建構呼吸治療臨床決策支援系統之研究

背景:本研究是基於病歷電子化(無紙化)及病人安全(跨領域團隊照護資訊流通)的考量下，將臨床使用屬於高危險儀器之呼吸器各項設定及監測參數予以資訊連線，使紙本病歷確實消失、臨床處置資料達到跨領域溝通無障礙、確保臨床工作品質一致性及資料累積成臨床大數據等目的。方法:具體作法分為三階段進行，第一階段為基礎軟體及硬體建設，將呼吸器的設定值及監測值參數以RM04 Wi-Fi嵌入式無線模組系統讀取呼吸器數據，再將數據轉成無線傳輸至N300RB-Plus無線網路基地台，以每一秒傳一筆資料至護理站的迷你商用電腦儲存，院內住院系統再以每五分鐘抓一筆資料來提供呼吸治療師選取輸入。第二階段為建置院內住院系統各項紀錄表格的畫面，來讓呼吸治療師選取的資料進入正確位址。第三階段初步建立決策平台1.每日評估、動脈血液氣體分壓值分析及肺功能三項快速功能查詢。2.跨領域團隊照護平台。3.交接班功能(以ISBAR模式)。結果:臨床決策支援系統建立後，在作業時間節省方面，平均每區每日節省約9.7小時。在紙張節省方面，平均每月可節省的紙張約377張至476張。另外每日評估、動脈血液氣體分壓值分析及肺功能三項快速功能查詢、跨領域團隊照護平台及交接班功能的建立，讓彼此間的溝通更加容易快速。結論:由以上的軟體及硬體建置確實已經達到臨床工作無紙化、接觸感染機率降低、更方便跨領域職類團隊溝通、降低文書作業時間來獲取更多時間於病人的治療、更容易掌握呼吸器使用狀況、更容易督察呼吸治療師的工作品質及呼吸器的機器性能，以達到維護病人安全的目標，為2020年達到可預防的死亡事件為零的行動宣言而努力。

關鍵字

呼吸器；呼吸治療；臨床決策支援系統

並列摘要

Background: This study is based on electronic medical records (paperless) and patient safety (cross-disciplinary team care plan information exchange) considerations, the clinical use of high-risk instruments, ventilator, its’ settings and monitoring parameters to be connected to information system, so that the paper for medical records have indeed disappeared, and clinical treatment data have reached the goal of cross-disciplinary team communication and accessibility, ensuring consistency of clinical work quality, and accumulating data into clinical big data. After this information platform was set, we can use the material in clinical education and research. Methods: The procedure is divided into three stages. The first stage is the basic software and hardware construction. The parameters of the ventilator‘s setting and monitoring are read by the RM04 Wi-Fi embedded wireless module system, and then wirelessly transmitted to the N300RB-Plus wireless network base station, every minute to pass a message to the mini-commercial computer storage, hospital information system and then every five minutes to catch a piece of information for the respiratory therapist selected. The second stage is to create the various record forms in the hospital information system screen. The first of third stage is to set up three quickly query functions; include the daily screening, arterial blood gas analysis and pulmonary function test. Second, set the platform of inter-professional practice and Hand-over function (in ISBAR mode). Result: After the establishment of the clinical decision support system for respiratory therapy, the average daily savings per area was about 9.7 hours in terms of saving time. In terms of paper saving, the average monthly savings of paper is about 377 to 476. In addition, the three quick functional queries of the daily screening, arterial blood gas analysis, and pulmonary function test, inter-professional practice platform and the establishment of hand-over functions make communication with each other easier and faster. Conclusion: The above software and hardware setup has indeed achieved the goal, include clinical paperless, reduced chance of contact infection, more convenient cross-disciplinary team communication, reduced respiratory therapist paperwork time and to obtain more time for patient treatment, easier to grasp the ventilator setting and monitoring information in real time, the invariability of the respiratory therapist work quality, and the machine performance of the ventilator can be more easily observed so as to achieve the objective of maintaining patient safety and to strive to achieve the goal of a zero-predictable death event in 2020.

並列關鍵字

Ventilator ； respiratory therapy ； clinical decision support system.

參考文獻

[1]朱師弘, (2014). 呼吸照護資訊管理系統建置及應用. Available: http://ndltd.ncl.edu.tw/cgi-bin/gs32/gsweb.cgi/login?o=dnclcdr&s=id=%22102CYCU5530001%22.&searchmode=basic