建構急診腫瘤病人安全照護資訊系統研究

The Simulation of Safety Net Practice on Emergency Department of Cancer Patients Care

陳正怡(Chang-I Chen)

指導教授 ： 李友專

共同指導教授 ： 彭汪嘉康(Jacqueline Whang-Peng)

臺北醫學大學/醫學院/醫學科學研究所/博士(2013年)

摘要

本研究是針對急重症環境裡，癌症病人治療過程中安全強化考量，尤其潛在危險因子如腫瘤的進展、化學治療副作用、免疫系統的降低、呼吸系統窘迫等緊急情況，都需要急診醫護團隊正確辨識、有效診斷，採取適當的治療照護，使就醫癌症病人恢復穩定狀態。本研究藉由資訊互動安全模式 (Data Interaction Model for Adverse Event Detection)，病人基本資料、診斷紀錄、治療處置、用藥安全、以及檢驗檢查等五大項資料庫，交互偵測運算的安全強全系統架構之下予以強化。 本研究針對癌症病人之檢驗極端值(Critical Laboratory Results Reports, CLRRs)的安全設計，安全架構從明確的癌症病人急診流程剖析(Protocol Analysis)、專業知識判斷 (Knowledge base support)、設定安全警示閾值(Critical Value)，進而有效收集臨床及時生理檢驗、檢查數據，依照團隊設定標準(Standard Operation Procedure, SOP)，針對設定疾病病人，臨床檢驗極端值警示CLRRs及時通知值班照護負責團隊，給予病人最適化醫療治療或處置回覆。不同於傳統醫療資訊系統，CLRRs主動及時回應預設醫療決策系統，配合醫護團隊動態照護特性，運用無線安全網路(Ubiquitous Data Access)進行臨床資訊彙集(Clinical Data Aggregation)，病人身份確認的無線射頻辨識系統(RFID)，有效協助病人及時動態檢驗、檢查或極端值(Critical Value)資訊。建構安全為核心醫療準則，讓醫護團隊隨時掌握病人臨床生理變化；依照癌症病人安全管理(Clinical Cancer Safety Management) 例如癌症病人急性臨床症狀，如化療或放療副作用，急性溶血、血小板降低 (Acute Hemolysis、Neutropenia )，急性呼吸窘迫 (Acute Respiratory Distress) 至急診就醫。本系統可以根據病人目前診斷(Diagnosis)、共病(Comorbidity)與其他危險因子評估(Risk Factor Evaluation)，提升病人從診斷、治療，到預後追蹤。強化攸關安全之及時醫療資訊的傳遞，降低可能產生安全威脅。本研究提供癌症病人就醫資訊安全系提出可行的解決方案，以急診安全網架構改進臨床上急症與癌症病人的安全，使病人多一份安全保障，臨床醫護團隊也更方便從容，改善癌症存活(Survivorship)，提供以病人安全為核心的急診醫療服務。

關鍵字

急診，癌症病人，安全網、無線射頻辨識、檢驗極端值

並列摘要

For cancer patients, admission to emergency department (ED) may be under the higher risk due to the clinical important crisis or acute onset problems but may also reflect problems not adequately addressed or managed during routine cancer care (1). Systemic approach of Data Interaction Model has assigned as the framework to improve the ED cancer care. Wireless radial frequency identification (RFID) was applying within ED patients for the safety purposes of identification for ED status of important laboratory results or procedures follow-up. Laboratory data is the central for the interaction with patient profile, diagnosis and history, medication, and the procedures. From the automatic transmitted of computer-generated Critical Laboratory Result Reports (CLRRs) to physicians, which can improve the care of cancer patients on the risk by improving the communication efficacy of important medical information. Older patients greater than or equal to 75 years of age had more CLRRs than younger patients. Patients with colorectal, liver, and lung cancer had a significantly higher number of CLRRs. More CLRRs were also seen in late-staged cancers. These conditions also have higher mortality rates.
In our study, that admission to hospital via the ED may be a clinically important indication of poorer survival for gastrointestinal (GI) disease or the multiple chronic conditions in cancer patients. In addition, the GI patients newly diagnosed in the ED showed stronger association of GI related cancer, our data demonstrates that critical laboratory values can be transmitted successfully to the physician. The impact of this system promises to improve the care of cancer population in the ED.
Nevertheless, in gastrointestinal cancers of our study had shown, emergent complications may be premature clinical symptoms of early diagnosis for the GI related cancer. Our study demonstrates that automated informatics alert system can be transmitted successfully to physicians. The impact of this system promises to improve the care of cancer patients on the ED care system. A prospective study to demonstrate the benefit this system is being planned.

並列關鍵字

Cancer Care, Emergency Department, Safety Net, RFID，Laboratory Critical Value.

參考文獻

1. Alexi A. Wright, Ingrid T. Katz, Bar Coding for Patient Safety. N Engl J Med 2005; 353:329-31.

2. Arts DG, de Keizer NF, Scheffer GJ. Defining and improving data quality in medical registries: a literature review, case study and generic framework. J Am Med Inform Assoc. 2002, (9):600-11.

3. Asaro PV, Boxerman SB. Effects of computerized provider order entry and nursing documentation on workflow. Acad Emerg Med. 2008;15:908-915.

4. AV: 4/2045/08 "Aplikacie technologie RFID pre vybrane postove procesy na podmienky HSS"

5. Bates DW, Cullen DJ, Laird N et al. Incidence of adverse drug events and potential adverse drug events: implications for prevention. JAMA. 1995; 274: 29-34.