained technicians to amplify and analyze the viral genetic material. Antigen tests may be performed at the point of care, providing rapid results within minutes. Antibody tests can also be conducted at the point of care or sent to a laboratory for analysis.
• Reporting Results: Results from COVID-19 tests are typically reported as positive, negative, or inconclusive. Positive results indicate an active infection, while negative results suggest the absence of the virus at the time of testing. Inconclusive results may require retesting or further evaluation.

Role in Public Health

1. Identification of Infected Individuals: Diagnostic testing helps identify individuals who are infected with the SARS-CoV-2 virus, whether they are symptomatic or asymptomatic. Identifying cases early allows for prompt medical intervention, isolation, and treatment, reducing the risk of transmission to others.
2. Isolation and Quarantine Measures: Positive test results enable healthcare providers and public health authorities to advise infected individuals to isolate themselves from others to prevent further spread of the virus. Additionally, close contacts of confirmed cases can be identified through contact tracing efforts and advised to quarantine to prevent potential transmission.
3. Surveillance and Monitoring: COVID-19 diagnostic testing is a crucial tool for surveillance and monitoring of the pandemic. Testing data provides insights into the prevalence of the virus within communities, trends in transmission rates, and the effectiveness of containment measures. This information guides public health officials in making informed decisions regarding interventions and resource allocation.
4. Containment and Mitigation Strategies: Testing data informs the implementation of targeted containment and mitigation strategies to control outbreaks and prevent the spread of the virus. This may include localized lockdowns, travel restrictions, and other measures aimed at limiting transmission in high-risk settings.
5. Resource Allocation and Planning: Testing data helps identify areas with high transmission rates and healthcare system strain, allowing for the allocation of resources such as medical supplies, personnel, and testing capacity to areas of greatest need. It also facilitates long-term planning for healthcare infrastructure and pandemic response efforts.
6. Research and Epidemiological Studies: COVID-19 diagnostic testing data contributes to epidemiological studies and research efforts aimed at understanding the transmission dynamics, clinical characteristics, and long-term effects of the virus. This research informs the development of public health policies, treatment protocols, and vaccination strategies.
7. Public Awareness and Education: Public health authorities use testing data to communicate information about the importance of testing, the availability of testing services, and guidelines for seeking testing based on symptoms, exposure history, and risk factors. Promoting testing awareness and accessibility encourages individuals to seek testing when necessary and helps foster community cooperation in controlling the spread of the virus.

Ovulation Predictor Kits

Ovulation predictor kits (OPKs) are tools used by women to detect the surge in luteinizing hormone (LH) that occurs just before ovulation. These kits help women identify their most fertile days, which is particularly useful for those who are trying to conceive or who want to understand their menstrual cycles better. Here’s how ovulation predictor kits work and how they are used:

1. Principle: Ovulation predictor kits work by detecting the surge in luteinizing hormone (LH) in a woman’s urine, which typically occurs 24-48 hours before ovulation. LH is a hormone produced by the pituitary gland, and its surge triggers the release of an egg from the ovary.
2. Testing Procedure: Ovulation predictor kits usually come with test strips or sticks that are similar in appearance to pregnancy test strips. The kits may also include a digital monitor or reader for interpreting the results. To use an OPK, a woman typically performs the following steps:
   • Start testing several days before the expected ovulation date, typically around the midpoint of the menstrual cycle.
   • Follow the instructions provided with the kit for collecting a urine sample and using the test strip or stick.
   • Dip the test strip into the urine sample or hold the absorbent tip of the stick in the urine stream for the specified amount of time.
   • Wait for the results to appear, which usually takes a few minutes.
3. Interpreting Results: A positive result on an ovulation predictor kit indicates that the LH surge has been detected, suggesting that ovulation is likely to occur within the next 24-48 hours. The intensity of the test line on the strip or stick may vary, but a test line that is equal to or darker than the control line typically indicates a positive result.
4. Timing Intercourse: Couples who are trying to conceive can use the information provided by ovulation predictor kits to time intercourse for the days leading up to and following ovulation, increasing the likelihood of conception.
5. Tracking Ovulation: Ovulation predictor kits can also be useful for women who are tracking their menstrual cycles for purposes such as fertility awareness, family planning, or understanding their reproductive health.
6. Limitations: While ovulation predictor kits can be helpful, it’s important to note that they are not foolproof. Some factors, such as irregular menstrual cycles, hormonal imbalances, and certain medications, can affect the accuracy of the results. Additionally, ovulation predictor kits do not confirm that ovulation has occurred; they only predict when it is likely to happen.

