目的：因應病人安全、健保規範及評鑑需求，醫令系統持續新增藥品相關之醫令 警示，但過多醫令警示除造成醫師開方過程複雜化外，也可能導致醫師對警示疲勞無 感。期待透過品質管理減少過度的醫令警示，提升醫師對醫令警示的接受度，以維護 用藥安全。 方法：(1) 透過不記名線上問卷評估與發現問題；(2) 成立跨領域品質管理小組； (3) 建置醫令警示系統記錄功能並設定優先改善之目標條件；(4) 設置達成目標值；(5) 繪製魚骨圖找出可能原因；(6) 分析真因；(7) 透過矩陣分析制定並落實改善對策，包 含「改良程式檢核設計邏輯」、「調整檢核條件設定」及「運用eliminate-combinerearrange-simplify (ECRS) 精實手法」。 結果：本次欲改善之目標警示案件數由2018 年 7 月分的57,873 件減少至同年 11 月分的 41,123 件，降幅 28.94%。此外，醫師接受警示的總比率也提升了 5.88%。 結論：為因應日新月異的臨床醫藥需求，以及避免過多的警示造成開方醫師產生 疲乏感，醫令警示系統需要持續不間斷地進行檢討與改善。適當且不過量的醫令警示 可以有效地提醒開方醫師，有助於提升病人用藥安全。
ABSTRACT
Objective: An ever increasing number of medication-related alerts are added to the computerized physician order entry (CPOE) system to meet the demand for patient safety, follow the payment restriction of the National Health Insurance Plan and achieve standards set by the hospital accreditation. However, excessive alerts not only complicate the prescribing process but also lead to “alert fatigue” among physicians. The current proposal aims to reduce excessive system alerts through the implement of quality management which may in turn increase the receptiveness of alerts by the physician and subsequently improve medication safety. Methods: (1) Identify the problem through online anonymous questionnaire. (2) Set up a cross-domain quality management team. (3) Set up an alert-monitoring system to identify priority targets for improvement. (4) Set a goal. (5) Draw a Cause-and-Effect diagram. (6) Identify the root cause. (7) Apply matrix analysis to determine improvement strategies including the “software modification,” “modification of the condition which triggered the alert” and “eliminate-combine-rearrange-simplify (ECRS) method.” Results: The monthly occurances of target alerts decreased from 57,873 in July to 41,123 in November with an estimated decrease of 28.94%. In addtion, the percentage of alert receptiveness by the physician increased by 5.88%. Conclusions: The alerting algorithm in the CPOE system needs to evolve constantly in accordance with the ever changing medical practices and yet to avoid creating alert fatigue with information overload. The appropriate and non-overloading number of alerts can assist physicians in making clinical decision effectively and improve patient safety.
