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Eefeqturi hospitaluri transfuziis jgufis Seqmna da marTva

Eefeqturi hospitaluri transfuziis jgufis Seqmna da marTva. Tbilisi, saqarTvelo seqtemberi/oqtomberi 2010 Christopher J. Gresens, M.D. VP & Medical Director, Clinical Services BloodSource. transfuziis jgufi. Pprezentaciis bolos auditorias unda SeeZlos …

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Eefeqturi hospitaluri transfuziis jgufis Seqmna da marTva

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  1. EefeqturihospitaluritransfuziisjgufisSeqmnadamarTva Tbilisi, saqarTvelo seqtemberi/oqtomberi 2010 Christopher J. Gresens, M.D. VP & Medical Director, Clinical Services BloodSource

  2. transfuziis jgufi Pprezentaciis bolos auditorias unda SeeZlos … aRweros rogor unda Camoayalibos da gauwios organizeba transfuziis jgufs gansazRvros sisxlis utilizaciis yvelaze mniSvnelovani aspeqtebi, Seajamos yvelaze metad gamosayenebeli teqnika warmatebuli transfuziis jgufis implementaciisa da menejmentisTvis

  3. transfuziis jgufi –ZiriTadi msjeloba da organizacia wevroba da funqcia sisxlis centris monawileoba interesTa konfliqti sisxlis utilizacia-gadaxedva

  4. xarisxis marTva da meTodebi transfuziis gverdiTi efqtebis monitoringi roli sisxlis menejmentSi transfuziis gaidlainebi implementacia da menejmenti Eefeqturi hospitaluri transfuziis jgufis Seqmna da marTva: fokusireba … transfuziis jgufi – ZiriTadipunqtebi

  5. transfuziis jgufi –mTavari kompetencia tranfuziis jgufi: pacientis usafrTxoeba yvelaze mniSvnelovania Edited by Sunita Saxena, MD and Ira A. Shulman, MD

  6. transfuziis jgufi –I. Sefaseba da organizeba transfuziis jgufis pirveladi miznebi mogvawodos obieqturi da srulyofili Sefaseba hospitalSi sisxlis da sisxlis produtebis gamoyenebis Sesaxebda … Seqmnas rekomendaciebi trasfuziologiis yvela aspeqtebze, raTa uzrunvelyos pacientis momsaxurebis umaRlesi standartebi.

  7. transfuziis jgufi –I. Sefaseba da organizeba tipiuri transfuzia Sedgeba interdisciplinaruli procesisgan, romelic moicavs 10 safexurs: Eeqimi iRebs gadawyvetilebas transfuziis Sesaxeb. Msamedicino personali agrovebs sisxls SeTavsebadobaze. Msamedicino personali awvdis analizs ganxilvisTvis laboratorias (trasfuziaze moTxovniT).

  8. transfuziis jgufi –I. Sefaseba da organizeba transfuziis 10 etapi (gagrZeleba): Llaboratoria atarebs testirebas. Llaboratoria uzrunvelyofs sisxlis momarageba/Senaxvas. Llaboratoria arCevs da amzadebs SeTavsebad erTeulebs. samedicino personali ibarebs sisxls.

  9. transfuziis jgufi –I. Sefaseba da organizeba transfuziis 10 etapi (gagrZeleba): samedicino personali awarmoebs identifikacias, iwyebs transfuzias da atarebs monitorings. samedicino personali awarmoebs oqms moTxovnebis Sesabamisad (reaqciis SemTxvevaSi). Llaboratoria ganixilavs am informacias, atrebs kvlevas da zogierT SemTxvevaSi gamoiTxovs komponents

  10. transfuziis jgufi –I. Sefaseba da organizeba jgufis multidisciplinaruli xasiaTi: transfuziis procesis kompleqsurobis gamo, jgufis struqtura multidisciplinarulia. es xels uwyobs jgufs: uwyveti da standartuli transfuziis praqtika da … gamWirvale procesi, sadac departamentebi da eqimebi swavloben erTmaneTis Secdomebze da warmatebebze

  11. transfuziis jgufi –I. Sefaseba da organizeba muSaoba hospitalis wesdebis farglebSi Hhospitalis wesdebam unda gaiTvaliswinos jgufis Seqmnis: struqtura pasuxismgebloba SexvedraTa sixSire da … angariSis dros

  12. sxva sakiTxebi xSirad, ufrosi samedicino personali qmnis jgufs da niSnavs xelmZRvanels. Sexvedra unda Sedges im sixSiriT, rogoric saWiroa (idealuria kvrtalSi erTxel). transfuziis jgufi –I. Sefaseba da organizeba

