小兒科醫師處方警示系統-以癲癇為例

A physician alert system for pediatric prescribing-Epilepsy as an example

徐竹君(Chu-Chun, Hsu)

指導教授 ： 劉建財

共同指導教授 ： 邱泓文

臺北醫學大學/醫學院/醫學資訊研究所/碩士(2010年)

https://doi.org/10.6831/TMU.2010.00208

摘要

有鑑於生物科技的發展迅速，新藥物的種類越來越多，加上兒童在身心的發展上尚未成熟與藥物的耐受程度又較成人弱，而國內又有層出不窮的醫療糾紛，所謂明者遠見於未萌，智者避難於無形，在現在這個醫療環境，有時候光靠人力研讀所有資訊並判斷所有的藥物交互作用已經是不太可能了，所以發展一套藉由電腻運算自動判讀資訊然後發出警示的系統已經勢在必行，而且現今已經有相當多的智慧型專家系統發展成型並應用，雖然藥物交互作用警示智慧系統已經有相當多人發展，但是其中絕大部分還是以成人或是整體醫療的觀點來加以設計，但是應用於小兒科的領域還是有所格格不入，例如：適用於兒童藥物的劑量、劑型、種類、投與方式、精確度、特性、耐受度和是否影響兒童發展和成長都與成人需求不同，更需要嚴格並精確的掌握，所以為了避免醫療糾紛、改善醫病關係，並增進醫療品質，發展一套適用現今的小兒科的藥物系統，並不會過於唐突多餘，反而有其必要之處。
發展此系統最主要的目的有以下幾點：希望能解決藥物交互作用警示系統(DDI altert system)的盲點，也就是將疾病與藥物的關係因素納進入系統，減少兒童在藥品使用疏失，減少醫病衝突，增加幼童的用藥安全，精確計算兒童用藥劑量。至於方法是使用ICD-9-CM碼來核對主述疾病的處方藥物是否不適當，再以病患檢驗數據(Lab data)排除因為身體疾病不能使用的處方藥物，最後精確計算用藥劑量。預期結果若ICD-9-CM碼、藥物資訊與疾病分類無礙的話，系統設計困難度會大大降低，而且可以達到系統設計的目的和預期的目標。

關鍵字

小兒科、決策支援、處方、藥物不良反應、癲癇

並列摘要

Abstract
According to the rapid development of bio-science, there are more and more varieties of new medicine. Plus children’s immaturity of body and personality, and the tolerance of medicine are weaker than adults’, furthermore, there are lots of medical dispute in this place. In this medical environment, sometimes it is impossible to depend on human studying all the information and determining all drug interactions, so it is necessary to build up a computer system with automatic operation, decision and warning. And pretty much intellective professional systems already put in use recently. Although many people develop intellective warning systems for drug interaction, but yet mostly their design are focus on adults or a complete medical treatment. It is still incompatible with the pediatrics application. For example: the suitability of children medicine about dosage, form, type, route, accuracy, characteristics, tolerant level and if it affects children development and growth, these are all different with adult’s requirement. We need more strict and precise management. Therefore, to avoid medical dispute and to increase the quality of medical treatment, we develop a medicine system applicable to pediatrics. And it is obligatory but not surplus.
These main purposes I build this system are below, such as to make up for the insufficiency of DDI alter system, which inputs any related element between medicine and disease to the system, to clear away any negligence of drug use on kids, to reduce therapy conflict, and to raise the safety of medicine use on children, then calculate drug dosage precisely. The method is by ICD-9 CM code checking if it’s inappropriate for the subject’s prescription, then Lab data have to eliminate any other prescription that diseases may not allow, finally calculates dosage accurately. If there is not any blocked result between ICD-9-CM code, medical information, and disease classification, the systematic design’s difficulty can be lessened, and it reaches to the purpose and the expectable achievement.

並列關鍵字

Drug、Child、ICD9、Decision support system、Drug Interactions、Computer Assisted、Pediatrics、Medication error、Prescription、Advising System

參考文獻

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