- 學位論文
注射劑醫囑結構化與臨床決策支援系統應用
A medical Decision Support System Based on Structured Injection Orders
摘要
所謂用藥疏失(Medication Errors)泛指由醫師開立處方，到藥師調劑，再到護理人員給藥或病患服藥之整個流程中，所有會發生的錯誤，包括整體流程中行為疏失及專業判斷的錯誤。藥物疏失事件大都發生住院病人，主要原因以醫護團隊間溝通不足、口頭醫囑交待不清楚、對縮寫認知不一致等。且大部分的醫院對注射劑及點滴加藥醫囑仍採用口頭醫囑之方式開立相關藥品，容易導致護理人員給藥時發生不當的藥物、劑量及稀釋濃度等。因此，本研究將建置注射劑用藥指引知識庫，匯集相關注射劑使用規範，改善舊有住院醫囑系統注射劑非結構化文字醫囑之問題，以結構化開立模式，提供正確使用指引，並經由電腦系統快速的運算功能，即時正確計算劑量、輸注時間與流速，建立檢核機置，減少給藥之疏忽，強化醫囑開立時錯誤之預警，提升醫療照護品質。 為評估「醫囑開立防錯介面」的效果，本研究針對醫囑開立之操作者運用「醫囑開立防錯介面」進行錯誤紀錄檢測，觀察開立注射劑醫囑之錯誤率及分析易造成用藥安全之注射劑項目，以輔助醫院內部進行正確用藥宣導教育，經錯誤紀錄分析評估結果證明系統之警示作用，操作使用者不再重覆開立錯誤注射劑藥囑，確實已達到教育訓練之目的。
並列摘要
Medication Errors, means the errors which occur during the whole process from prescribing by doctors, filling prescriptions by dispensers, and medicating by nursing staff or taking medicine by patients. It includes negligence and judgments errors in the whole process. The main reasons are lack of communications in medical groups, unclearly handing over between shifts, blurred orders, and different recognition to abbreviation...etc. Even so, concerning physician prescribed the parenteral injections and IV (intravenous) were still ordered orally which leads nursing staff using the wrong medicine, dosage and dilution concentrations…etc. easily. Therefore, this study is going to build the database of injection orders to collect the rules for injections and structure IV orders to solve the unstructured text injection orders on the Inpatient Computerized Physician Order Entry (CPOE) System. By the injection user guide and the fast computing capabilities, to provide the correct recommended usage dose, Injection time and rate immediately. And the alarm function can reduce medication negligence; promote the qualities of medical care. The effects of error-preventing mechanism design in CPOE were assessed. In this study, we were focusing those who application of error-preventing mechanism designs in CPOE system and error detection record. Observation the error rates of CPOE of injection and Analysis the items which could easily lead to drug safety in injection. Education advocacy of proper medication within hospital were assisted. The alerting effects of this system had been proved by the assessment of analysis of error record. The physician did not repeat to mistake in injection CPOE. The purpose of education and training were achieved.
參考文獻
延伸閱讀
- 邱千慈（2010）。某醫學中心臨床決策支援系統對重複用藥之影響〔碩士論文，國立臺灣大學〕。華藝線上圖書館。https://doi.org/10.6342/NTU.2010.03078
- 鄭景耀、吳明芬、劉文雄（2018）。藥學客觀結構式臨床測驗（OSCE）教案設計實務。臺灣臨床藥學雜誌，26(4)，251-257。https://doi.org/10.6168/FJCP.201810_26(4).0001
- 黃欣怡、陳仲揚、高聖博、謝美玲、謝明蓁（2016）。新進藥事人員客觀性結構式臨床技能測驗模式之建立。北市醫學雜誌，13(4)，562-569。https://doi.org/10.6200/TCMJ.2016.13.4.11
- 張舉哲（2011）。建構以馬可夫理論分析消費行為之管理決策支援系統－以某藥局為例〔碩士論文，元智大學〕。華藝線上圖書館。https://doi.org/10.6838/YZU.2011.00139
- 陳鈺薇（2013）。The Effect of Medical Budgeting System on Medical Decision Behaviors〔碩士論文，國立臺中科技大學〕。華藝線上圖書館。https://doi.org/10.6826/NUTC.2013.00022