Ovulation predictor kits are valuable tools for women who want to monitor their menstrual cycles and identify their most fertile days. When used correctly and in conjunction with other methods of fertility tracking, they can help improve the chances of conception for couples trying to get pregnant.

Reference

1. Munroe WP. Home diagnostic kits. Am Pharm. 1994;NS34:50-59.
2. Lee C, Hart LL. Accuracy of home pregnancy tests. Ann Pharmacother. 1990; 24:712-713.
3. Jeng LL, Moore RM, Kaczmarek RG, Placek PJ, Bright RA. How frequently are home pregnancy tests used? results from the 1988 National Maternal and In- fant Health Survey. Birth. 1991;18:11-13.
4. Coons SJ. A look at the purchase and use of home pregnancy test kits. Am Pharm. 1989;NS29:46-48.

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Total Parenteral Nutrition (TPN), also known as total nutrient admixture (TNA), is a method of feeding individuals who are unable to obtain adequate nutrition through oral intake or enteral feeding (feeding through the gastrointestinal tract). TPN provides all the necessary nutrients a person needs directly into the bloodstream through a central venous catheter.

Total Parenteral Nutrition and IV admixtures and their compatibility issues may be short-term or long-term nutritional therapy, and may be administered on acute medical floors as well as in critical care areas. The caloric requirements of each patient are individualized according to the degree of stress, organ failure, and percentage of ideal body weight. TPN is used with patients who cannot orally ingest or digest nutrition (Triantafillidis & Papalois, 2014).

TPN may be administered as peripheral parenteral nutrition (PPN) or via a central line, depending on the components and osmolality. Central veins are usually the veins of choice because there is less risk of thrombophlebitis and vessel damage (Chowdary & Reddy, 2010). According to Chowdary & Reddy (2010), candidates for TPN are:

1. Patients with paralyzed or nonfunctional GI tract, or conditions that require bowel rest, such as small bowel obstruction, ulcerative colitis, or pancreatitis.
2. Patients who have had nothing by mouth (NPO) for seven days or longer.
3. Babies with an immature gastrointestinal system or congenital malformations.
4. Patients with chronic or extreme malnutrition, or chronic diarrhea or vomiting with a need for surgery or chemotherapy.
5. Patients in hyperbolic states, such as burns, sepsis, or trauma.

Here’s how TPN works:

1. Assessment: TPN is typically prescribed for patients who cannot tolerate oral or enteral feeding due to conditions such as gastrointestinal disorders, bowel obstruction, severe malabsorption, or after certain surgeries where the gastrointestinal tract needs to rest and heal.
2. Formulation: A healthcare provider, often a registered dietitian or a specialized nutrition support team, formulates the TPN solution based on the individual’s specific nutrient needs. The solution contains a balanced mixture of carbohydrates, proteins, fats, vitamins, minerals, and electrolytes tailored to the patient’s requirements.
3. Administration: The TPN solution is prepared under sterile conditions in a compounding pharmacy or hospital pharmacy. It is then infused into a large central vein, such as the superior vena cava or the jugular vein, using a central venous catheter. This catheter is usually inserted into a major vein in the chest or neck under sterile conditions.
4. Monitoring and Adjustments: Patients receiving TPN require close monitoring of their nutritional status, electrolyte levels, blood glucose levels, and liver function tests. Adjustments to the TPN formula may be made based on the patient’s clinical condition, nutritional status, and laboratory results.
5. Potential Complications: While TPN can be life-saving for patients who cannot tolerate oral or enteral feeding, it is not without risks. Complications of TPN can include infections at the catheter site, bloodstream infections (sepsis), electrolyte imbalances, liver dysfunction, and metabolic complications such as hyperglycemia or hypoglycemia.
6. Transition to Enteral Feeding: Whenever possible, healthcare providers aim to transition patients from TPN to enteral feeding as the gastrointestinal tract heals or becomes functional again. Enteral feeding is preferred over TPN because it helps maintain the integrity of the gastrointestinal mucosa and reduces the risk of infection and other complications associated with TPN.

TPN is a valuable therapeutic option for patients who cannot obtain adequate nutrition through oral or enteral routes, but it requires careful monitoring and management to optimize patient outcomes and minimize complications.

