探討部立醫院遠端抗生素審核中心之可行性評估－南區地區醫院為例－

To Investigate The Feasibility Asessment of The Health and Welfare Ministry Hospital Antibiotic Distal Audit Center ~ Southern District Regional Hospital Case Study~

郭昭吟(Chao-Yin Kuo)

指導教授 ： 張怡秋

國立中正大學/管理學院/資訊管理系醫療資訊管理研究所/碩士(2015年)

摘要

摘 要
近年來世界衛生組織(WHO)已推動抗生素管理計畫(ASP)，來減緩及控制泛抗藥性菌株形成，故國內衛生署、健保署或醫院內部皆列為重要措施。然而醫院專任感染管制人力不足，國內醫策會於民國92年於推動「病人安全品質監測」計畫，感染管制監測皆為每年目標之一，其中對抗生素的不當使用會造成細菌抗藥性，多重泛抗藥性菌株也增加，導致病人疾病惡化、合併症及醫療費用增加，皆是提升病人安全重要課題。
本研究目的為利用個案醫院使用遠端連線審核抗生素管理作業成效，推廣至衛生福利部醫療管理委員會(醫管會)，並模擬「衛生福利部影像判讀中心」模式，以提供規劃衛生福利部醫院「遠端抗生素審核中心」模組参考；以南區部立地區醫院為研究對象，醫院區分執行「遠端連線審核」及「傳真審核」，人員有醫療人員、感控醫師、決策者共24人，實際了解抗生素管理流程及成效，採用質性研究以半結構深度訪談為資料蒐集方式來做結果歸納分析。
訪談內容分析顯示，抗生素管理成效及幫助性，遠端連線審核醫院成效大於傳真審核醫院，而在探討規劃設立「遠端抗生素審核中心」時，醫療人員、感控醫師、決策者等人支持度為100%、推動可行性上有87%，推動的困難度上50%醫療人員及感控醫師擔心主要為醫院成本高，而決策者認為如何讓上層長官重視為首要條件，成本費用為次要。
本研究結果可讓部立無專任感控醫師醫院及醫管會作為配合政府推動抗生素管理方案的方法，共同提升病人照護品質，減少醫院成本，符合醫院評鑑規範，達到資源共享目的。

關鍵字：感染管制、泛抗藥性菌株、抗生素管理計畫、影像判讀中心

關鍵字

抗生素管理計畫 ； 泛抗藥性菌株 ； 感染管制 ； 影像判讀中心

並列摘要

Abstract
World Health Organization （WHO）have promoted Antimicrobial Stewardship Program (ASP) recently to reduce and control the emerge of pan-drug resistant strain,The Ministry of Health and Welfare, National Health Insurance Administration, and the hospital all adopt the program include it as an important action.The Joint Commission of Taiwan(JCT), has promoted “patient safety quality monitoring” program to, monitor infection control as the yearly goals for misuse of antibiotic will cause bacteria resisitance,and multi-drug resistant strain will lead to disease exacerbate,raise the complications, and increase health care costs. These are all important issues to enhance patient safety.
This research aims to extendthe effect of manageing antibiotic by remote connection to the Hospital and Social Welfare Organizations Administration of the case hospital and imitate “Image Reading Center,“IRC”mode, as reference to plan a“remote antibiotic examination center”. The case are district hospitals in southern district , one as the“remote connection examination” and the other as“fax examination”, Qualitative research using semi-structured indepth interviews were conducted for 24 interviewees including medical care personnels, infection control doctors, and decision makers to obtain their oppinionts abut practically procedure and the effect of antibiotic management.
The results showed that all the interviewees agreed that the “remote connection examination” is more helpful in antibiotic management than “fax examination”. While investigate the planning of “remote antibiotic examination center”, the support rating is also 100%,the feasibility of promoting the concept is 87%，50% of medical care personnel and infection control doctor worried that high costs for hospital is the main problem for promotion the concept while the decision maker considered that how to make the top executive pay attention to is the priority, cost is theminor.
This result provide theantibiotic management method for hospital which lack of infection control doctor and Administrationin of the Hospital and Social Welfare Organizations to coordinate with the government,raise the quality of patient care, reduce the costs,in accordance with the hospital accreditation standard, achieve the goal of resource sharing.

Keywords: Infection Control, Pan-drug Resistent Strain, Antimicrobial Stewardship Program (ASP), Image Reading Center (IRC)

並列關鍵字

Antimicrobial Stewardship Program (ASP) ； Pan-drug Resistent Strain ； Infection Control ； Image Reading Center (IRC)

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