  13. transfuziis jgufi –I. Sefaseba da organizeba Ees aris transfuziis jgufis magaliTi,romelic efeqturad aris integrirebuli hospitalis struqturaSi … bordi aRmasrulebeli komiteti xarisxis gaumjobesebis komiteti N sisxlis transfuziis nacionaluri samsaxuri (NBTS) transfuziis komiteti

  14. transfuziis jgufi –II. wevroba da funqciebi wevroba gansazRvrulia hospitalis wesdebiT, sxva damatebiTi faqtorebiT, mag hospitalis zoma da tipi; mis mier SemoTavazebuli servisebi; aqvs Tu ara mas dRis stacionarSi transfuziis programa;

  15. xelmZRvanelisarCeva jgufisxelmZRvaneliundaiyospirovneba, romelsacaqvssaTanadocodnatrasfuziologiaSi. (sasurvelia, romesariyoshospitalistransfuziissamsaxurisTanamSromeli, raTaAarmoxdesinteresTakonfliqti). transfuziis jgufi –II. wevroba da funqciebi

  16. II. wevroba da funqciebi magaliTi idealuri (Tumca TiTqmis arasdros gaTvaliswinebuli) jgufis wevrobis …

  17. transfuziis jgufi –II. wevroba da funqciebi transfuziis jgufis roli unda gascdes sisxlis utilizaciis mimoxilvas … to discuss Form 1 Pause…

  18. transfuziis jgufi –II. wevroba da funqciebi 1 etapi:SemuSavdes mimarTulebada procedurebi, mag transfuziis gaidlainebi (SemuSavebuli NBTS-is mier) sisxlis utilizaciis gaidlainebi Ppacientis informirebuloba 2etapi:personalis treningi, Camoyalibebuli mimarTulebebisa da procedurebis aTvisebisTvis Eetapebi hospitalSi usafrTxo transfuziis danergvisTvis Pause to discuss Form 2

  19. 3 etapi:SemuSavdes efeqturi sistema yovelwliurad kompetenciis Sesamowmeblad. transfuziis jgufi –II. wevroba da funqciebi Eetapebi hospitalSi usafrTxo transfuziis danergvisTvis Pause to discuss Form 3

  20. transfuziis jgufi –II. wevroba da funqciebi Bbevr SemTxvevaSi transfuziis jgufi danergavs sisxlis utilizaciis programas, romelic aqvs 2 komponenti: 1komponenti:Sefasdes eqim-specifiuri da servis-specifiuri sisxlis moxmarebis praqtika. 2komponenti:Sefasdes institutis mier sisxlis moxmarebis praqtika. Pause to discuss Form 4

  21. transfuziis jgufi –III. sisxlis centris monawileoba NBTS samedicino direqtoris CarTuloba rodesac sisxlis centris eqimi aris jgufis aqtiuri wevri, hospitalisTvis sasargebloa imdenad, ramdenadac: is iRebs ukeTes sakonsultacio serviss. is swavlobs gacilebiT mets adglobrivi (da saerTaSoriso) sazogadoebebis praqtikis Sesaxeb

  22. ra sargebloba moaqvs klinikisTvis NBTS direqtoris monawileobas … ufro metad xelmisawvdomia uwyveti profesiuli ganaTleba. da, man unda SeiZinos Cvevebi pacientis movlis gaumjobesebisTvis. transfuziis jgufi –III. sisxlis centris monawileoba

  23. transfuziis jgufi –IV. interesTa konfliqti “situacia, rodesac pirovnebas… aqvs konkurenciuli profesionaluri an personaluri, finansuri valdebulebebi, romlebic xels uSlian mas srulad Seasrulos Tavisi valdebulebebi.” samarTlebrivi gansazRvrebiT intresTa konfliqtia:… The ‘Lectric Law Library, 2005 [http://www.lectlaw.com/def/c095.htm (accessed , 2006)]

  24. transfuziis jgufi –IV. interesTa konfliqti • interesTa konfliqti SesaZlebelia iyos sayovelTao Mmiuxedavad amisa, … • seriozuli problemebi SeiZleba gaCndes, Tu ar moxda konfliqtis: • identificireba, gamoaSkaraveba da Semdeg … • sworad mimarTva.

