某地區教學醫院門診臨床決策支援系統警告型態分析

The Analysis of Alert Patterns in Clinical Decision Support System in a Regional Teaching Hospital

陳佳君(Chia-Chun Chen) ； 沈里彥(Lee-Yen Shen) ； 許益彰(Yi-Zhang Xu) ； 劉珮汶(Pei-Wen Liu)

《健康管理學刊》 16卷1期 (2018/06) Pp. 55-64

摘要

現今醫院電腦醫令系統（computerized physician order entry system, CPOE）中多內建有臨床決策支援系統（clinical decision support system, CDS），可藉由系統檢核協助醫師避免開立問題處方。但多重的檢核系統建置後，當警告的「量」增加時，卻可能造成醫師忽略（override）檢核系統產生警示的現象。因此本研究分析某地區教學醫院105年度門診臨床決策支援系統警告數據形態與醫師對警告的接受度，以評估系統是否達到預期的警示成效。研究方法採回溯性觀察分析系統產生的21648筆警告記錄，並進一步分析四個警示次系統數據形態。結果發現藥物過敏警示系統產生警告數最少，但醫師接受警告比例最高；顯示此警示系統對醫師處方決策有重要的影響。其餘藥物交互作用、重複用藥、同藥理作用重複等警示系統則都有警告數量多，醫師接受度低的情況；顯示醫師對警告產生疲乏，下意識忽略有意義系統警告。因此本研究也針對各警示系統提出改善策略，以供醫院管理者提高臨床決策支援系統警示的效能、降低醫師開立問題處方機率進而達到維護病人安全的目標。

關鍵字

臨床決策支援系統 ； 系統警告 ； 過敏警示 ； 交互作用警示 ； 重複用藥警示

並列摘要

Computerized physician order entry system (CPOE) contains clinical decision support system (CDS),which have been defined as computer programs that assists physicians in avoiding error prescriptions. However, when physicians facing such amount of alerts, they might override those alerts, which defined as alert fatigue. In order to evaluate whether the Clinical Decision Support System reaches to the expectable achievements , this research analyzed the alert patterns and the acceptances of physicians in the system at a local community hospital. In this retrospective observation study, we retrospectively collected 21648 alert records from the databank of the system and further analyzed those data by four subsystems. We draw a conclusion that although the least alert records collected from drug allergy alert system, it's the most acceptances rate adopted by physicians. It revealed that Drug allergy alert system plays a significant role when physicians are making the prescription. In contrast, the acceptances rate is low in drugdrug interaction alert system, repeated prescription checking system and therapeutic duplication checking system. We supposed that it is result from alert fatigue, which caused physicians override the alert systems. In the results of this study, we proposed modifications to improve the clinical decision support systems and to reduce the rate of error prescriptions, therefore improving the safety of patients.

並列關鍵字

Clinical decision support system ； System alert ； Drug allergy alert system ； Drug-drug interaction alert system ； Repeated prescription checking system ； Therapeutic duplication checking system