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研究生:陳瑋婷
研究生(外文):Wei-Ting Chen
論文名稱:在運用高風險警示系統下評估醫師更改抗生素醫囑的時間
論文名稱(外文):Effect of High Risk Results Reminder System on the Interval of Changing Antibiotics Orders in a Hospital
指導教授:徐建業徐建業引用關係
指導教授(外文):Chien-Yeh Hsu
學位類別:碩士
校院名稱:臺北醫學大學
系所名稱:醫學資訊研究所
學門:醫藥衛生學門
學類:醫學技術及檢驗學類
論文種類:學術論文
論文出版年:2007
畢業學年度:95
語文別:中文
論文頁數:49
中文關鍵詞:高風險警示系統
外文關鍵詞:High Risk Results Reminder System
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論文名稱:在運用高風險警示系統下評估醫師更改抗生素醫囑的時間
臺北醫學大學醫學資訊研究所
研究生姓名:陳瑋婷
畢業時間: 95 學年度 第 2 學期
指導教授:徐建業 臺北醫學大學醫學資訊研究所副教授兼所長
協同指導教授:李友專 陽明大學生物醫學資訊研究所教授兼所長

動機:許多研究調查顯示,資訊科技可以有效減少醫療失誤及不良事件比率,衛生署為推動以資訊科技協助增進病人安全,其中包含高風險警示系統(High Risk Results Reminder,HRR)建置及成效。本研究即利用微生物培養高風險警示系統的建置,評估系統的成效。
目的:分析微生物培養高風險警示系統上線前後,醫師更改抗生素醫令的處理時間差異,藉此觀察醫師行為是否於系統上線前後有縮短,以評估系統的有效性。
實驗設計:95年1~6月為系統介入實驗期,94年1~6月為未介入的對照期間。
結果:經由觀察所有微生物培養高風險檢驗結果產生後發現,系統介入後醫師更改的抗生素醫囑時間平均差77.13分鐘,統計具顯著(p=.004<0.05)。此外,當發現血液中含有微生物時,系統介入後醫師更改的抗生素醫囑時間平均差69.01分鐘,統計具顯著(p=0.010<0.05)。由於一般病房中有高風險警示,一天內之顯著性(p=0.010<0.05),相較於加護病房之顯著性(p=0.151>0.05)有差異,此系統對於一般病房的資料顯示醫師更改抗生素醫囑時間明顯較有差異。
結論:整體而言,系統介入後,醫師更改醫囑的行為都有加快。在系統介入後,對一般病房的病人保護作用較大。
Title of Thesis:Effect of High Risk Results Reminder System on the Interval of Changing Antibiotics Orders in a Hospital
Author:Chen, Wei-Ting
Thesis advised by : Chien-Yeh Hsu
Taipei Medical University,
Graduate Institute of Medical Informatics
Thesis co-advised by : Li, Yu-Chuan
National YangMing University,
Institute of Biomedical Informatics

Many research indicate that information technology can reduce medical errors and medical adverse events rate. The Department of Health improves patient safety by promoting information technology, including the establishment of High Risk Results Reminder System and its evaluation. This study also evaluates the effects of the establishment of High Risk Results Reminder System on the culture .
Purpose:Effect of High Risk Results Reminder System on the interval of changing antibiotics orders in a hospital .
Design and settings:The culture of High Risk Result Reminder System was activated in one medical center for a 6-month intervention period from January to June 2006; compared with a 6-month control period without intervention from January to June 2005.
Result:When the system was set online, doctor reduced time to modify the antibiotics order. There was a significant difference after intervention (p=.004<0.05). The results of the culture in blood showed the significant difference between before and after the system online (p=0.010<0.05). In one day, the general ward there was significantly different between the system online before and after (p=0.010<0.05), but the ICU there showed no significant difference (p=0.151>0.05).
Conclusions:Doctors have reduced time to modify the order after intervention of the system. The shorting of delay has proven to be more prominent in the general ward patients than in the ICU inpatients.
