Intravenous Admixture Services Research Articles

Intelligent supervision of PIVAS drug dispensing based on image recognition technology.

Pharmacy Intravenous Admixture Services (PIVAS) are places dedicated to the centralized dispensing of intravenous drugs, usually managed and operated by professional pharmacists and pharmacy technicians, and are an integral part of modern healthcare. However, the workflow of PIVAS has some problems, such as low efficiency and error-prone. This study aims to improve the efficiency of drug dispensing, reduce the rate of manual misjudgment, and minimize drug errors by conducting an in-depth study of the entire workflow of PIVAS and applying image recognition technology to the drug checking and dispensing process. Firstly, through experimental comparison, a target detection model suitable for drug category recognition is selected in the drug-checking process of PIVAS, and it is improved to improve the recognition accuracy and speed of intravenous drug categories. Secondly, a corner detection model for drug dosage recognition was studied in the drug dispensing stage to further increase drug dispensing accuracy. Then the PIVAS drug category recognition system and PIVAS drug dosage recognition system were designed and implemented.

Development of regional pharmacy intravenous admixture services data reporting and analysis platform for enhanced quality control ability

BackgroundPharmacy intravenous admixture service (PIVAS) center has emerged as an important department of hospitals as it can improve occupational protection and ensure the safety and effectiveness of intravenous infusions. However, there is little research on the standardized capability and risk evaluation of PIVAS by using modern information technology. In this research, we established Regional Pharmacy Intravenous Admixture Services Data Reporting and Analysis Platform (RPDRAP) to improve quality control ability for PIVAS management. RPDRAP including evaluation matrix for quality control monitoring. The construction of platform is based on guidelines for the Construction and Management of PIVAS and management specifications of PIVAS in China.MethodsRPDRAP was established in 2018. This platform comprises a data collection system and a data analysis system. The data collection system consists of 67 data items. Data collection relied on online platforms through data acquisition module. The collected data were analyzed using a model with 20 indicators within the data analysis system. Fifteen hospitals, public comprehensive healthcare facilities with more than 500 beds, participated in the platform’s application evaluation.ResultsThe study revealed significant differences in PIVAS total score, supervisors, and workload between 2020 and 2022. The platform’s application results demonstrated improvements in personnel management, work efficiency, and infection control within these PIVAS. Although statistical significance was observed in only 8 out of the 25 items, most of the scores showed an increase, with a small portion remaining unchanged and no decline in scores.ConclusionsThis platform can be recommended for PIVAS homogeneous and regional efficient management. The use of this platform not only improves the quality control ability of PIVAS but also enables the management department to quickly grasp the current situation and characteristics of each PIVAS through standardized data collection and analysis.

Statistical analysis of the storage time of finished product infusion.

This retrospective study determined the storage time of finished infusion in each hospital ward and assessed whether the storage time of finished infusion was within an acceptable range. The research object was the finished infusion (one bag of infusion with only one drug) that is centrally dosed at the Pharmacy Intravenous Admixture Service (PIVAS) of Jiading District Central Hospital Affiliated Shanghai University of Medicine & Health Sciences. We used an automatic scanner to assess the placement time of finished infusion products in various wards of the hospital. We classified the drugs used in various wards, analyzed whether their placement times were reasonable, assessed the reasons for unreasonable placement times, and took intervention measures. Similarly, the storage time of finished infusion was deemed reasonable or unreasonable, the reasons for unreasonable storage times were analyzed, and intervention measures were taken. In September 2021, the proportion of infusions stored for an unreasonable time was 12.69%, a decrease of 5.37% compared with August 2021, indicating the effectiveness of intervention measures. By using statistical analysis and intervention measures, our PIVAS improved the standardized use of finished infusion products and ensured the safety of medication for patients.

Practice of quality control circle activities to reduce the errors in rechecking of finished drug products in pharmacy intravenous admixture service

Practice of quality control circle activities to reduce the errors in rechecking of finished drug products in pharmacy intravenous admixture service

Investigation on status and needs of pharmacy intravenous admixture service (PIVAS) personnel training: A qualitative focus group interview study.

