建構急診小兒科常用藥物劑量決策支援系統促進用藥安全

Establishment of a Drug-dosage Decision Supporting System to Improve Drug-safety in Pediatric Emergency Department

近年來病人安全之議題受到極大的重視，雖然有許多有關如何改善病人安全的報告發表，但是其中以小兒用藥安全之議題的文獻卻仍相當的缺乏。根據研究報導，小兒科的病患比成年人更易因為醫療疏失而發生傷害，因為小兒藥物劑量通常需要醫師做劑量之調整，然而在劑量計算過程卻是一個相當容易 發生藥物錯誤（Medication Error，簡稱 ME）因素。小兒用藥缺乏一個標準劑量值，因為同年齡嬰幼兒的體 重個體化差異性很大，因此小兒科病患容易遭遇 ME 及傷害，尤其是在急診小兒科。近年來國內的急診小兒藥物疏失頻傳，探究其原因為缺乏專為小兒科所設計的資訊系統，來協助醫療人員提升小兒用藥安 全。因此本研究之目的在整理急診小兒常見 ME 之藥物，歸納整理相關之藥物劑量資訊並建立劑量決策規則，並建立一個「急診小兒常用藥物劑量決策支援系統」來輔助急診小兒科之醫療人員，期望降低藥 物劑量錯誤發生率，提升急診小兒科病患之用藥安全。 本研究是以北部某醫學中心急診小兒科作為研究施行單位。首先整理有關急診小兒常見 ME 之文獻資料，歸納出常用之藥物，然後收集統整相關藥物的劑量建議、適應症狀、給藥途徑及藥物劑量等資訊， 制定劑量決策規則並將此規則建立於藥物劑量資料庫中，並建置以 Web 為操作介面的「急診小兒常用藥物劑量決策支援系統」，用來協助急診醫療人員進行小兒用藥劑量之評估。最後以劑量合理性評估及系統 滿意度調查之方式來評估系統之效果與接受度。 整理歸納出急診小兒常見 ME 之藥物，並建置劑量決策規則及急診小兒常用藥物劑量決策支援系統。 經由藥師及醫師進行系統評估，系統建議劑量合理性可達98.3%。針對使用者滿意度調查之結果，回收 20 份臨床專業人員之有效問卷，系統總滿意度達 7.1%。醫療人員認為本系統可以提供快速且適合病患 之劑量建議，對於小兒劑量之評估相當有幫助，僅可以減輕工作上之心理壓力且可以降低 ME 之發生。 此評估結論肯定了本研究之結果。

The issue of patient safety is highly respected in recent years. Although there were much reports about how to improve patient safety, few discussion about medication-safety in pediatric patients. Accordingly, pediatric patients suffered from more adverse drug events and harms easily in medical malpractice than adults. Usually, dosage adjustment by physician is necessary in pediatric medication. However, medication error often happens when calculated about drug dosage. Pediatric patients, especially who visit emergency room(ER) are more valuable to medication error, due to lack of standardized dosage of pediatric medication. Much medical malpractice in pediatric drugs was announced recently. The reason is that there is no drug-dosage information system designed for pediatrics. Pediatric patients suffered from more adverse drug events and harms than adults. The aim of this study was to collect the category of common medication error in pediatric patients, and to build a drug-dosage decision support System. Then we applied it to improve patient safety in pediatric emergency department by reducing the incidence of dosage errors. This study was performed in an emergency unit in a medical center in North Taiwan. Initially, by literature review and a professional conference we collected the drugs most common prone to ME (Medication Error) in the pediatric emergency care setting. Next, we collected these drugs’ information about therapeutic indications, dosage, administration, maximum dose. After arranging and categorizing these drugs’ information, we created an electronic database for pediatric dosage in emergency room. Subsequently, a weight-based pediatric dosage decision support system was designed on web interface to support the pediatric emergency care professionals (ex. physicians, pharmacists and nurses) prescribing or re-checking the dosage. Finally, the effect of system was evaluated by the investigation analysis by emergency care staffs. In results, there are the most common prescribed in the emergency department and prone to medication error selected and made the rules of dose calculation in this study. All the emergency staffs who involve in this study agreed that this system is beneficial to prescribe or re-check the pediatric dosage. This system was evaluated by 20 clinical professionals for its usage and 97.1% users satisfied with it. Moreover, over 98% decisions provided by this system were evaluated as correct and acceptable. We hope that the healthcare professionals could spend less time to calculate the dosage and get more correct recommend dosage and reduce medication error by this pediatric dosage decision support system in the future.