運用預設定資訊技術改善醫囑途徑與頻次開立疏失

Using information technology of default setting to improve prescription error related dosing route and frequency

利用電腦醫囑輸入系統可避免手寫處方之疏失發生，但處方之正確開立，尚須透過藥師專業知識的協助，因此發展出臨床決策支援系統提供交互作用、過敏、極量等管控機制，但過多警報反而造成開立不便與警示疲乏而失效。故本研究想藉由提供醫囑開立途徑與頻次之預設定給醫師及時且非警報模式之用藥資訊，並評估是否能減少病安異常事件。調查本院藥品資料與醫囑開立現況，將藥品常用頻次或途徑經設定預帶至處方開立畫面。當點選該藥品時，系統會自動帶出常用頻次或途徑。已提供預設頻次或途徑之藥品，醫師尚可依臨床需求進行調整，可避免影響臨床之特殊使用。此外，藉由每月病人安全通報系統回報之藥物事件進行檢討，分析系統設置後之改善成效，包含設置前後筆數與改善率之比較。比較本院預設定資訊系統設置前1年（2014年）與設置後1年（2015年）病安通報資料，頻次與途徑疏失之處方開立疏失由設置前每月7.4筆降低至2.8筆，改善率達62.9%。本研究提出藥品途徑與頻次之預設定功能確實可降低該類處方疏失之發生，且可在不干擾醫囑開立情形下，提供醫師即時且靜態的藥品資訊。

Computerized physician order entry (CPOE) systems could avoid the errors from poor handwriting prescriptions. Although the clinical decision support system (CDSS) could improve patient safety and lower medication-related costs, researchers have warned that ''alarm fatigue'', caused by excessive numbers of warnings, could jeopardize the process of prescription writing. The aim of this study was to provide instant medical information without giving unnecessary alarms. The default unique frequency and route was automatically entered into the prescription writing for CPOE system, but it was allowed to change according to clinical necessity. Medication error records were periodically reviewed and analyzed on a monthly basis. Data from patient safety reporting systems (PSRS) was compared between 1 year before (2014) and 1 year after (2015) the mechanism was implemented (from 2014 Jan to 2015 Dec). The incorrectly prescribed number was 7.4 cases per month before and 2.8 cases per month after the implementation of preemptive information, with an improvement of 62.9%. CDSS within CPOE can accelerate workflow and enhance health-care quality and patient safety by offering the caregivers sufficient information with less disruption. More effort and collaboration will still need to be made by both doctors and pharmacists to improve the prescription systems.