This study aimed to investigate the status and the needs of personnel training in pharmacy intravenous admixture service (PIVAS) and provide a reference for the comprehensive training of pharmacists in PIVAS in China. A total of 21 pharmacists from PIVAS of West China Hospital, Sichuan University and West China Second University Hospital, Sichuan University were selected by purposive sampling to conduct 3 rounds of focus group interviews, and the Colaizzi phenomenological method was used for qualitative analysis. The personnel training in PIVAS is mainly on practical skills for daily work but rarely on comprehensive quality, adopting centralized lectures and regular assessment while lacking in individualized training. The needs of staff focus on career development, which was settled through improving comprehensive ability in training, especially scientific research ability, for solving problems in daily work and obtaining corresponding outputs. PIVAS personnel training should pay more attention to comprehensive quality and scientific research ability, and establish an individualized, refined, and specialized training system to meet the needs of talent development and improve the quality of pharmacy services.

Real-world study of the leakage of two types of infusion bags in multicenter pharmacy intravenous admixture service (PIVAS).

Background: This study sought to analyze the leakage rate, economic loss caused by leakage, leakage reasons, and usage of upright polypropylene infusion bags and non-polyvinyl chloride (PVC) infusion bags, two types of closed intravenous infusion containers used in pharmacy intravenous admixture service (PIVAS), to improve the product quality of drug infusion packaging materials, reduce drug and clinical economic losses, and reduce the safety hazards of medication. Method: A real-world study was used to collect statistics for these infusion containers. The study was conducted in 21 hospitals in China from September to December 2022. Upright polypropylene infusion bags or non-PVC infusion bags in PIVAS of these 21 hospitals were chosen as the research material. Results: In total, 2,349,899 upright polypropylene infusion bags and 3,301,722 non-PVC infusion bags were collected. Eleven cases of upright polypropylene infusion bag leakage occurred (with a the leakage rate of 0.05‱), and 394 cases of non-PVC infusion bag leakage occurred (with a leakage rate of 1.19‱). The leakage rate of non-PVC infusion bags was significantly higher than that of upright polypropylene infusion bags (p < 0.01). The main reason for leakage in upright polypropylene infusion bags was sharp objects such as glass fragments or aluminum caps piercing the bag. The main reason for leakage in non-PVC infusion bags was squeezing, stacking, and uneven arrangement that causes folding of edges. For non-PVC bags, additional reasons for leakage included leakage at the nozzle joint, excessive manual or machine throwing force, and excessive dosage. The economic loss of upright polypropylene infusion bags was 1,116.56 CNY. The economic loss of non-PVC infusion bags was 32,210.86 CNY. Conclusion: Based on real-world study data on the leakage of upright polypropylene infusion bags and non-PVC infusion bags in multicenter PIVAS, it can be concluded that the leakage rates of upright polypropylene infusion bags are significantly lower than those of non-PVC infusion bags in PIVAS, and the economic losses due to upright polypropylene infusion bags are lower than those due to non-PVC infusion bags in PIVAS. Therefore, we can infer that upright polypropylene infusion bags are superior to non-PVC infusion bags.

Investigation of the status of depression and anxiety among leaders and staff in pharmacy intravenous admixture services in China.

We aimed to investigate the status of depression and anxiety among leaders and staff in pharmacy intravenous admixture services (PIVAS) and analyze influencing factors to provide a reference for improving their mental health status. This study involved a multi-center cross-sectional survey. PIVAS leaders and staff from across China were invited to participate. The Generalized Anxiety Disorder-7 and 9-item Patient Health Questionnaire were used to measure the status of anxiety and depression. A multiple linear regression model was used to analyze influencing factors. In total, 137 PIVAS leaders and 501 staff were included in this study. The results showed that 43.8% (60/137) of the leaders had anxiety and 38.7% (53/137) had depression. Among staff, 47.3% (237/501) had anxiety and 46.5% (233/501) had depression. Multiple linear regression showed that for PIVAS leaders, the degree of recognition by doctors was associated with anxiety scores, whereas PIVAS charge standard, PIVAS profit and loss situation, and the degree of recognition by doctors were associated with depression scores. For PIVAS staff, satisfaction with working in PIVAS was associated with anxiety scores, and job title, working hours per day, and satisfaction with working in PIVAS were associated with depression scores. Depression and anxiety are common among PIVAS leaders and staff working in hospitals in China. Hospitals should implement measures to improve the mental health of PIVAS leaders and staff.

Combining the Real-Time Vial Sharing Strategy with Daily-Rate Charge Mode for Antimicrobial Drugs of Inpatients: An Economical and Practical Method for Patients and Hospitals.

