住院病房雲端照護系統——科技、效率、安全與護理友善

Cloud Care in a Hospitalization System-Technology, Safety, Efficiency and Nurse-Friendliness

IOM（2001）提出病人安全、以病人為中心、有效醫療、效率、及時與公平六大醫療品質目標，人口老化與慢性病使個案安全風險提高；因此病人風險評估越顯重要，跨團隊及時照護介入需求也就越高。護理師是病人照護團隊中評估發現病人問題的關鍵角色，資訊系統又是公認確保病人安全、促成醫療改變的重要方法之一，因此以護理為主體發展之行動化與雲端化的住院照護相當值得投入。本文分享新科技技術－利用生理監測儀的無線上傳功能，將測量值「主動上傳」至醫院資料庫，運用雲端運算技術作最快速及正確的資料傳輸。另發展「護理風險評估系統」以入院護理評估為主體，擴大整併營養、復健、自殺∕傷、健康生活（戒菸）與返家適應等五項風險評估，護理師將評估結果輸入系統，系統自動轉拋高風險條件病人清單給照護團隊；以上兩種研發，在資料拋轉後形成跨團隊溝通平台，提供及時介入再評估與照護；自此住院病房全面實施「無所不在的照護」（Ubiquitous care）。經由實際觀察、時間測量、問卷調查與意見訪談等方式進行成效評估，發現：操作便捷與自動拋轉寫入的系統特色減少了護理師記憶、重覆抄寫、通報等工作負荷及干擾，確保通報資料之完整與正確；同時排除團隊成員之等待通知或須親臨閱讀的限制，醫師在任何網路可及之處皆能主動查詢，團隊由被動變成主動訪視。此行動化、雲端化的高科技真正減輕護理工作負荷，讓護理回歸病人直接照顧與關懷，提升團隊溝通與照護效能與職場友善，持續朝向IOM醫療照護品質目標邁進。IOM (2001) proposed that safety, effectiveness, efficiency, patient-centeredness, timeliness, and equitability are the six aims for medical quality improvement. Aging and chronic diseases increase the patient risk. Therefore, the high-risk assessment of patient safety becomes increasingly important, and the demand of multidisciplinary care grows gradually. Nurses are the key person among the healthcare team of revealing patient problems. Informatics is recognized as one of the important methods to ensure patient safety, contributing to the medical change. Thus, nursing-initiative mobilization and cloud hospitalized-patient care are worthwhile to invest.The purpose of this article is to share a new technology, a wireless physiological monitoring system automatically transporting measured values to the hospital database, and to use cloud computing technology for the most rapid and correct data transmission. In addition, based on the admission nursing assessment, including nutrition, rehabilitation (functional status), suicide/self-harm, healthy-lifestyle (smoking cessation) and discharge planning, the five-risk assessment was integrated and the nursing-initiative patient risk assessment was developed. After the assessment by nurses, information encoded into system then was automatically transported to the cloud computing service. High-risk patient note was the output for healthcare team. Because of the above two research and development, after the automatic data transportation, multidisciplinary communication platform was constructed. Healthcare team members could provide reassessment and care timely. The ubiquitous care in hospitalization units was then fully implemented.The effectiveness evaluation method was implemented by actual observation, time measurement, questionnaire survey, and interview. The Cloud Care in a Hospitalization System has specific characteristics of easy operation and automatically transporting data to the system, and that decreases nurses constantly making notes, transcribing repeatedly, and having heavy workload and interruptions, and ensures the completeness and correctness of patient information. Simultaneously, that excludes the team members' waiting to be notified or limitations of reading in person. Physicians can actively inquire anytime and anywhere as long as the Internet is accessible. The patient visits are from passive into active by healthcare team members. Therefore, the mobilized and cloud high technology makes nurses have more time to provide patient direct care and enhance multidisciplinary communication, care performance and nurse-friendly workplace, thereby stepping toward the aims of IOM.