條碼之動態性應用評估：以急診胸痛臨床路徑管理為例

The Evaluation of The Dynamic Use of Bar Code: Taking the Clinical Pathway Management of the Chest Pain Patients in Emergency Department as an Example

條碼是資料輸入與辨識相當簡便、普及與經濟的方式，亦為醫療環境中病患安全管理的輔助工具。不過目前條碼之使用，仍以傳統靜態之標示為主，缺乏隨工作與環境變動所需具備之動態應用需求。由於醫護照顧工作與環境具備相當程度之動態特性，因此本研究乃以某醫學中心之急診胸痛患者臨床路徑管理為例，進行動態應用之可行性評估。評估條碼為39碼，系統開發採用主從式架構及Visual Basic.Net程式語言，搭配Microsoft SQL Server資料庫與Microsoft之BarcodeX元件進行簡易臨床路徑系統之開發，並配合Epson Photo 925印表機設備印製條碼；研究以科技接受模式(TAM)設計問卷，針對代表性急診護理人員採用訪談方式評估條碼動態應用之可行性。條碼資訊的設計包含患者ID、臨床路徑與疾病嚴重度，其中嚴重度以條碼的顏色顯示。系統包含新增病患、臨床路徑、條碼精靈三項主要功能及病患導覽、動態監控、使用者資訊等輔助功能；在照護過程中，無論是新增病患、臨床路徑區塊之病人，當處置或照護階段改變時，可透過條碼精靈由系統自動或根據實際需要手動產生條碼，紀錄病患即時狀態，於照護過程中提供重要輔助資訊。評估結果顯示條碼之動態應用除具備原先傳統之操作簡便優點外，更可具備色彩辨識、降低照護工作遺忘率、即時記錄病患資料之功效，技術可行性相當高，未來無疑亦可當作「智慧型標籤(Smart Tag, Radio Frequency Identification, RFID)」新技術的另一種選擇。不過未來實施之可行性仍須考量環境建置、條碼限制及病患感受等因素。

Barcode has been a very simple, popular and economic tool for data entry and identification. It also has been widely used in medical care to assure patient safety. Since all of the labels on the barcode have kept unchanged once they were created in most of the current applications, the value of barcode might be underestimated. The purpose of this study was to evaluate the feasibility of the dynamic use of barcode for the clinical pathway management of the chest pain patients in the Emergency Department of a teaching medical center in Taipei. The system was client-server based and programmed in Visual Basic. Net. The 39-code barcode was used for the study and designed using the Microsoft BarcodeX component. The Microsoft SQL Server was chosen for the database. The Epson Photo 925 color printer was used to generate the barcode labels. The Technology Acceptance Model (TAM) was used to evaluate the acceptability of systems by the emergency nurses. Barcode label carried three pieces of information patient ID, clinical pathway status, and acuity level which was represented by the color of label. The system was composed of six functions: New Patient, Clinical Pathway Design, Barcode Generating Wizard, Patient Data, Pathway Monitoring, and Administration. Barcode label could be easily generated automatically or manually and then pasted to the chart during the care process to display the most updated information of caring. The results showed the positive technical feasibility of the dynamic use of barcodes for patient care in terms of easiness, information- rich identification, process reminding, and simple but important patient data entry. This practice might be a good alternative to the 'Radio Frequency Identification (RFID)' technique in medical care. However, we still need to further examine the practical factors such as applied environments, barcode limitations, and patient preferences to assure its implementation feasibility.