  25. transfuziis jgufi –IV. interesTa konfliqti • zogierTi eqsperti miiCnevs, rom jgufis xelmZRvaneli ar unda avirCioT Semdegi ori poziciidan: • hospitalis transfuziis servisis samedicino direqtori an… • sisxlis centris (e.g., NBTS) samedicino direqtori. • maTi azriT, am direqtorebs gauWirdebaT miukerZoebeli gadawyvetilebis miReba. • Ees azri ar aris universalurad aRiarebuli.

  26. transfuziis jgufi –IV. interesTa konfliqti • pirovnuli urTierTobebi xSirad warmoadgens interesTa konfliqtis gansakuTrebul saxes, radgan Znelia gaakritiko (Tundac konstruqciulad) sakuTari kolega da megobari. Pause to discuss Forms 5 & 6

  27. transfuziis jgufi –V. sisxlis utilizaciis gadaxedva Mmimdinare vs retrospeqtruli sisxlis utilizaciiis gadaxedva?

  28. transfuziis jgufi –V. sisxlis utilizaciis gadaxedva • Mmimdinare gadaxedvis upiretesoba: • mimdinareobs realur droSiamdenad is… • xels uwyobs transfuziis praqtikis gaumjobesebas. • Nnakli: • saWiroa intensiuri da ZviradRirebuli Sroma da … • mas SeuZlia moaxdinos arasasurveli konfrontacia, Tu ar iqna kargad Catarebuli –im SemTxvevaSi, sadac pacientisTvis zianis miyeneba naklebad mosalodnelia, ukeTesia droebiT Tavi SevikavoT, da mogvianebiT ganvagrZoT intensiurad • [Note: mimdinare gadaxedvam ar unda daagvianos pacientisTvis daxmarebis gaweva]

  29. transfuziis jgufi –V. sisxlis utilizaciis gadaxedva • retrospeqtuli gadaxedva upiratesobebi (mimdinare gadaxedvasTan SedarebiT) • Nnaklebad Sromatevadia da aseve .. • Ppotenciurad naklebi safrTxis matarebeli. nakli: ar gaZlevT saSualebas aqtiuri CarevisTvis (i.e., the cat’s already out of the bag). sxva sakiTxebi • idealuria rodesac retrospeqtruli analizi xdeba trasfuziidan male (meore dRes) . • Ees analizi ar aris aucilebeli iyos 100% inkluziuri • sanimuSo analizi Cveulebriv xelmisawvdomia.

  30. transfuziis jgufi –V. sisxlis utilizaciis gadaxedva • im ESemTxvevaSi, roca gadaxedva ver xerdeba standartis Sesabamisad, SesaZlebelia moxdes Semdegi: • transfuziologs mosTxoven axsnaganmartebas (werilobiTac), Catarebuli transfuziis Sesaxeb. • hospitalis transfuziologiis komiteti ganixilavs pasuxismgeblobis sakiTxs. • Tu transfuziis komitets ar ZaluZs Sefaseba, angariSi egzavneba samsaxuris ufross da samedicino stafis ofiss • iSviaTad, incidents moyveba mandatis ganxilvis sakiTxi

  31. transfuziis jgufi –V. sisxlis utilizaciis gadaxedva Semdegi kategoriebi, saukeTeso SemTxvevaSi, unda iyos sisxlis utilizaciis monitoringis procesis nawili: Camoyalibebuli praqtikuli nabijebi pacientis identificireba analizis Segroveba da moniSvna infeqciuri da arainfeqciuri gvediTi movlenebi Near-miss events [Continued …]

  32. sisxlis utilizaciis aspeqtebi (gagrZelebi)… gamoyeneba da gadayra gamoyenebis adqvaturoba sisxlis gadasxmis protokoli samsaxurebis unari daakmayofilon pacientis moTxovnilebebi eqspertTa rekomendaciebis dacva transfuziis jgufi –V. sisxlis utilizaciis gadaxedva

  33. transfuziis komiteti –VI. xarisxis menejmenti/instrumentebi transfuziis servisis aqtivoba ori ZiriTadi mimarTulebisaa: sisxlis komponentebis maragis marTva: romelic moicavs SekveTas, miRebas, da gadayras

  34. Ppacientis testireba:moicavs etapebs laboratoriaSi SekveTidan da: medical record through the following: analizis Segroveba, miReba da Semdegi procesebi testireba da Sedegegis gadaxedva Sedegebis angariSi ganfaseba follow-up konsultaciebis momzadeba transfuziis komiteti –VI. xarisxis menejmenti/instrumentebi

