探討遠端抗生素審核中心之可行性－以個別深度訪談南區地區醫院為例

Assessing the Feasibility of an Antibiotic Distal Audit Center: In-Depth Interviews with Southern District Regional Hospitals Staff

郭昭吟(Chao-Yin Kuo) ； 尹賢琪(Hsien-Chi Yin) ； 李宜昌(Yi-Chang Li)

《醫療資訊雜誌》 25卷4期 (2016/12) Pp. 35-50

摘要

抗生素管理計畫(Antimicrobial Stewardship Program, ASP)已推動多年以降低細菌對抗生素的抗藥性增加等問題，故國內衛生福利部、健康保險署或醫院內部皆將其列為重要措施，國內醫策會於民國92年推動「病人安全品質監測」計畫，更將感染管制監測列為每年目標之一，而抗生素的不當使用會造成細菌抗藥性等問題，導致病人疾病惡化、合併症及醫療費用增加，皆是提升病人安全重要課題。然而專任感染管制人力不足的醫院，則較難達到感控的目標，因此本研究目的為利用個案醫院使用遠端連線審核抗生素管理作業成效，推廣至衛生福利部醫療管理委員會(醫管會)，並模擬「衛生福利部影像判讀中心」模式，以提供衛生福利部醫院規劃「遠端抗生素審核中心」模組参考。研究方法採用質性研究以半結構深度訪談蒐集資料，以南區部立地區醫院為研究對象，醫院區分執行「遠端連線審核」及「傳真審核」，受訪人員有醫療人員、感管醫師、決策者共24人，以實際了解抗生素管理流程及成效，並將訪談結果歸納分析。訪談內容分析顯示，針對抗生素管理成效及幫助性，遠端連線審核醫院成效大於傳真審核醫院，而在探討規劃設立「遠端抗生素審核中心」時，醫療人員、感管醫師、決策者等受訪者之支持度及推動可行性上分別為100%及87%，推動的困難度上50%醫療人員及感管醫師認為醫院會考量其高成本，而決策者則認為如何讓上層長官重視此議題為首要條件，成本費用則次要。本研究結果可讓部立無專任感管醫師的醫院及醫管會參考，配合政府推動抗生素管理方案的方法，共同提升病人照護品質，減少醫院成本，符合醫院評鑑規範，達到資源共享目的。

關鍵字

感染管制 ； 抗藥性 ； 抗生素管理計畫 ； 影像判讀中心

並列摘要

The Antimicrobial Stewardship Program (ASP) has been in place in Taiwan for years to mitigate the increasing resistance of bacteria to antibiotics. The Ministry of Health and Welfare, the National Health Insurance Administration, and Taiwan hospitals have all adopted the program because this problem is crucial. Furthermore, the Joint Commission of Taiwan (JCT) has defined infection control as a yearly goal while promoting their ＂patient safety quality monitoring＂ program. Misuse of antibiotics causes antimicrobial resistance, leads to the exacerbation of diseases, increases complications, and raises health care costs. Addressing these issues is essential for enhancing patient safety. However, not all hospitals have an enough workforce to execute the program. The purpose of this research was to increase the case hospital’s effectiveness through the remote connection of antibiotic management with the Hospitals of Social Welfare Organizations Administration, which was achieved by imitating the functions of the Image Reading Center (IRC) and using the IRC as a reference during the planning of an ＂antibiotic distal audit center.＂ The case hospitals were two district hospitals in southern Taiwan, one with a ＂remote connection examination＂ and the other with a ＂fax examination.＂ Semi-structured in-depth interviews were conducted with 24 interviewees who comprised medical care staff, infection-control doctors, and decision-makers, their opinions regarding practical procedure and the effect of antibiotic management were obtained. The results revealed that ＂distal antibiotic auditing＂ is more helpful within antibiotic management than ＂fax auditing.＂ Regarding the planning of an ＂antibiotic distal audit center,＂ the support and feasibility ratings were 100% and 87%, respectively, among the interviewees. In addition, half of the medical care personnel and infection-control doctors interviewed were concerned that high costs for hospitals would be the main hindrance to the promotion of the concept, whereas the decision-makers discussed how top executives might be encouraged to afford the subject the highest priority, with cost considered a minor issue. The results can serve as a reference regarding antibiotic management for both hospitals, which lack sufficient infection-control doctors, and for the Hospital and Social Welfare Organizations who must follow the government’s policy of antimicrobial stewardship, increase the quality of patient care, decrease costs, award hospital accreditation standards, and achieve resource-sharing goals.

並列關鍵字

Infection control ； antibiotic-resistance ； Antimicrobial Stewardship Program (ASP) ； Image Reading Center (IRC)s