Antimicrobial agents' wastage is a huge problem, especially for pediatric patients, resulting in excessive drug expenditure and increasing the economic burden on patients' families. Moreover, the cost of disposing of antimicrobial agents' waste and the risk of environmental and occupational exposure also increased. This study aimed to explore the cost-effectiveness of the vial-sharing strategy combined with the daily-rate charge mode for pediatric inpatients to provide a strategy for reducing patients' expenditures, saving medical costs, and reducing drug proportion. This retrospective study was conducted at Pharmacy Intravenous Admixture Service (PIVAS), Shenzhen Children's Hospital, Guangdong Province, China, in 2022. Data on prescription drugs were collected from the PIVAS system. Ten antimicrobial drugs with a frequency of prescriptions no less than twice once daily were selected, and the drug costs, drug weight, and drug saved were further analyzed according to the combination of real-time vial sharing strategy and daily-rate charge mode. Traditional single vial charge mode without vial sharing was set as a control strategy. The actual expenditure of the hospital was also calculated and analyzed. During 2022, ¥ 4,122,099 (34.4%) was saved for inpatients by applying a vial-sharing strategy on ten antibacterial agents, and more than 46,343,750 mg (24.6%) of drugs were totally saved. The top 5 drugs saved by the real-time vial-sharing strategy were cefoperazone-sulbactam, vancomycin, amoxicillin-sulbactam, ceftazidime, and meropenem. Taken the price into consideration, the top five payment-saved drugs were vancomycin (¥ 1,522,385), meropenem (¥ 1,311,475), cefoperazone-sulbactam (¥ 736,697), imipenem-cilastatin (¥ 406,092), and amoxicillin-sulbactam (¥ 51,394). Moreover, the account balance of the hospital was up to ¥ 426,499. The real-time vial sharing strategy combined with the daily-rate charge mode greatly reduces drug wastage and patients' payments. It may be useful for hospitals with PIVAS to achieve vial-sharing while protecting the best interest of inpatients.

Long-term physicochemical stability of 5-fluorouracil at selected standardised rounded doses in polyolefin bags.

Chemotherapy doses are usually prescribed on the basis of body surface area but dose banding is emerging as an efficient alternative. Dose banding presents the possibility of in-advance preparation in a Centralized Intravenous Admixture Service. To evaluate the long-term stability of 5-fluorouracil at banded doses (700 mg and 800 mg) in polyolefin bags. Ten polyolefin bags were prepared under aseptic conditions and stored at 23 ± 2°C for 24 days. Five of them were composed of 14 mL 5-fluorocuracil (700 g) in 100 mL 0.9% sodium chloride solution and the five other of 16 mL 5-fluorouracil (800 mg) in 100 mL 0.9% sodium chloride solution. At defined times, physical stability parameters were assessed: optical densities, pH measurements, visual and microscopical inspections. Solutions concentrations were measured using high-performance liquid chromatography coupled with a photodiode array detector. No change was observed on pH and optical density measurements during the study period. Visual and microscopical inspections remained free of colour change, precipitate, microagregate or crystal. The concentrations of 5-Fluorouracil in 800 mg bags remained stable for 24 days while the concentration in 700 mg bags showed a stability of at least 17 days. Five-fluorouracil at banded doses of 700 and 800 mg in polyolefin bags is physicochemically stable for at least 17 days at 23 ± 2°C. These results support the possibility of in advance centralised preparation.

Studies on the optimization of decontamination protocol for surfaces contaminated with cytotoxic drugs in PIVAS.

The goal of this study was to create a cleaning procedure by comparing the performance of six different cleaning methods on the surfaces in pharmacy intravenous admixture service (PIVAS) work area. A stainless steel plate was simulating contaminated by gemcitabine, cyclophosphamide, epirubicin, etoposide, and paclitaxel, which was then dried and cleaned by per current cleaning protocols. The residues were collected and quantified by ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS). Based on the most appropriate cleaning protocol, three cleaning variables were optimized: (1) use of dry gauze after cleaning agent application; (2) cleaning paths (inside-out vs. outside-in); (3) cleaning times (once or twice). Best conditions were tested with real samples from a hospital PIVAS. This 10-2 M sodium dodecyl sulfate (SDS) and dry gauze cleaning protocol increases cleaning efficiency as well as saves time. Different from the traditional cleaning manner, we found that cleaning from outside to inside can not only improve the cleaning efficiency but also overcome the uneven distribution of drug residues caused by cleaning action. When simulating contamination at a high dose (4 mg/mL) level, it was found that the decontamination efficacy increased with repeating one more time. The 10-2 M SDS and dry gauze cleaning protocol could obtain the best cleaning effect. The success of cytotoxic drug decontamination is determined not only by the cleaning solution, but also by the cleaning route and frequency. Compared with the traditional cleaning manner, there was a significant reduction in the contamination levels in the PIVAS work area after the cleaning protocol with 10-2 M SDS and dry gauze.

