運用資訊科技開發肝臟移植藥事照護系統

Development of the Pharmaceutical Care System in Liver Transplantation Using Information Technology

李俐瑤(Li-Yao Lee)

指導教授 ： 黃耀斌

高雄醫學大學/藥學院/藥學系碩士在職專班/碩士(2015年)

摘要

研究背景與動機：本院(高醫附院)自執行肝臟移植照護作業以來，藥師在肝臟移植照護團隊中佔有不可或缺的角色，但由於肝臟移植病人用藥多重性(polypharmacy)的特質，在各移植階段藥品開立的正確性與相關檢查的完整性就顯得格外重要。但目前照護藥師因無適當之資訊工具協助，導致作業效率低，而且用藥評估與用藥指導為紙本作業無法有效地進行連貫性檢視病人院內外用藥，導致病人術後照護品質不佳。
研究目的：本研究希望運用資訊科技建置以藥師照護肝臟移植病人為基礎的資訊系統，並能提醒醫師於各移植照護階段正確開立用藥與相關檢查，提供肝臟移植病人完整且適切的照護環境。
研究方法：首先，匯集藥師實務經驗，並確認業務需求，再與資訊室程式設計師討論介面設計與欄位規劃，最後以「網路化」資訊技術作為本管理系統建置之理論基礎，使用「PowerBuilder v9.0」為主要程式語言搭配「Oracle v11g」資料庫儲存資料。
研究結果與討論：本研究成功地建置「肝臟移植藥事照護系統」，本系統提供「新增個案」、「新增評估」、「新增指導」、「藥師溝通」、「醫師溝通」、「用藥/檢驗」、「統計報表」與「藥物諮詢」、「病人照護查詢」與「雲端藥歷查詢」十項主要功能。移植病人之照護階段可由系統自動偵測更新讓藥師即時掌握病人照護狀態；在新增個案上，醫師於門診收案後由藥師進行確認並以簡訊通知雙方，藥師可依照護階段及病人用藥情形進行用藥評估及指導，期間亦可藉由溝通介面搭配簡訊通知與醫師進行即時性的雙向聯繫。用藥/檢驗功能提供各階段用藥及檢查之建議予以查詢參考，在統計表單功能，可設定各項篩選條件進行統計，即時呈現各項紀錄的統計筆數與百分比，報表結果可作為後續定期檢討改善之依據。另外在諮詢功能上，此系統亦連結藥物諮詢紀錄系統記錄病人詢問之相關問題；，檢視病人院外、院內及同醫療體系用藥，可透過雲端藥歷查詢及病人照護查詢，達到病人用藥連貫性審視，確保肝臟移植病人用藥安全。
結論：本研究將傳統照護及人工紀錄方式提升為系統化照護及紀錄模式，透過資訊科技的協助，快速且有系統地紀錄藥事照護作業中的服務量與問題資料，並提供自動化之統計報表予以檢討改善，未來期望將此系統協助擴展藥師照護團隊，提升肝臟移植藥事照護之品質與效率(如降低排斥或感染次數及延長併發症發生時間)，以提供本院肝臟移植病人更優質之照護服務。

關鍵字

肝臟移植 ； 資訊科技 ； 藥事照護

並列摘要

Background and Motivation: In the development of liver transplantation in KMUH (Kaohsiung Medical University Chung-Ho Memorial Hospital), clinical pharmacists play an indispensable role in liver transplant care team. Because of the polypharmacy in liver transplant patients, drugs usage and exact examination checking are particularly important . It would be lower efficiency without appropriate support of information systems. Due to traditional paper work of medication assessment and education for the patents, it is not the effectively coherent view of patient's medications process in hospital or at home, so it causes poor quality of postoperative care for the patients.
Purpose: The aim of this study is to utilize the information technology (IT)to build a system to remind physicians of correct medications prescription and on-time lab test. And clinical pharmacists can use this system to care patients effectively in medication assessment and patient education.
Materials and Methods: Firstly, we collect practical experience of pharmacists, and recognize the related business needs. Then we discuss with IT staff about interface design and column planning. The system theory of information technology is used as the management system of basis, PowerBuilder V 9.0is adopted as the main implementation language, and Oracle V10 g is used as the database tool.
Results and Discussion: This study has successfully built up the "Pharmaceutical care system in liver transplantation" so that pharmacists can use assessment by medications and condition of patients and also communicate through interfaces to match text message notifications for bidirectional real-time interaction with physicians. In addition pharmacist can record function in a statistical form and can set the filter conditions for statistical analysis, and report the results as the basis for subsequent periodic review and improvement. This system can also be combined with PharmaCloud and the patient care health system to support the simultaneous review the medications usage of patients at home or in hospital. This will achieve coherence medication review and ensure the safety of liver transplant patients.
Conclusion: This system prompts the traditional care and the artificial records way to a systematic care and data-recording mode. Through information technology assistance , it provide fast response and this system can collect data from pharmacists for clinical service and also can provide automation of statistics function for unusually data. We expect that this system can be extended to assist pharmaceutical care and to upgrade the quality and efficiency of liver transplant.

並列關鍵字

Liver transplantation ； Information Technology ； Pharmaceutical care

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