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研究生:許秋琴
研究生(外文):HSU CHIU CHIN
論文名稱:運用資訊科技提昇住院病患用藥安全之探討-以某中部醫學中心為例
論文名稱(外文):The Discussion of using Information Technology to Promote Medication Safety- Inpatients at a Medical Center in Middle Taiwan
指導教授:藍守仁藍守仁引用關係
指導教授(外文):Lan SJ
學位類別:碩士
校院名稱:亞洲大學
系所名稱:健康管理研究所
學門:商業及管理學門
學類:醫管學類
論文種類:學術論文
論文出版年:2008
畢業學年度:96
語文別:中文
論文頁數:70
中文關鍵詞:用藥安全電腦條碼藥物不良事件
外文關鍵詞:medication safetyBar codeadverse drug event(ADE)
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二十一世紀中,病人安全議題愈來愈受到重視;民國91年自北城給錯藥事件後,台灣亦開始重視病人安全及藥物不良事件問題,台灣醫策會(2003)調查發現,50%醫事人員曾處理或發生藥物不良事件,其中比例最高者為藥物傷害(23%);最常見不良事件之前五名分別為:給錯口服藥、院內感染、手術造成之合併症、住院跌倒及打錯針,但當前各醫院資訊化的進展不一,期待各醫院能運用資訊科技(Information Technology)建構較完整的資訊機制,故嘗試探討應用資訊科技(Information Technology)提昇病患用藥安全。
本研究主旨在探討利用資訊科技,自動化無線射頻之辨識機制,使用行動護理車及手持式電腦條碼閱讀器,提昇病患用藥安全之探討。
本研究為橫斷式(A cross-sectional)研究,採描述性相關設計(descripitive correlational design),主要透過結構式問卷調查方法,以某中部醫學中心護理人員為研究對象,使用自行設計問卷,實施測試調查,數據收集後,將所得資料編碼、建檔,以SPSS12.0套裝軟體分析資料,依據研究目的和變項性質,選擇以描述性及推論性統計進行相關分析檢定。
此研究指出,使用Bar code是很有效的方法來面對藥物錯誤,其為簡單的方法可確認藥物劑量,核對正確的病人辨識,每個步驟亦可被精確的檢查,本研究主要發現如下:
一、針對藥安全文化與基本資料之變異性分析,結果在婚姻項目有顯著差異。
二、針對滿意新的藥品管理制度與基本資料之變異性分析,在ICU經驗項目有顯著差異。
三、用藥安全文化之向後逐步迴歸分析,顯示教育程度(專科 vs 大學/碩士) 及年齡(46- 50歲 vs 25歲以下)達顯著水準。
四、用藥安全教育之向後逐步迴歸分析,顯示ICU經驗(有 vs 無) 及工作時數(60-
99HRvs 20-39HR) 達顯著水準。
五、滿意新的藥品管理制度之向後逐步迴歸分析,顯示工作年資(11-15年 vs 16年以
上) 達顯著水準
本研究依上述結論,分別對醫院管理者、學校教育者、護理人員、及後續研究者提出以下建議:
許多研究顯示使用BPOC,可以降低用藥錯誤,BPOC將成為主流,但其非為唯一預防藥物錯誤的解決之道,標準流程、安全藥物貯存、藥物之適當標示及其他安全措施仍不該被忘記,尤其護理人員是防止醫療疏失的最後一道防線,應建構以病人為中心的安全醫療環境,透過運用條碼、無限射頻辨識技術及資訊科技,提昇病患用藥安全,使病患能接受更安全之用藥資訊設計,有效預防人為疏失,提供病人有更安全品質之醫療環境。IOM估計每年與藥物相關的發病率及死亡率的花費約77,000,000美金,若電腦條碼技術可用於未來20年,將可攔阻一半的藥物錯誤,其將省下93,000,000美金,故建議未來藥品的產品編號及到期日期設計到電腦條碼內,委託藥廠必須包裝藥物於單位劑型。
醫療保健系統今天正日益複雜,而電腦條碼Bar code、無線射頻辨識系統與行動護理電腦等資訊科技,除了應用於用藥安全,亦可外推應用於輸血管理、手術病患辨識、產婦與嬰兒辨識、失智老人管理、檢驗管理,相信在未來不久將如火如荼導入醫療產業。
The issues of patient safety and medication errors have been getting emphasized worldwide in the 21th century.The problems of patient safety and adverse drug events have also been paid attention since the incident of medical error caused a baby girl died in Taiwan. Taiwan Joint Commission on Hospital Accreditation (2003) shown that about 50% of healthcare professionals have dealt with medical events. Adverse drug events were the highest rate of medical incidents (23%) from the study, hospital-acquired infection were about 12%, and post-operation complications and invasive treatments or tests were the third high ranking of medical events. Moreover, the top five most common medical adverse events include oral medication errors, nosocomial infections, post-operation complications, patient falls, and injections errors. The purpose of this study is going to investigate the efficiency of Information Technology, the system of automatic identification, the use of mobile laptops, and barcode readers in reducing medical adverse errors and increasing patient safety. Besides, the study is also going to exam whether these computerized medical systems could decrease the rate of adverse drug errors, save time for medication checks, advance the results of tracing the reasons of medical errors, and assist nursing staffs with ensuring the five patient rights at the bedside that include right medication, right patient, right dose, right route of administration and right time. The research used cross-sectional correlation study method and operates quasi-experimental design for the study in a medical center in the middle Taiwan. All data were collected, recorded and analyzed by SPSS software. There were some suggestions that high technology should be considered for using in computerized medical system that in order to promote patient safety in appropriate medication intake, effectively prevent medical negligence and provide higher quality of health care to patients.