Application of information-intelligence technologies in pharmacy intravenous admixture services in a Chinese third-class a hospital

BackgroundPharmacy intravenous admixture service (PIVAS) center has emerged as an important department of hospital as it can improve occupational protection and ensure the safety and effectiveness of intravenous infusions. However, medication errors were considered to be a significant challenge in PIVAS, so information-intelligence technologies were introduced to optimize the management of PIVAS. Our article summarized the application of information-intelligence technologies in PIVAS of a large third-class A hospital in China, and provided an example for PIVAS in other hospitals at home and abroad.MethodsPrescription-reviewing rules containing intravenous medications and infusion solution guideline were recorded in the database of prescription-cheking system. Drugs information were recorded in the PIVAS management system with special identification and warning labels to reduce intravenous infusion errors. Automatic labeling device was used to label the infusion bags, and the quality control program database of intelligent compounding robot for cytotoxic drugs was established ingeniously. Automatic sorting devices were applied for the third batch of finished infusion admixtures, and intelligent logistics robots were used to transport the infusion to the ward.ResultsAfter establishing and implementing of prescription-reviewing rules in the prescription-cheking system database, the number of prescriptions checked by pharmacists increased from 18 to 43 per minute. The success rate of intervention with irrational medical orders increased from 85.89% to 99.06% (P < 0.05). By introducing various intelligent devices, automatic labeling significantly enhanced work efficiency and reduced the error rate (P < 0.001). Furthermore, the use of intelligent intravenous compounding robots significantly reduced the risk of errors (P < 0.001).ConclusionsThe application of information-intelligence technologies in PIVAS can improve work efficiency and reduce error risk. However, some intelligent devices have failed to achieve the expected effect in practical use, and further improvements are needed to meet the demands of PIVAS in the future.

Cost analysis of implementing a vial-sharing strategy for chemotherapy drugs using intelligent dispensing robots in a tertiary Chinese hospital in Sichuan.

IntroductionChemotherapy drug wasting is a huge problem in oncology that not only results in excessive expenses on chemotherapy drugs but also increases the cost of disposing of chemotherapy waste and the risk of occupational exposure in the environment. The main objective of this study was to evaluate the potential for hospitals in China to employ a real-time vial-sharing strategy that can save drug costs.MethodThis study was conducted retrospectively at Pharmacy Intravenous Admixture Services (PIVAS), People's Hospital of Sichuan Province, China, from September to November 2021. Data on prescription drugs wasted were collected from the Hospital Information System (HIS). To assess the real-time vial-sharing strategy, we estimated drug wastage and drug waste costs using intelligent robots that dispense multiple prescriptions simultaneously.Results24 of the 46 wasted drugs were cost-saved. The vial-sharing strategy saved 186,067 mg of drugs, or ~59.08% of the total amount wasted, resulting in savings of 150,073.53 China Yuan (CNY), or 47.51% of the cost of the total waste.ConclusionOur investigation established that employing a real-time vial-sharing strategy using an intelligent robot to dispense multiple prescriptions simultaneously is cost-effective. Additionally, this approach presented no safety issue concerns, such as the introduction of impurities to sterile compounding via repeated interspersing or the incorrect registration of information during drug storage, often encountered with traditional vial-sharing strategies.

Effect of a Pharmacy-based Centralized Intravenous Admixture Service on the Prevalence of Medication Errors: A Before-and-After Study.