標題 i
審定書 ii
致謝 iii
目錄 iv
表目錄 vi
圖目錄 vii
中文摘要 viii
英文摘要 x
第1章 緒論 1
1.1 研究背景 1
1.2 研究動機 4
1.3 研究目的 6
第2章 文獻查證 7
2.1 醫療警示系統 7
2.2 病人安全 8
第3章 研究材料與方法 12
3.1 資料庫建置 12
3.2 系統建置 13
3.3 系統設計 14
3.4 系統流程 15
3.5 系統需求 18
3.6 醫師反應時間評估 18
第4章 分析與結果 23
4.1 94、95年1~6月所有資料分析 31
4.2 94、95年1~6月血液檢體資料分析 32
4.3 微生物培養簡訊發送前二名的資料分析 33
4.3.1 Coaugulase neg. sta.(MRS)資料分析 33
4.3.2 Escherichia coli資料分析 34
4.4 病房分析 35
4.4.1 加護病房資料分析 35
4.4.2 一般病房資料分析 36
第5章 討論 38
5.1 所有資料無母數分析 38
5.2 血液檢體資料分析 39
5.3 微生物培養簡訊發送前二名資料分析 39
5.4 依照病房分析 40
第6章 結論與建議 41
6.1 結論 41
6.2 建議 42
參考文獻 43
中文文獻 43
英文文獻 43
電子資料 45
附錄 46
附錄一 使用者滿意度調查 46
中文文獻
郝德慧、李友專、李彥良、王博彥、陳正怡、龍安靖、邱文達,建立醫院之病人安全資訊基礎建設,台灣醫學,民93,8(4),542-548
莊淇源、蕭炳昆,病患安全與醫療疏失-淺談重症加護病房注意事項,醫療資訊雜誌,民93,13(1),91-102
孫漣,<臨床即時警示系統--以腎臟科為例>,國立陽明大學公共衛生學研究所,碩士論文,民86.6.
英文文獻
Bates DW, et al:Improving Safety with Information Technology. The New England Journal of Medicine 2003;348(25):2526-2534
Bone RC. The sepsis syndrome: definition and general approach to management. Clin Chest Med ,1996; 17:175-81.
Classen DC, Pestotnik SL, Evans RS, Burke JP. Computerized surveillance of adverse drug events in hospital patients. JAMA, 1991;266:2847-51.
Institute of Medicine. Improving the 21st-century health care system. Crossing the quality chasm: A new health system for the 21st century. Washington, DC: National Academy Press,2001.
JCAHO, 2006 JCAHO National Patient Safety Goals Approved, Joint Commission Perspectives 2005.
Jha AK, Kuperman GJ, Teich JM et al. Identifying adverse drug events: Development of a computer-based monitor and comparison with chart review and stimulated voluntary report. JAMIA , 1998;5:305-314.
Kohn LT, et al. To err is human: building a safer health system. Washington, D.C.:National Academy Press, 2000.
Kuperman GJ, Boyle D, Rittenberg E at al. How Promptly Are Inpatients Treated for Critical Laboratory Results? JAMIA, 1998;5: 112-119.
Kuperman GJ, Teich JM, Tanasijevic MJ et al. Improving Response to Critical Laboratory Results with Automation. JAMIA, 1999;6:512-522.
MJ Ball, DE Garets, TJ Handler: Leveraging IT to Improve. Year book of Medical Informatics, 2003, 153-8.
Rind DM, Safran C, Phillips RS et al. Effect of Computer-based Alerts on the Treatment and Outcomes of Hospitalized Patients. Arch Intern Med, 1994;154: 1511-1517.
Sailors R.M., East T.D. Clinical Informatics: 2000 and Beyond. Proc AMIA Symp, 1999, 609-613.
Schoenberg R, Sands DZ, Safran C. Making ICU Alarms Meaningful: A Comparison of Traditional vs. Trend-based Algorithms. Proc AMIA Symp, 1999, 379-383.
Shabot M, LoBue M, Chen J. Wireless Clinical Alerts for Critical Medication, Laboratory and Physiologic Data. Proceedings of the 33rd Hawaii International Conference on System Sciences (HICSS) IEEE Computer Society, Jan. 2000.
Shabot M.M., Gardner R., Kuperman G.J., Sittig D.F., Warner H.R. ClinicalAlerting Systems for Health Care Decision Support. Proc AMIA Symp, 1999.
Shea S, Sideli RV, DuMouchell W et al. Computer-generated Informational Messages Directed to Physicians: Effect on Length of Hospital Stay. JAMIA, 1995;2: 58-64.
Sorin DI, David O, Julian Z. A Comprehensive Computerized Critical Laboratory Results Alerting System for Ambulatory and Hospitalized Patients. Medinfo, 2001,469-473.
Sorin DI, David O, Julian Z.A Comprehensive Computerized Critical Laboratory Results Alerting System for Ambulatory and Hospitalized Patients. Medinfo, 2001, 469-473.
Wagner MM, Pankaskie MC, Hogan WR et al. Clinical Event Monitoring at the University of Pittsburgh. Proc AMIA Annu Fall Symp, 1997, 188-192.
電子資料
病人安全簡介,病人安全資訊網,Available at: http://www.patientsafety.tw/big5/Content/Content.asp?cid=2
國家生技醫療品質獎暨國家品質標章(2004),病人安全執行小組與病人安全資訊中心,Available at: http://ad.cw.com.tw/ad/ch/2004ibmi/i.htm
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