The study found that nurses who have ICU experiences or longer seniority (11-15 years vs. 16 years) can reach the level of the new medication administration system. Regardless of whether nurses had experience of ICU, their education level, ages and work hours, they can also reach the level of medication safety education program.Bar code is an effective method to reduce the incidences of medication errors that can be used in confirming medication dosage, patient identification, and checking each procedure of medication administrations. BPOC will be a new mainstream, which it may be expected to develop a safer environment and higher quality medical services to patients. However, it is not the only way to prevent the incidences of medication errors, nurses and healthcare professionals are still playing the most important role to be the last defense of keeping the basis of patients’ safety.IOM estimated annual drug-related morbidity and mortality rate of about 77 million U.S. dollars spent, if the computer bar code technology can be used for the next 20 years, will be able to block the wrong half of the drug, it will save 93 million U.S. dollars, the proposed future pharmaceutical products And the expiration date design to computer bar code, commissioned by the pharmaceutical companies to package drugs in the flat type.
目 錄


第一章 緒論
第一節 研究動機與背景 1
第二節 研究目的 3
第三節 病人安全名詞界定 4
第二章 文獻探討
第一節 RFID-無線射頻辨識 7
第二節 醫院行動護理電腦 11
第三節 CPOE-電腦化醫令系統 14
第四節 電腦條碼重點照護 17
第五節 電腦條碼重點照護在各國之應用 18
第三章 研究方法
第一節 概念架構 23
第二節 研究假設 24
第三節 研究設計 25
第四節 研究對象 33
第五節 研究工具 33
第六節 研究倫理 36
第七節 資料統計方法與分析 36
第四章 研究結果
第一節 描述性統計分析 38
第二節 變異數分析及t撿定 47
第三節 研究信度分析 54
第四節 研究變項相關分析 55
第五節 研究迴歸分析 58
第五章 討論
第一節 討論 60
第二節 研究限制 62
第六章 結論與建議
第一節 結論 63
第二節 建議 64
參考文獻 66
附錄
附錄一 運用資訊科技提昇住院病患用藥安全之探討問卷調查內容 70
表 目 錄
表 2-1 RFID種類和特徵 10
表 2-2 RFID最常使用的頻率 10
表 4-1個人屬性描述性統計分析 41
表 4-2個人屬性描述性統計分析 42
表 4-3用藥安全文化資料分佈 44
表 4-4用藥安全教育資料分佈 45
表 4-5電腦條碼重點照護及核藥更新作業資料分佈 46
表 4-6用藥安全文化與基本資料之變異性分析 48
表 4-7用藥安全教育與基本資料之變異性分析 48
表 4-8電腦條碼重點照護與基本資料之變異性分析 49
表 4-9滿意新的藥品管理制度與基本資料之變異性分析 49
表 4-10用藥安全文化與基本資料之變異數分析 50
表 4-11用藥安全教育與基本資料之變異數分析 51
表 4-12電腦條碼重點照護與基本資料之變異數分析 52
表 4-13滿意新的藥品管理制度與基本資料之變異數分析 53
表 4-14"第一、二、三部分"信度分析 54
表 4-15用藥安全文化平均分數 55
表 4-16研究變項相關分析 56
表 4-17用藥安全文化之向後逐步迴歸 57
表 4-18用藥安全教育之向後逐步迴歸 57
表 4-19滿意新的藥品管理制度之向後逐步迴歸 57
圖 目 錄
圖2-1 RFID系統架構圖 8
圖2-2 RFID之運作流程 9
圖2-3 行動護理電腦車 12
圖2-4 行動e療護理站示意架構 13
圖2-5 電腦化醫令系統 16
圖2-6 電腦化醫令系統藥品查詢 16
圖2-7 barcode scanner 17
圖3 研究架構圖 28
圖4 電腦條碼重點照護與核藥更新作業滿意度之線性關係 37
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