  35. transfuziis komiteti –VI. xarisxis menejmenti/instrumentebi 10 ZiriTadi principi qmnis qveynis sisxlis bankis standartebis xerxemals: organizacia resursebi aRWurviloba momwodebeli da momxmarebeli procesis kontroli

  36. xarisxis sistemis ZiriTadi principebi… dokumentacia da Canawerebi gadaxra, gverdiTi efeqtebi Sefaseba: Sinagani da garegani procesis gaumjobeseba koreqciis da prevenciis gziT Senoba da usafrTxoeba transfuziis komiteti –VI. xarisxis menejmenti/instrumentebi

  37. transfuziis komiteti –VI. xarisxis menejmenti/instrumentebi Pause to discuss Forms 7 through 9

  38. transfuziis jgufi –VII. transfuziaze reaqciis kontroli Ees aris jgufis yvelaze mniSvnelovani funqcia, radgan zedmiwevniT Segrovebuli informacia aucilebelia SemdegSi aseTi problemebis Tavidan acilebis mizniT. Pause to discuss Form 10

  39. transfuziis jgufi –VIII. roli sisxlis menejmentSi risi saSualebiT SeiZleba gaumjobesdes transfuziis jgufis roli sisxlis menejmentSi: preoperaciulad pacientis hemoglobinis donis gansazRvra. intraoperaciuli sisxlis konservaciis monitoringis strategiis gaumjobeseba. koncentrireba advilad xelmisawvdom samedicino programebze eqimebisa da eqTnebisTvis.

  40. transfuziis jgufi – IX. transfuziis gaidlainebi Pause to discuss Form 11 yvelaze kargi transfuziis gaidlainebic SesaZlebelia daixvewos, asaxos yvela moTxovnileba da iyos praqtikuli damxmare eqimebisTvs

  41. transfuziis jgufi –X. implementacia da menejmenti Sexvedrebis dagegmva ganrigi unda Sedges jgufis CamoyalibebasTan erTad. wliuri ganrigi ufro mosaxerxebelia. Sexvedrebi sauzmis da lanCis dros ukeTesia daswrebis TvalsazrisiT

  42. transfuziis jgufi –X. implementacia da menejmenti Sexvedrebis dagegmva programa unda moicavdes dros, xangrZlivobas da adgils aseve unda moicavdes mokle informacias sakiTxebze da momxsenebelze.

  43. programa … TiToeuli sakiTxi unda iyos moniSnuli: “qmedeba” (i.e., follow-up work required) or … “informacia” (i.e., no follow-up required). Sexvedris handouts -ebi unda darigdes winaswar, diskusiisTvis mosamzadeblad. transfuziis jgufi –X. implementacia da menejmenti Pause to discuss Form 12

  44. transfuziis jgufi –X. implementacia da menejmenti Sexvedrebi: angariSi unda iyos detaluri, mokle da informatiuli. SemuSavdes angariSis standartuli forma. Pause to discuss Forms 13-to-17

  45. transfuziis jgufi –X. implementacia da menejmenti Sexvedra adeqvaturi atmosfero Sexvedris dros maqsimalurad unda gakeTdes aqcenti “ra” da ara “vin” yvela wevrma unda warmoadginos Secdomebi (i.e., rogorc Tavisi, aseve kolegebis Secdomebi).

  46. Sexvedrebi Sexvedrebis Semdeg gaavceleT Sexvedris Sesaxeb inormacia (sasurvelia pirveli kviris manZilze). infomacia unda iyos mokle da tevadi. transfuziis jgufi –X. implementacia da menejmenti

  47. transfuziis jgufi –Sejameba Cven dRes yuradReba gavamaxvileT … msjeloba da organizacia wevroba da funqcia sisxlis centris monawileoba interesTa konfliqti sisxlis utilizacia-gadaxedva

  48. gansaxilveli sakiTxebi … xarisxis kontrolis menejmenti transfuziaze reaqciis kontroli roli sisxlis menejmentSi transfuziis gaidlainebi implementacia da menejmenti transfuziis jgufi –Sejameba

  49. Transfusion Committees – End Discussion Where do we go from here? What may Global Healing and BloodSource do to assist?

  50. Transfusion Committees –Other Notable References • J.C. Faber. “Expanding the Role of Hospital Blood Banks.” ISBT Science Series (2007) 2: 76-81. • P. Ouellet. “Hospital Transfusion Committee.” ISBT Science Series (2007) 2: 82-84. • S. Saxena and I.A. Shulman. “Resurgence of the Blood Utilization Committee.” Transfusion (2003) 43: 998-1006.

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