财团法人医院评鉴暨医疗品质策进会

1、February 09, 2010, MGH, Swaziland Practical Approaches to development of patient safety information systemsChien-Tsai Liu, Professor Graduate Institute of Biomedical Informatics, Taipei Medical University The Conference on Patient Safety & Integrated Health RecordsPatient safety definitions Narr

2、owly: the issues specifically related to adverse events and their preventionBroadly: any aspect of healthcare and health services that may lead to patient injury, and any interventions, including clinical, organisational and policy changes that aim to reduce injuryPatient safety is now one of the mo

3、st important issues in healthcare internationally through the initiative “World Alliance for Patient Safety” led by the World Health Organisation (Oct. 2004 )Medical ErrorsAdverse EventsNo harm eventsNear MissesPreventableeventsSentinel EventsNegligenceA Venn diagram of Patient safety definitions 財團

4、法人醫院評鑑暨醫療品質策進會財團法人醫院評鑑暨醫療品質策進會 .tw/Deaths associated with medical errors5 elements for improving Patient safety A just or fair culture that encourages a reporting and questioning culture that is complemented by systems for reporting and analysing incidents both locally and nationa

5、lly. A good in depth analysis process to establish root causes for selected individual incidents and aggregate incident reviews which enables learning. A process to ensure that actions are implemented, and corresponding improvements in patient safety and quality of care can be demonstrated. Effectiv

6、e processes for sharing information at various levels - nationally, organisationally and clinically - for learning and improvement. A redefinition of both punitive and non-punitive compensation systems in the healthcare environment, and an assessment of their impact on the patient safety culture and

7、 its achievements. Major causes of medical errors & adverse events Major causes of medical errors & adverse events Incomplete or missing informationMany adverse drug events could be avoided if healthcare providers had more complete information about which drugs their patients are taking and

8、whyLack access to patients complete medical history. Organizational factorsDeficiencies in system design, organization and operation, including an organizations strategy, its quality management tools, and its capacity to learn and adaptMain strategies for preventing medical errors and adverse events

9、 using ITnTools to improve communicationnMaking knowledge more readily accessiblenAssisting with calculationsnPerforming checks in real timenAssisting with systemic checking & monitoringnProviding decision supportBates and Gawande, NEJM 2003IT in healthcare applications: a reviewnDecision Suppor

10、t SystemsnComputerized Physician Order EntrynAdverse event systems & alert systemsnElectronic Medical Record (EMR)nIncident reporting systems ICT systems can lead to considerable benefits in patient safety only if they are user-friendly and fully integrated with other relevant systems.HAI survei

11、llance systems: an example Hospital acquired infection (HAI) surveillance is a systematic, ongoing data collection, analysis and reporting process that quantitatively monitors temporal trends in the occurrence and distribution of susceptibility and resistance to antimicrobial agents, and provides in

12、formation useful as a guide to medical practice, including therapeutics and disease control activities. . A HAI surveillance system features: Multiple systems involvedIntegrated work & information flows;Decision support; Monitoring & Alerts; ReportingUTI Risk factors extracted from EMRsRisk

13、factorsDescriptionSources fromfeverfever (body temperature 38)CPOE + IMSUrine/blood culture orderUrine/blood culture ordersCPOE + LISUrine/blood culture resultpositive urine/blood bacterial resultsLISurine routine examinationpyuria (urine specimen 10 white blood cell WBC/mm or 3 WBC/high power field

14、 of unspun urine)LISantibioticoral and injection antibioticsCPOE+ MMSinvasive devicesindwelling urinary catheter, cystoscopy, PCN, double J, cystofix IMSLIS : Laboratory information system; IMS: Inpatient management information System PMS: Medication management information system; CPOE: computerized

15、 provider order entryOther EMRsInterconnected secure networksMsg deliveryData collection & integration engineHAI surveillance databaseAnalysis, visualization & presentationAlerts & reporting management Early detection of infected cases & clusters (DSS)RIS(Radiology images reports)LIS

16、(Culture orders & results)IMS(patient admission data )CPOE(diagnosis & orders)NRS(care plan &drug administration) The framework of HAI surveillance systemIntegrated patient profiles based on the CDC guidelinesDashboard for summary of patients infection informationRefresh patients informa

17、tionSelection of risk predictorsRed: positive/yes; green: negative/noClick a specific patient to view his detailed admission data Decision support: Algorithms for detection of suspected HAI casesDiscrimination functions demonstrate high sensitivity ( 99.25%) & Specificity ( 94.92 %) the confirme

18、d cases can be exported to the excel files for further analysisThe confirmed cases can be linked to CDCs reporting system.Summary IT systems in healthcare applications have shown the effectiveness in reducing the number of advent events, and improving practitioner performance. The systems also could introduce or facilitate new types of errors (information errors and human-machine interface flaws) Evidence-based evaluation methods for evaluating such safe systems are critical.Summary (2) Evidence