建置醫院智慧型藥品管控輔助系統-以骨鬆藥物Forteo為例

Development of an intelligent drug control management system--a case study of Forteo control

倪健珍(Chien-Chen Ni)

指導教授 ： 劉建財

臺北醫學大學/醫學科技學院/醫學資訊研究所/碩士(2014年)

https://doi.org/10.6831/TMU.2014.00092

摘要

在國內許多醫療服務機構在近一、二十年來紛紛投入發展醫院管理資訊系統，不僅可提升醫療服務流程的時效性，更能有效減少人為相關的作業疏失。一般來說，臨床醫師最常給予病患的治療方法為藥物治療，藥品使用不當對病人之傷害，嚴重者會有致命的危險。行政院衛生福利部將用藥安全列為103年至104年的醫療品質及病人安全首要目標，用藥安全已成為近年來各國醫療界最重視的議題之一。醫師開立合理的藥物處方，不但可避免用藥疏失，也能減低醫療資源的浪費，而藥師在確保用藥安全及控制藥費支出的把關上扮演了重要角色，運用資訊科技系統輔助藥師審核可省下藥師人力。

本研究將在雙和醫院開發智慧型藥品管理系統，並以第二線高價藥品 Ferteo為例，探討藥品管制規定電腦表示方法和相關資料庫的設計，並進行系統實施後的評估。

比較系統上線前後健保核刪狀況，在101年系統開始上線前，99年至100年的Forteo健保核刪率為9.8%，101年起上線至103年6月的健保核刪率降至0.58%，顯示核刪狀況大幅改善。另外我們在102年7月起啟動系統日誌檔，以記錄醫師填寫使用申請單時產生的警示訊息以及醫師對警示訊息的反應，統計至103年6月的申請填單數共97件，其中74件發生過警示，8件未完成填單而放棄申請，顯示本系統可防止醫師開立處方時易疏忽的狀況及偵測不當的Forteo藥品處方。實施本系統後，省略藥品緊急採購申請及藥師審核的程序，改善作業效率，並能提醒醫師進一步確認病人對藥物使用安全的疑慮，有助於藥品使用安全性。

最後討論系統使用限制有：系統設計侷限單一藥品、條件檢核限制如骨密度BMD T score值、骨折部位、骨折日期無法自動從院內的放射檢查報告帶入、系統無讀取病患IC卡中的用藥歷史功能而無法準確獲取用藥總量、現階段的資訊系統無法解析純文字病歷，需醫師自行查閱看診歷史確認病患的用藥禁忌症。本研究的結論是實施本系統確實可防止醫師開立不當處方，有助保障用藥安全，改善健保核刪狀況及作業效率，在未來將繼續研究解決系統使用限制的方法。

關鍵字

健保核刪 ； 骨質疏鬆 ； 用藥安全 ； 藥品管控 ； 醫令資訊系統

並列摘要

Information technology has been rapidly developed in recent two decades. Many health care organizations in our country have invested in the development of information technology. It can not only improve the efficiency of care processes, but also reduce human negligence. Generally, drugs therapies are the most common intervention for clinicians to treat patients. Medication error will lead to death or severe harm to patient. The Ministry of Health and Welfare has identified drug safety as its primary goal in healthcare quality from 2014 to 2015. Drug safety has become one of the most important issues in healthcare organizations in many countries recent years. Physicians make rational prescriptions that could avoid medication errors, and reduce the waste of medical resources. Pharmacists play an important role in drug safety to ensure and control drug dispense. Computer systems can assist pharmacists in checking prescriptions and improve their efficiency.

In this study we built an intelligent drugs control system in Shuang-Ho Hospital for prescribing an osteoporosis medication –Forteo, a second-line and expensive drug. We designed a knowledge base and the rules for prescribing the drug. We also evaluated physicians’ behavior of using the system.

In this study, we compared the Health Insurance claim system between pre and post implement in 2012. In pre-system implementation, the Health Insurance claim rate of Forteo was 9.8% during 2010 to 2011. Post-system implementation of system, its rate reduced to 0.58% from 2012 to July 2014. It shown that improved status of Health Insurance claim significantly. Furthermore, we started to record the physicians’ response to system alert message when they filled out the application form since July 2013. Upto June 2014, the total number of filled application forms were 97, of which 74 warning occurred, and eight of them had been give up to applying Forteo due to did not complete to fill the form. It showed that the system can prevent negligence when physician prescribing, detected the improper prescriptions for Forteo drug. After system implemented, through the omitting procedures of the emergency procurement of drugs and pharmacists to review the applications, it will improve operational efficiency, remind the physician to further confirm the concerns with drug use, improve safety medication.

Finally, The limitations of this system include the following: Utilized only single medication; Restriction on checking conditions such as : Bone density BMD T score, Fracture site, unable to bring the date of examine fracture into this system from radiation inspection system automatically, unable to obtain the total amount of medication of patients accurately without IC card; Health information systems unable analyze text records in the hospital in this stage, so the physicians have to search the patient's history medical records on their own to confirm the contraindications about patients. Finally, we do prevent improper prescriptions and guarantee drug safety, improve the conditions of Health Insurance claim and operational efficiency by using drug control management system. In future study, we will continuously work on this system and try to solve those limitations in the system.

並列關鍵字

osteoporosis ； drug safety ； management and control drug ； computerized physician order entry

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