TPN is not compatible with any other type of IV solution or medication and must be administered by itself. TPN must be administered using an EID (IV pump), and requires special IV filter tubing for the amino acids and lipid emulsion to reduce the risk of particles entering the patient. Agency policy may allow amino acids and lipid emulsions to be infused together above the filters. TPN tubing will not have any access ports and must be changed according to agency policy. Always review agency policy on setup and equipment required to infuse TPN.

Mechanism of Action TPN

TPN is a mixture of separate components which contain lipid emulsions, dextrose, amino acids, vitamins, electrolytes, minerals, and trace elements. Clinicians should adjust TPN composition to fulfill individual patients’ needs. The main three macronutrients are lipids emulsions, proteins, and dextrose.

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The mechanism of action of Total Parenteral Nutrition (TPN) involves bypassing the gastrointestinal tract and delivering all essential nutrients directly into the bloodstream. Here’s a breakdown of how TPN works:

1. Nutrient Delivery: TPN delivers a balanced mixture of macronutrients (carbohydrates, proteins, fats) and micronutrients (vitamins, minerals, electrolytes) directly into the bloodstream. This bypasses the need for digestion and absorption in the gastrointestinal tract.
2. Central Venous Access: TPN solutions are administered through a central venous catheter, which is usually placed into a major vein such as the superior vena cava or the jugular vein. This central access allows for rapid dilution and distribution of nutrients throughout the body.
3. Cellular Uptake: Once in the bloodstream, nutrients from the TPN solution are transported to cells and tissues throughout the body. Cells take up nutrients through various transport mechanisms to support metabolic processes, growth, and repair.
4. Energy Production: Carbohydrates from the TPN solution serve as the primary energy source for cells. They are metabolized through glycolysis and the citric acid cycle to produce ATP, the cellular energy currency.
5. Protein Synthesis and Tissue Repair: Amino acids from the TPN solution are used for protein synthesis, which is essential for tissue repair, muscle function, enzyme production, and immune function.
6. Fat Metabolism: Lipids (fats) in the TPN solution provide essential fatty acids and serve as a concentrated energy source. They are metabolized to produce ATP and are also important for cell membrane structure and function.
7. Vitamin and Mineral Support: Micronutrients such as vitamins and minerals in the TPN solution are essential for various metabolic pathways, enzymatic reactions, and overall health. They support functions such as antioxidant defense, bone health, and nerve transmission.
8. Fluid and Electrolyte Balance: TPN solutions are formulated to maintain fluid and electrolyte balance in the body. Electrolytes such as sodium, potassium, chloride, calcium, and magnesium are included in the solution to support cellular function, nerve conduction, and muscle contraction.
9. Metabolic Regulation: TPN solutions are tailored to the individual patient’s needs based on their clinical condition, nutritional status, and metabolic requirements. Close monitoring of blood glucose levels, electrolytes, and other metabolic parameters is essential to prevent complications such as hyperglycemia, electrolyte imbalances, and liver dysfunction.

Administration of TPN

The administration of Total Parenteral Nutrition (TPN) involves several key steps to ensure safe and effective delivery of nutrients directly into the bloodstream. Here’s an overview of how TPN is administered:

1. Patient Assessment: Before initiating TPN, a comprehensive assessment of the patient’s nutritional status, medical history, underlying condition, and metabolic requirements is conducted. This helps healthcare providers determine the appropriate composition and dosage of the TPN solution.
2. Formulation of TPN Solution: A specialized nutrition support team, which may include dietitians, pharmacists, and physicians, formulates the TPN solution based on the patient’s individual needs. The solution is customized to provide the appropriate balance of carbohydrates, proteins, fats, vitamins, minerals, and electrolytes.
3. Central Venous Access: TPN is administered through a central venous catheter, which is typically inserted into a large central vein such as the superior vena cava or the jugular vein. Central venous access allows for the rapid and efficient delivery of the TPN solution into the bloodstream.
4. Sterile Technique: The insertion of the central venous catheter and the preparation and administration of the TPN solution require strict adherence to sterile technique to minimize the risk of infection.
5. Compounding of TPN Solution: The TPN solution is compounded under sterile conditions in a pharmacy or a specialized compounding facility. The components of the solution are carefully measured and mixed according to the prescribed formula.
6. Monitoring and Adjustment: Patients receiving TPN require close monitoring of their nutritional status, fluid balance, electrolyte levels, blood glucose levels, and liver function. The TPN solution may be adjusted based on the patient’s clinical condition, laboratory results, and metabolic requirements.
7. Infusion Pump: The TPN solution is infused continuously or intermittently using an infusion pump. The infusion rate is carefully controlled to ensure a steady flow of nutrients into the bloodstream over the prescribed duration.
8. Regular Assessments: Healthcare providers regularly assess the patient’s response to TPN, including monitoring for signs of complications such as infection, metabolic abnormalities, or catheter-related problems.
9. Transition to Enteral Nutrition: Whenever possible, healthcare providers aim to transition patients from TPN to enteral nutrition (feeding through the gastrointestinal tract) as soon as their gastrointestinal function allows. Enteral nutrition is preferred over TPN because it helps maintain the integrity of the gastrointestinal mucosa and reduces the risk of complications associated with TPN.

