輸血醫囑資訊系統導入不符合警示後紅血球使用分析

Analysis of Red Blood Cell Use after Implementing Adaptive Alerts in the Computerized Physician Order Entry System

楊茜淳(Chien-Chun Yang) ； 吳宗圃(Tsung-Pu Wu) ； 黃美真(May-Jen Huang)

《醫療品質雜誌》 13卷6期 (2019/11) Pp. 36-43

https://doi.org/10.3966/199457952019111306008

摘要

目的：為降低不必要的輸血，建置即時線上審查的輸血醫囑資訊系統。當申請紅血球血品時，需選擇輸血的適應症，若血紅素（Hb）數值高於其選擇適應症規範之閾值時，系統會出現警示視窗。材料與方法：收集系統使用前後各5個月的紅血球使用資料進行比較。結果：系統導入前後領血申請分別為3,572及3,482筆；血品使用分別為6,969及6,773單位。系統導入後用血量有下降，審查不符合有216筆，不符合率為6.2%，出現警示視窗後取消申請0筆。結論：根據統計，新系統導入後用血量是降低的。未來應更進一步調整系統中適應症選項及審查標準使其更符合臨床實際需求，並執行適當的人員的教育訓練及考核，相信對於執行成效會更有助益。

關鍵字

輸血審查 ； 醫囑資訊系統 ； 不必要的輸血

並列摘要

Objectives: To prevent unnecessary blood transfusions, we upgraded the physician order entry system by implementing online transfusion auditing. Prescribers must select an indication while ordering red blood cells (RBCs) for transfusion. The system displays pop-up alerts if the patient's hemoglobin level is above the threshold for the selected indication. Material and Methods: Five-month data of RBC orders for transfusion, which included orders recorded before and after implementation of the adaptive alert system, were collected and analyzed. Results: After implementation of the alert system, the number of RBC orders decreased from 3,572 to 3,482, and the number of RBC units transfused decreased from 6,969 to 6,773. In total, 216 (6.2%) pop-up alerts indicating possible inappropriate RBC orders were observed. However, none of the prescribers canceled their orders after receiving warnings. Conclusions: Our analysis revealed that RBC transfusion rates decreased after the implementation of the adaptive alert system. We believe that modifying the current database of indications and review criteria according to the needs of clinical settings and providing effective staff education and assessment programs can improve the outcomes of using the adaptive alert system.

並列關鍵字

Transfusion auditing ； computerized physician order entry system ； unnecessary transfusions