應用數位化科技於抗生素整合管理－－以成人門診抗生素為例

A Digital-Technologic Integration Platform for an Antimicrobial Stewardship Program - Prescribing Antibiotics for Adults in Ambulatory Care

目的：運用醫療資訊科技建置監控平台，以強化抗生素管理，並提升醫療照護品質。方法：結合現有醫療資訊系統自動化排程管理與SAS 雲端智慧平台整合功能，即時將各子系統數據於雲端運算後，整合管理後轉載於網頁，由感控部門進行動態性Top-Down 模式監測各項數值變化，定期於抗生素小組會議中檢討與改善。結果：研究期間本院泌尿科門診抗生素的用量有持續增加趨勢，運用此平台監控與改善後，其門診抗生素的開方率由27.6% 下降至23.1%（P<0.001），廣效性抗生素如fluoroquinolones 的開方率和使用量皆顯著降低。結論：透過資訊自動化與快速處理，再配合定期查核報表自動輸出，大幅降低人工的查閱與書寫時間，提升感染管制策略的效能，與醫療環境及病人安全品質。

Objectives: To use cloud computation and business intelligence, knowledge management technologies to establish a healthcare-associated infection management platform to comprehensively monitor an antimicrobial stewardship program and to make effective decisions about security-related applications in order to improve patient care and facilitate quality performance and patient safety. Methods: Knowledge management technology can retrieve data periodically and automatically from the data warehouse. The data can then be transformed or analyzed based on the demands of indicator owners or a hospital’s decision makers. The platform, serving as infrastructure, provides instant and real time data storage and analyses services on the web. Data stratifi cation services allow the antimicrobial stewardship program team to audit and provide feedback for quality improvement. Results: During the study period, increasing ambulatory antibiotic prescribing rates were found in the urology department. After the quality management mode was applied, both the antibiotic prescribing rate and consumption were significantly reduced for fluoroquinolones, a class of broad-spectrum antibiotics. Conclusions: This informative visual platform can be implemented in an interdisciplinary fi eld, by monitoring output via automated reports and decreasing paperwork. It also has enormous potential for improving performance measurement and patient safety.