臺灣博碩士論文加值系統

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。

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.

注射劑醫囑結構化與臨床決策支援系統應用 i
審定書 ii
上網授權 iii
誌謝 iv
目錄 v
表目錄 vii
圖目錄 viii
論文摘要 ix
Abstract xi
第一章 緒論 1
1.1 研究背景與動機 1
1.2 研究目的 3
1.3 論文架構 3
第二章 文獻回顧 4
2.1病人安全 4
2.1.1病人安全定義 4
2.2醫療用藥疏失 7
2.2.1疏失定義 7
2.2.2醫療用藥疏失 8
2.3注射劑醫囑 13
2.4電腦醫囑資訊系統/臨床決策支援系統 16
2.5國內外相關注射劑醫囑資訊系統研究 17
第三章 系統架構與設計 23
3.1系統開發原則 23
3.2系統架構概述 23
3.2.1注射劑知識庫 25
3.2.2臨床決策支援應用 31
3.3系統評估 37
第四章 研究結果 40
4.1 系統開發工具 40
4.2 系統運作狀況 40
4.2.1 注射劑知識庫平台 42
4.2.2 注射劑知識庫平台注射劑項目分析 44
4.2.3臨床決策支援應用 44
4.2.4警示紀錄 51
4.2.5錯誤警示紀錄分析 51
第五章　討論與結論 72
5.1系統比較 72
5.2研究限制 74
5.3 結論 74
5.2 對於學術研究、醫療產業及其他應用方面預期之貢獻 75
參考文獻 76

中文文獻
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財團法人醫院評鑑暨醫療品質策進會：台灣病人安全通報系統2010年年報。Retrieved from http://www.tpr.org.tw/images/pic/files/台灣病人安全通報系統2010年度報表_201106241151.pdf
財團法人醫院評鑑暨醫療品質策進會：台灣病人安全通報系統2013年第三季季報。Retrieved from http://www.tpr.org.tw/images/pic/files/台灣病人安全通報系統2013第三季季報表_final_201312091557.pdf
曾憲鈺（2012，12月21日）‧《設計的法則》錯誤 (Errors)‧2014年07月01日。
Retrieved from http://www.innofaci.com/2012/12/21/design-principle-errors
劉惠文：病人安全-醫師疑義處方分析實務，台灣泌尿科醫學會月訊，第179期，2010年05月，P.51-52 Retrieved from http://www.tua.org.tw/form/Folder/99/990513/179.pdf
賴聖鵬(2003年)，藥師進行注射劑教育課程對護理人員知識、態度和行為的影響，臺北醫學大學藥學研究所碩士論文，民92
顏秉文、蕭士軒：醫囑電腦化系統，慈濟醫學，2007;19(Suppl 1):29-32
蘇麗智、簡淑真、劉波兒、蘇惠珍、林靜娟、呂麗卿等(2012)‧實用基本護理學(下冊)‧臺北：華杏。

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電子資源
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