以提升病人安全為目的之RFID手術室醫療系統規劃與研究

Abstract

醫院醫療管理一直都是社會大眾關心的焦點，醫院各部門中，手術室人員面對的工作繁多且風險性高。醫療不良事件發生的場所有39.5%發生在手術室，可知手術室不良事件的發生率較醫院其他部門有偏高的情形。能在手術室服務流程上作有效管理，對提升病人安全及促進醫療服務品質，將可以較迅速之發揮成效，因此本研究以基隆長庚醫院的手術室為導入標的。 對於手術與全醫療界業而言，最重要的事莫過於提升病人安全，利用本研究提出之RFID(無線射頻辨識系統)手術室醫療系統將有助益。 目前台灣醫療業界導入RFID之現況多從事件觀點(例如以防範SARS而以RFID進行病人追蹤之用)及少部分病人辨識點之介入來導入RFID系統，無法真正落實提升病人安全之理想。 本研究將分析目前RFID於國內醫療系統的使用狀況，並針對手術室容易出錯的環節發展出一套RFID管理系統，如依照本系統流程進行手術的各項核對細節，可避免因醫療人員疏失所造成的傷害。 本研究設計並提出具有「提升病人安全(Improve patient safety)、自動驗證(Auto-checking)、 作業記錄(Proof-of-action)、精簡資訊顯示(Essential-display)、自動提示(Auto-reminder)」等五大特點之系統，設計與規劃主要分為兩項來說明： 一、邏輯設計： 本研究應用企業資源規劃(ERP)之觀念，以全面性之系統、組織結構、作業流程之整體架構來設計以提升病人安全的RFID醫療管理系統，化被動的資訊系統為主動的管控系統。 二、實體設計： 為實現RFID手術室醫療管理系統之理想，必須考量實體設備之特性、規格。本研究除了流程之邏輯設計外，亦設計實體系統之手術室電腦系統流程與畫面設計、基礎系統設施、行動化RFID 讀寫器、RFID標籤、內含RFID之手圈及其印製機與碎紙機等五項。 在個案研究中詳細敘述醫院於未導入RFID系統時的不便與易容出錯的狀況，提出導入之後的便利性與正確性的差異，可清楚驗證RFID手術室醫療系統的優點與實用性。

As hospital medical care management continues to be a focus concern of the general public, among all hospital departments, the tasks of surgical room personnel are not only fastidious but also with greater risks. 39.5% of medical malpractice incidents take place at the surgical room, a telltale sign reaffirming the scenario that ratio of surgical room malpractice occurred tends to be higher than that at the other departments. Hence the ability to effectively manage the surgical room service procedure that would poise to safeguard patient safety and enhance the overall medical care service quality can help to derive an instantaneous yield. With that, the study has chosen the Chang Gung Memorial Hospital in Keelung as the introductory study subject. As far as the surgical community and the entire medical care industry are concerned, the most critical element lies in how best to enhance patient safety. While utilizing the Radio Frequency Identification (RFID) system’s surgical room medical care system proposed by the study would help to achieve the goal. The current state of RFID induction by Taiwan’s medical care industry has largely broached from the event perspective, i.e. using RFID for patient tracking in SARS prevention, and from the identification point of a small number of patients that keep from truly realizing the ideology of enhancing patient safety. The thesis has focused on the present state of RFID adaptation in the local medical care system, together with focusing on some of the links at the surgical room that are prone to error, to develop a RFID management system, which is posed to greatly reduce harm caused by medical staff negligence when used to validate the surgical checklist. The study has devised and presented a system backed by five major characteristics of Improve Patient Safety, Auto-checking, Proof-of-action, Essential-display and Auto-reminder; the design and development can be described in two major categories, 1.Logical Design The study adopts the Enterprising Resource Planning (ERP) concept to devise an overall framework backed by comprehensive system, organization structure and operating flow for devising a RFID medical care management system that serves to enhance patient safety, and transforming a passive information system into an active control and monitoring system. 2.Tangible Design To achieve the ideology of the RFID surgical room medical care system, there is a necessity to take into account the characteristic and specification of the tangible equipment. For which, the study not only focuses on the logistical design of the flow, but also emphasized on devising a tangible system’s surgical room computer system flow and drawing design, infrastructure system facilities, encompassing five categories of mobile RFID scanner, RFID tagging, built-in RFID manual drawing, as well as a printer and a shredder. The case study that describes in-depth the inconvenience before a hospital inducts a RFID system and the state of errors that prone to occur, together with the differences in convenience and accuracy following the system induction duly presented, clearly validates the RFID surgical room medical care system’s advantage and practicality, and its tangible yield in excelling patient safety and improving the overall medical care service quality.