Total Parenteral Nutrition (TPN) and IV admixtures compatibility issues are crucial considerations in clinical practice to prevent adverse reactions and maintain patient safety. Here’s an overview of both TPN and IV admixtures compatibility issues:

Total Parenteral Nutrition (TPN):

1. Chemical Incompatibilities: TPN solutions contain a complex mixture of nutrients, electrolytes, and other components. Chemical incompatibilities can occur when certain components in the TPN solution interact with each other, leading to precipitation, degradation, or alteration of the solution’s composition.
2. Physical Incompatibilities: Physical incompatibilities involve changes in the appearance, color, or clarity of the TPN solution, which may indicate the formation of precipitates or other undesirable changes. Physical incompatibilities can result from interactions between different components of the TPN solution.
3. Electrolyte Imbalance: TPN solutions contain electrolytes such as sodium, potassium, calcium, and magnesium. Imbalances in electrolyte concentrations can occur if the TPN solution is not formulated or administered correctly, leading to adverse effects such as hyperkalemia or hypokalemia.
4. Microbial Contamination: TPN solutions are at risk of microbial contamination during compounding, handling, or administration. Proper aseptic technique and sterile compounding procedures are essential to minimize the risk of contamination and prevent infections in patients receiving TPN.
5. Compatibility with Medications: Some medications may be incompatible with TPN solutions due to chemical or physical interactions. Compatibility testing should be performed to ensure that medications added to the TPN solution do not compromise its stability or efficacy.

IV Admixtures:

1. Drug-Drug Interactions: When multiple medications are administered intravenously as part of an IV admixture, drug-drug interactions can occur. These interactions may alter the pharmacokinetics or pharmacodynamics of the medications, leading to reduced efficacy or increased risk of adverse effects.
2. Chemical Incompatibilities: Chemical incompatibilities between medications in an IV admixture can result in precipitation, degradation, or other changes that compromise the stability and safety of the solution. Certain medications are known to be incompatible with each other and should not be mixed in the same IV infusion.
3. Physical Compatibility: Physical compatibility refers to the ability of medications to remain stable and homogeneous when mixed together in an IV admixture. Physical incompatibilities can manifest as changes in color, clarity, or pH of the solution, indicating potential problems with stability or compatibility.
4. Administration Considerations: IV admixtures should be prepared and administered according to established guidelines and best practices to minimize the risk of compatibility issues and ensure patient safety. Proper labeling, storage, and administration procedures are essential to prevent errors and adverse reactions.
5. Compatibility Testing: Compatibility testing should be performed whenever medications are mixed together in an IV admixture to assess the stability and compatibility of the solution. Compatibility testing may involve visual inspection, pH measurement, and other analytical techniques to identify potential issues before administration.

In summary, both TPN and IV admixtures compatibility issues require careful attention to ensure the safety and effectiveness of intravenous therapy in clinical practice. Healthcare providers should be knowledgeable about the principles of compatibility testing and take appropriate precautions to minimize the risk of adverse reactions and complications associated with TPN and IV admixtures.

References

1. Braunschweig C, Liang H, Sheean P. Indications for administration of parenteral nutrition in adults. Nutr Clin Pract. 2004 Jun;19(3):255-62. [PubMed]
2. Chowdary KV, Reddy PN. Parenteral nutrition: Revisited. Indian J Anaesth. 2010 Mar;54(2):95-103. [PMC free article] [PubMed]3.
3. Weimann A, Ebener Ch, Holland-Cunz S, Jauch KW, Hausser L, Kemen M, Kraehenbuehl L, Kuse ER, Laengle F., Working group for developing the guidelines for parenteral nutrition of The German Association for Nutritional Medicine. Surgery and transplantation – Guidelines on Parenteral Nutrition, Chapter 18. Ger Med Sci. 2009 Nov 18;7:Doc10. [PMC free article] [PubMed]4.
4. Messing B. [Parenteral nutrition: indications and techniques]. Ann Med Interne (Paris). 2000 Dec;151(8):652-8. [PubMed]5.
5. Maudar KK. TOTAL PARENTERAL NUTRITION. Med J Armed Forces India. 1995 Apr;51(2):122-126. [PMC free article] [PubMed]

