- 學位論文
以病患為中心的營養照護支援系統
Patient Centered Nutritional Care Supporting System
摘要
醫院中對一些急性病病人之治療，會很戲劇性地顯示出營養和疾病的關係，以及營養的供給對疾病痊癒過程之決定性角色。而提供病患飲食的服務，在醫院中也日益重要。 而傳統的飲食處方、飲食通知等，往往是由醫師開立病患之飲食處方，再由病房護理人員填寫飲食通知單通知營養室，故病患之營養及飲食通知作業多半憑著醫師及護理人員本身之知識、經驗及直覺而決定，藉著營養評估系統之發展，可有效幫助臨床營養師客觀且快速地評估病患之營養狀況，及時修正及調整病患之飲食狀況，而減少病人營養不良的問題，以提高病人的恢復能力。 本研究旨在建構營養系統的最佳應用，強調以病人為中心之營養照護概念，病人之各項資料皆集合於一特定環境，此即為patient profile之觀念。將營養系統中所有子系統聯結，亦與醫院其它臨床系統聯結，例如護理資訊系統(NIS)、檢驗資訊系統(LIS)、醫療資訊系統(HIS)、藥物資訊系統(PIS)結合，以病人為核心，與醫師、護士、藥師與其它臨床人員組成一核心團隊(Core Team)之模式，在照護病人之過程中，不斷地輸出病人之舊資料以及輸入新資料，即不斷地新增及讀取病人之profile。而透過系統的自動化，綜合病人的各項資料(patient profile)作有效的推論供營養師參考，建立標準的流程，亦可節省大量及繁瑣之紙張流程，讓營養師能更投注營養養專業上，以提高病人之營養照護品質。 本研究以Web-Based介面設計，由營養師操作，由系統分析產生營養評估結果，詮釋之營養評估結果產生營養計劃最後轉換為產生飲食通知單，此過程皆經由一連串有根據証據之推論基礎，最後作出之決策由營養師作最後之確認完成飲食通知。 本系統達到個人化、證據化、簡單化、合作性、標準化、品管化等效益，而除了具備電腦化的優點外，在營養服務、營養研究及營養教育上都有長足的貢獻，提供給臨床營養師在給予病人進行營養照護時，能有一有效之輔助系統，以增加效率。
並列摘要
As the tendency of nutrition information system, medical decisions of nutrition must be made more scientifically. How to utilize computer technology to improve nutrition procedures is nowadays the major point for nutrition personnel. This study focuses on constructing the best application of nutrition system. It means to connect other clinical systems in a hospital, such as the combination of NIS (Nurse Information System), LIS (Laboratory Information System) , HIS (Hospital Information System), PIS (Pharmacy Information System), to compose a Core team with doctors, nurses, pharmacists and other clinical personnel. In this way, core team can gain patients’ all clinical information fast and efficiently. Via the automation of the system, synthesizing all information to make an effective inference as the reference for dietitians. It not only reduces the human errors and complications of management, but also establishes standard working procedure. In addition, plenty of paper work can also be reduced. Therefore, the dietitians can concentrate on their expertise to enhance the nutrition care qualities for patients. The features of our system are: 1. Core Team supported Nutritional system 2. Patient Centered Nutritional Assessment 3. Rule-based Nutritional Diagnosis Decision Support 4. Evidence-based Nutritional Diagnosis support In addition to the advantage of computerizing, The System of this study also has great contributions in nutrition service, nutrition study, and nutrition education. Our system successfully combines doctors, pharmacists, dietitians, nurses, and social workers as a core team, and patients as core members By the development of nutrition assessment system, dietitians can quickly and objectively assess patients’ nutrition states, then modify and adjust patients’ diet in time, which can decrease the problems of malnutrition and increase patients’ healing abilities.