Development of the Pharmaceutical Care System in Liver Transplantation Using Internet-based Information Technology

運用網路化資訊科技開發肝臟移植藥事照護系統

As a result of liver transplant patients with multiple medication (poly-pharmacy) characteristics, pharmacists have played an essential role in the liver transplant care team since liver transplant care activity was introduced into our hospital in 2002. However, due to the lack of adequate information tools and both medication evaluations and instructions being in paper format, pharmacists have not been able to conduct patients' current medication review as effectively as desired, which might have led to less effective care quality in postoperative patients. The aim of this study was to build an internet-based liver transplant patient information system to improve medical care quality and to ensure patient medication safety. Pharmacist practical experiences were collected and evaluation confirmed the need for more rigorous information processing| then, the Information Technology Department was involved in the discussion process on an interface and function design for this system. The management system was built on utilization of "PowerBuilder v9.0" as the main programming language with "Oracle v11g" information database storage, which was based on "internet-based" information technology as the theoretical foundation. "Liver Transplant Medication Care System" in our hospital was successfully built under this study, which provides the following functions: (1) transplant patient's care status will be detected by this system and the pharmacist will be informed immediately| (2) medication evaluations and instructions can be conducted according to patient care stage, along with instant mutual communication between physicians by the interface system and message reminder| (3) physicians will be provided with all kinds of recommendations for medications and examinations at various stages| and (4) periodic review and improvements based on statistics by using instant screening criteria on statistics form will be introduced. This study has successfully turned traditional care and paper record systems into a systematic care and recording mode through internet-based information technology. This system can effectively assist pharmacists in liver transplantation care and ensure medication safety on liver transplant patients.

本院自2002年執行肝臟移植照護作業以來，由於肝臟移植病人多重性用藥的特性，所以藥師在肝臟 移植照護團隊中佔有不可或缺的角色，但照護藥師因無適當資訊工具協助導致作業效率低，且用藥評估 與用藥指導為紙本作業，無法有效地進行連貫性審視病人院內外用藥，導致病人術後照護品質不佳。本 研究希望運用網路化資訊科技建置以照護肝臟移植病人為中心的資訊系統，以提升醫療照護的品質及保 障病人用藥安全。首先，匯集照護藥師實務經驗並確認業務資訊化需求，再與資訊室程式設計師討論介 面設計與欄位規劃，最後以「網路資訊技術作為本管理系統建置之理論基礎，使用「PowerBuilder v9.0」 為主要程式語言搭配「Oraclevllg 資料庫儲存資料。本研究成功地建置「肝臟移植藥事照護系統」，本 系統提供各項功能有：（1）系統自動偵測並即時提醒藥師移植病人的照護狀態|（2）藥師可依照護階段及病 人用藥情形進行用藥評估及指導，期間亦可藉由溝通介面搭配簡訊通知與醫師進行即時性的雙向聯繫|（3） 用藥檢驗功能提供各階段用藥及檢查之建議給予醫師查詢使用|（4）統計表單功能提供各項篩選條件可即 時呈現各項統計數據以定期檢討改善|（5）透過雲端藥歷查詢病人院外、院內及同醫療體系用藥，達到用藥 連貫性審視。本研究將傳統照護及人工紀錄方式提升為系統化照護及紀錄模式，透過網路化資訊科技的協助快速且有系統地執行藥事作業，未來希望此系統可有效地協助藥師肝臟移植的照護作業（如降低排斥或感染次數及延長併發症發生時間），以確保肝臟移植病人用藥安全。