運用品管圈手法改善化學治療醫囑資訊系統提升給藥執行成效

Using Quality Control Tools to Improve the Chemotherapy Order Information System

統計某區域教學醫院70位病人化學治療給藥醫囑執行過程中，共142次成效不彰(本文指跡近錯誤次數及給藥醫囑執行過程時間)，其中跡近錯誤109次(76.8%)，給藥醫囑執行過程>1.5小時佔81.43%；以魚骨圖分析，主要問題為：藥物劑量、滴數計算錯誤、重覆謄寫投藥與治療記錄單。期藉本案降低跡近錯誤為0次，施打藥物過程<1.5小時之達成率提升為85%。改善期間透過階段性進行：1.整併治療表單、統整藥物種類及方法；2.設計各癌別醫囑套餐、開發藥物自動換算模式；3.整合醫囑-藥物資訊系統，提升醫囑執行效率等改善方案。改善過程中5件成效不彰，跡近錯誤佔2次，經再度改善跡近錯誤降為0次；執行過程<1.5小時提升至91.93%。運用品管圈手法改善化學治療醫囑資訊系統，確實能提升化學治療給藥醫囑執行過程正確，降低跡近錯誤及減少給藥醫囑執行過程時間，增進團隊工作效率。

The statistics regarding the process of executing chemotherapy drug orders administration in 70 patients in a regional teaching hospital show that there were 142 times less-effective orders in total for the period of study. There were 76.8% near misses out of 109 times, and 81.43% taking more than 1.5 hours to execute. We analyzed the factors by fishbone diagram and found the main problems to be the following: dosage calculation of drugs, counting error in microdrop setting, and repeatedly written drug administration and treatment records. Based on these findings, our project goals were to reduce the near misses to none and increased the efficiency of executing drug administration order of less than 1.5 hours to 85%. During the period, we did the following: (1) integrated treatment sheets, drug types and administration methods, (2) designed bundles of drug use for different cancers and develop drug dosage automatic conversion model, (3) linked the order and drug information system to promote the efficiency of executing drug order administration. We reduced to five ineffective cases and two near miss cases. After further improvement, near misses were reduced to none and the rate of executing drug administration order less than 1.5 hours increased to 91.93%. In conclusion, using quality control tools to improve the chemotherapy order information system can truly improve the accuracy of the process of executing chemotherapy drug administration order. Also, it can reduce near misses and the time we spend on executing drug administration orders. Finally, it can increase the team work efficiency.