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An Electronic Health Record (EHR) is a digital version of a patient’s medical history. It is a
longitudinal record of patient health information generated by one or several encounters in any healthcare providing setting. The term is often used interchangeably with EMR (Electronic Medical Record) and CPR (Computer-based Patient Record). It encompasses a full range of data relevant to a patient’s care such as demographics, problems, medications, physician’s observations, vital signs, medical history, immunizations, laboratory data, radiology reports, personal statistics, progress notes, and billing data.

An EHR system integrates data for different purposes. It enables the administrator to utilize the data for billing purposes, the physician to analyze patient diagnostics information and treatment effectiveness, the nurse to report adverse conditions, and the researcher to discover new knowledge.

EHR has several advantages over paper-based systems. Storage and retrieval of data is obviously more efficient using EHRs. It helps to improve quality and convenience of patient care, increase patient participation in the healthcare process, improve accuracy of diagnoses and health outcomes, and improve care coordination. It also reduces cost by eliminating the need for paper and other storage media. It provides the opportunity for research in different disciplines. In 2011, 54% of physicians had adopted an EHR system, and about three-quarters of adopters reported that using an EHR system resulted in enhanced patient care.

History of EHR

The first known medical record can be traced back to the fifth century B.C. when Hippocrates
prescribed two goals for medical records.

1. A medical record should accurately reflect the course of disease.
2. A medical record should indicate the probable cause of disease.

Modern EHR can provide additional functionalities that could not be performed using paper-based systems. Modern-day EHR first began to appear in the 1960s. Early EHRs were developed due to physicians’ concerns about the increasing complexity and size of medical data. Data retrieval was much faster using digital format. In 1967, Latter Day Saints Hospitals in Utah started using Health Evaluation through Logical Programming (HELP) software. HELP is notable for its pioneering logical decision support features. In 1969, Harvard Medical School developed its own software Computer Stored Ambulatory Record (COASTER) and Duke University began to develop The Medical Record (TMR).

In 1970, Lockheed unveiled the Technicon Medical Information Management System/ Technicon Data System (TDS). It was implemented at El Camion Hospital in California. It came with a groundbreaking Computer Provided Order Entry (CPOE) system. In 1979, Judith Faulkner, a computer programmer established Human Services Computing Inc., which developed the Chronicles data repository. The company later became Epic Systems. It was initially based on a single longitudinal patient record and designed to handle enterprise-wide data from inpatient, ambulatory, and payer environments.

In 1985, The Department of Veterans Affairs launched the automated data processing system, Decentralized Hospital Computer Program (DHCP), which includes extensive clinical and administrative capabilities within its medical facilities. It received the Smithsonian Award for best use of Information Technology in Medicine in 1995. The current variant of DHCP is VistA (Veterans Health Information Systems and Technology Architecture). By providing care to over 8 million veterans operating in 163 hospitals, 800 clinics, and 135 nursing homes, VistA manages one of the largest medical system in the United States.

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From 2000 and beyond, EHR software has been increasingly trying to incorporate other functionalities to become an interactive companion for physicians and professionals. In January 2004, President George W. Bush launched an initiative for the widespread adaptation of EHRs within the next 10 years. He said in his State of the Union Address, “By computerizing health records, we can avoid dangerous medical mistakes, reduce costs, and improve care”.

Components of EHR

The main purpose of EHR is to support clinical care and billing. This also includes other functionalities, such as improving the quality and convenience of patient care, improving the accuracy of diagnoses and health outcomes, improving care coordination and patient participation, improving cost savings, and finally, improving the general health of the population. Most modern EHR systems are designed to integrate data from different components such as administrative, nursing, pharmacy, laboratory, radiology, and physician’ entries, etc.

Electronic records may be generated from any department. Hospitals and clinics may have a number of different ancillary system providers; in that case, these systems are not necessarily integrated to the main EHR system. It is possible that these systems are stand-alone, and different standards of vocabularies have been used. If appropriate interfaces are provided, data from these systems can be incorporated in a consolidated fashion; otherwise a clinician has to open and log into a series of applications to get the complete patient record.