Intravenous admixture preparation errors (IAPEs) may lead to patient harm. The primary aim of this study was to assess the effect of a pharmacy-based centralized intravenous admixture service (CIVAS) on IAPEs. We conducted a before-and-after study in 3 clinical wards before CIVAS implementation and in the CIVAS unit 18 months after implementation. Intravenous admixture preparation error data were collected by disguised observation. The primary outcome was the proportion of admixtures with 1 or more IAPEs. Secondary outcomes were the type and potential severity of IAPEs, noncompliance to hygiene procedures, and nursing staff satisfaction with the CIVAS. The primary outcome was analyzed using a multivariable mixed-effects logistic regression model. One or more IAPEs were identified in 14 of 543 admixtures (2.6%) in the CIVAS unit and in 148 of 282 admixtures (52.5%) in the clinical wards (odds ratio, 0.02; 95% confidence interval, 0.004-0.05). The most common IAPE types were wrong solvent or diluent (n = 95) and wrong volume of infusion fluid (n = 45). No potentially harmful IAPEs occurred in the CIVAS unit as opposed to 22 (7.8%) in the clinical wards. Disinfection procedures were better adhered to in the CIVAS unit. Overall nurse satisfaction with the CIVAS increased from a median of 70 (n = 166) 5 months after intervention to 77 (n = 115) 18 months after intervention ( P < 0.001) on a 100-point scale. Centralized intravenous admixture service performed notably better than the clinical wards with regard to IAPEs and noncompliance to hygiene procedures. Nurses were satisfied with the CIVAS. Hence, the implementation of CIVAS is an important strategy to improve medication safety in hospitals.

Establishment and validation of analytical methods for 15 hazardous drugs by UPLC-Q/Orbitrap-HRMS

BackgroundCytotoxic drug residues in pharmacy intravenous admixture services (PIVAS) have always been a major problem for pharmaceutical workers and the PIVAS environment,which is not only pollutes the PIVAS environment, but also causes serious harm to the life and health of the staff. This study aimed to establish an ultra-high performance liquid chromatography quadrupole orbitrap high resolution mass spectrometry (UPLC-Q/Orbitrap-HRMS) method for the rapid detection and monitor of 15 cytotoxic drugs.MethodsUPLC-Q/Orbitrap-HRMS method was used to establish a rapid detection method for 15 cytotoxic drugs such as cytarabine, gemcitabine and so on. The daily precision and accuracy of this method were verified by injecting four concentrations of standard solution on the same day, and the same four concentrations of standard solution were injected within three days respectively to verify the daily precision of this method. The signal-to-noise ratio (SNR) of 10:1 was calculated as the limit of quantity. The mixed standard solution of 15 cytotoxic drugs with concentrations of 0.5, 1, 3, 10, 30, 100, 300, and 1,000 ng/mL was configured and detected by this method for linearity and range.The stability of this method was investigated using a mixture of 15 drugs (15MIX) standard solutions at high concentration (300 ng/mL) and low concentration (10 ng/mL) at room temperature for 12 and 24 hours, respectively. A standard solution of each drug, 15MIX and blank solution were taken to verify the exclusivity of the method.ResultsThe results showed that the method had good specificity, and the intraday precision of all drugs was less than 10% and the intraday precision was less than 15%. At the same time, the standard curve had good linearity, R2 was greater than 0.99, and the limit of quantification of most drugs was about 1 ng/mL.ConclusionsIn this study, an UPLC-Q/Orbitrap-HRMS method was established for the rapid detection of 15 cytotoxic drugs, providing technical support for the monitoring of cytotoxic drug residues in PIVAS, which is of great significance for environmental contamination mornitoring as well as occupational exposure alert.

The effect of auxiliary admixture equipment on the hygiene conditions and quality of Pharmacy Intravenous Admixture Services

The effect of auxiliary admixture equipment on the hygiene conditions and quality of Pharmacy Intravenous Admixture Services

Multi-center survey on the training status of staff working in pharmacy intravenous admixture services (PIVAS) in mainland China: Perspectives of PIVAS staff.