Administrative System Components

Administrative data such as patient registration, admission, discharge, and transfer data are key components of the EHR. It also includes name, demographics, employer history, chief compliant, patient disposition, etc., along with the patient billing information. Social history data such as marital status, home environment, daily routine, dietary patterns, sleep patterns, exercise patterns, tobacco use, alcohol use, drug use and family history data such as personal health history, hereditary diseases, father, mother and sibling(s) health status, age, and cause of death can also be a part of it.

During the registration process, a patient is generally assigned a unique identification key comprising of a numeric or alphanumeric sequence. This key helps to link all the components across different platforms. For example, lab test data can create an electronic record and another record is created from radiology results. Both records will have the same identifier key to represent a single patient. Records of a previous encounter are also pulled up using this key. It is often referred to as the medical record number or master patient index (MPI). Administrative data allows the aggregation of a person’s health information for clinical analysis and research.

Radiology System Components

In hospital radiology departments, radiology information systems (RIS) are used for managing
medical imagery and associated data. RIS is the core database to store, manipulate, and distribute patient radiological data. It uses Current Procedural Terminology (CPT) or International Classification of Diseases (ICD) coding systems to identify procedures and resources. An RIS can generate an entire patient’s imagery history and statistical reports for patients or procedures. Although many hospitals are using RIS, it may or may not be integrated with the central EHR system.

Pharmacy System Components

In hospitals and clinics, the pharmacy department’s responsibility is to maintain the inventory,
prescription management, billing, and dispensing medications. The pharmacy component in EHR will hold the complete medication history of a patient such as drug name, dosage, route, quantity, frequency, start and stop date, prescribed by, allergic reaction to medications, source of medication, etc. Pharmacists serve an important public health role by administering immunizations and must have the capabilities to document these services and share this information with other healthcare providers and public health organizations.

They assure safe and effective medication and supporting patient-centered care. Pharmacies are highly automated in large hospitals. Again, it may be independent of central EHRs. The Food and Drug Administration (FDA) requires all the drugs to be registered and reported using a National Drug Code (NDC). Coding systems used are NDC, SNOMED, and RxNorm.

Clinical Documentation

A clinical document contains the information related to the care and services provided to the
patient. It increases the value of EHR by allowing electronic capture of clinical reports, patient
assessments, and progress reports. A clinical document may include.

1. Physician, nurse, and other clinician notes
2. Relevant dates and times associated with the document
3. The performers of the care described
4. Flow sheets (vital signs, input and output, and problems lists)
5. Perioperative notes
6. Discharge summaries
7. Transcription document management
8. Medical records abstracts
9. Advance directives or living wills
10. Durable powers or attorney for healthcare decisions
11. Consents (procedural)
12. Medical record/chart tracking
13. Release of information (including authorizations)
14. Staff credentialing/staff qualification and appointments documentations
15. Chart deficiency tracking
16. Utilization management
17. The intended recipient of the information and the time the document was written
18. The sources of information contained within the document

Clinical documents are important because documentation is critical for patient care, serves as a legal document, quality reviews, and validates the patient care provided. Well-documented medical records reduce the re-work of claims processing, compliance with CMS (Centers for Medicare and Medicaid Services), Tricare and other payer’s regulations and guidelines, and finally impacts coding, billing, and reimbursement. A clinical document is intended for better communication with the providers.

It helps physicians to demonstrate accountability and may ensure quality care provided to the patient. A clinical document needs to be patient centered, accurate, complete, concise, and timely to serve these purposes.

Conclusions

Electronic health records are the obvious and inevitable future of patient care in hospitals and medical practices. This chapter discusses several aspects of the EHRs. EHR systems are gaining nationwide popularity in the United States recently due to “Meaningful use legislation and reimbursement. It is being widely installed in hospitals, academic medical centers,” and outpatient clinics throughout the nation. Besides healthcare benefits like improved patient care, safety and reduced costs, it creates great opportunity for clinical and translational research.

Widespread adoption of EHRs can foster the improvement of quality in healthcare services, safety and efficiency, and most importantly, public health. Having great potential for benefits, successful deployment of EHRs has several challenges to overcome. There are notable limitations of the use of EHR data in research purposes. In the era of technology, the necessary laws lag far behind. While other developed countries have showed widespread adoption, in the United States, the overall adoption is considerably low. Bigger Government initiatives and enhanced standardization today can lead to a brighter healthcare tomorrow.

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