The technical level and comprehensive quality of pharmacy intravenous admixture services (PIVAS) staff are central to ensure the safety and effectiveness of intravenous infusions. However, these aspects are lacking in traditional pharmacy education. This study aimed to investigate the training status of staff working in PIVAS and explore factors that affected training status, which might contribute to the establishment of a comprehensive, standardized training system.A multi-center cross-sectional survey was conducted via a WeChat Group targeting PIVAS staff in hospitals to investigate the differences of current training status between different regions, hospital levels, genders, job titles, educational degrees, employment types, and working years.In total, 501 participants completed the questionnaires. The main contents of training for PIVAS staff included: professional theoretical knowledge (99.40%, 498/501), practical operation abilities (97.01%, 486/501), pre-job training (92.61%, 464/501), and standard operating procedures (90.22%, 452/501). The most common frequency of staff training was 1–2 times a month (51.9%, 260/501). Overall, 56.5% (283/501) of participants thought staff training was sufficient and 60.1% (301/501) of participants thought PIVAS attached importance to staff training. However, only 45.7% (229/501) of the participants were satisfied with the training modes.The contents of training for PIVAS staff in mainland China were relatively rich, but the aspects of management tools, comprehensive ability development, and career development planning tend to be relatively weak. It is necessary to develop training standards for PIVAS staff to improve employee capabilities and job satisfaction.

Investigation of the service demands of nurses on pharmacy intravenous admixture service based on the Kano model

Investigation of the service demands of nurses on pharmacy intravenous admixture service based on the Kano model

Multi-center investigation on personnel training and scientific research status of pharmacy intravenous admixture services (PIVAS) in mainland China based on the perspectives of PIVAS leaders.

We sought to analyze the current situation of personnel training and scientific research regarding pharmacy intravenous admixture services (PIVAS), to provide evidence-based medical knowledge to inform personnel training for PIVAS in mainland China.A cross-sectional survey was used to examine the current status of PIVAS personnel training, research capabilities, needs, and research output of PIVAS personnel based from the perspective of leaders in PIVAS in China. The survey period was from March to April 2019.A total of 137 hospitals in China participated in this survey. The main training content areas of PIVAS staff in each hospital were professional theoretical knowledge (100.00%, 137/137) and practical operation ability (98.54%, 135/137). The frequency of training was typically 1 to 2 times/month (56.9%, 78/137). The average duration of a single training session was typically 1 h or less (68.6%, 94/137). The most common forms of PIVAS training were lectures (94.89%, 130/137) and practical operations (79.56%, 109/137). A total of 51.8% (71/137) of PIVAS leaders believed that PIVAS personnel had a high degree of scientific research needs, but 61.3% (84/137) believed that few personnel had mastered scientific research methodology, and 41.6% (57/137) believed that the scientific research ability of personnel was relatively poor. Among PIVAS personnel, only 38.7% (53/137) had specialized scientific training. The annual total SCI output was 0 to 18 articles (median 0 articles) and the total number of national-level funding grants was 0 to 2 (median 0). There were no significant differences in the training of PIVAS personnel and scientific research between different provinces and hospital levels.The training content of PIVAS personnel in China was found to be relatively rich, but management tools, career development, and training in scientific research were found to be relatively weak, and the scientific research output was very low. It is necessary to build a comprehensive training system for career development among PIVAS personnel.

The impact of pharmacist oriented mode on risk control in a Chinese centralized intravenous admixture service centre

Centralized intravenous admixture service (CIVAS) centres, which are pharmaceutical departments found in Chinese hospitals, provide high-quality intravenous fluids and pharmaceutical services for patients, and errors in their working procedures can lead to adverse consequences. Pharmacists, the primary CIVAS centre personnel, play a role in risk control; however, to date, the effect of pharmacists’ participation in risk management has not been reported. The main aim of this study was to evaluate the pharmacist’s role in risk control and evaluate its impact. A retrospective observational study was designed to assess the principal working process in the CIVAS centre of a provincial healthcare setting. Errors in the main working process were identified, and intervention measures were formulated. The pharmacist intervention effect was evaluated by assessing the identification rate of improper prescriptions; the incidence rate of drug preparation, compounding, packaging and delivery process errors; and expenditures on wasteful drugs. There was a higher identification rate for improper prescriptions after the intervention (P < 0.05), while the incidence of drug preparation (P < 0.05), admixture (P < 0.05), and packaging and delivery errors (P < 0.01) was significantly lower; the total wasteful medication expenditure was also dramatically reduced. The potential creativity of pharmacists in error control can provide dependable intravenous drugs for patients and reduce the running expenditures for CIVAS.

Analysis of irrational medical orders after pre-review and interventions in pharmacy intravenous admixture service

Analysis of irrational medical orders after pre-review and interventions in pharmacy intravenous admixture service