TWI692777B

TWI692777B - Intelligent drug warning system for acute kidney injury

Info

Publication number: TWI692777B
Application number: TW107140713A
Authority: TW
Inventors: 蘇建豪; 許茜甯; 王郁青; 戴慶玲; 李浩銓
Original assignee: 長庚醫療財團法人高雄長庚紀念醫院
Priority date: 2018-11-16
Filing date: 2018-11-16
Publication date: 2020-05-01
Also published as: TW202020886A

Abstract

一種智能化急性腎損傷藥物警示系統，藉由系統自動運算血清肌酸酐的變化，及時警示醫師腎損傷程度以及潛在問題用藥，並提供相關處置與劑量調整建議，透過智慧化、人性化以及視覺化的設計，降低警示疲倦，提升使用端對於警示的接受度與縮短對急性腎損傷的反應時間，以提升照護品質並改善病人預後。 An intelligent drug warning system for acute kidney injury. By automatically calculating the changes in serum creatinine, it can alert doctors of the degree of kidney injury and potential problem medication in time, and provide relevant treatment and dose adjustment suggestions. Through intelligentization, humanization and visualization The design reduces the fatigue of warnings, improves the acceptance of warnings at the user end and shortens the reaction time to acute kidney injury, so as to improve the quality of care and improve the prognosis of patients.

Description

智能化急性腎損傷藥物警示系統 Intelligent drug warning system for acute kidney injury

本發明為一種急性腎損傷藥物警示系統，尤指一種智能化急性腎損傷藥物警示系統，藉由系統自動運算血清肌酸酐的變化，及時警示醫師腎損傷程度以及潛在問題用藥，並提供相關處置與劑量調整建議。 The present invention is an acute kidney injury drug warning system, especially an intelligent acute kidney injury drug warning system. The system automatically calculates changes in serum creatinine to promptly alert physicians to the degree of kidney injury and potential problem medication, and provide relevant treatment and Dose adjustment recommendations.

參閱圖11、圖12，過去研究指出醫師電腦開方合併臨床決策支援系統(computerized clinical decision support systems,CCDSS)可降低30-60%的開方錯誤，並減少30%可預防性藥品不良反應事件的發生。但隨著臨床決策系統數十年的發展與使用下，發現因不當的介面或操作設計、過多較不嚴重或不具臨床相關的警示、傳達時機與內容不當，導致醫師對檢核警示的接受度偏低，警示覆蓋率(override rate)高達50-90%。開方者甚至在不經思考的情況下，忽略系統所提供的訊息與警示，在行為學上稱之為「警示疲乏(alert fatigue)」，故一個有效的CCDSS應該符合以正確的格式、透過正確的管道、在正確的時間提供正確的資訊給正確的人(CCDSS 5 rights)。 Referring to Figures 11 and 12, past studies have indicated that physicians' computerized clinical decision support systems (CCDSS) can reduce prescribing errors by 30-60% and reduce preventable adverse drug reaction events by 30% happened. However, with the development and use of clinical decision-making systems for decades, it has been found that due to improper interface or operation design, too many less serious or non-clinical warnings, improper communication timing and content, leading to the acceptance of physicians for inspection warnings On the low side, the alert coverage rate (override rate) is as high as 50-90%. The prescriber even ignores the information and warnings provided by the system without thinking, which is called "alert fatigue" in behavior, so an effective CCDSS should conform to the correct format, through The right channel, the right information at the right time to the right person (CCDSS 5 rights).

急性腎損傷(Acute kidney injury,AKI)為住院病人常見併發症，對病人預後與住院花費均有重要的影響。透過自動化計算血清肌酸酐濃度(Serum creatinine,Scr)變化雖可提升AKI的辨認，然對照護過程與臨床結果的改善目前未有一致的效果，同時也可能會增加腎臟科照會的工作負荷以及醫療資源的使用。2016年Kanagasundaram等人便嘗試了解使用者對住院病人AKI & CCDSS的使用經驗，發現當警示可能會中斷使用者預期工作流程時，特別內含複雜或強制操作選項時，可能會誘使使用者盡速關閉警示系統並繼續完成原先預期的工作流程。故儘管解決AKI alert fatigue的方式可能不同，如何協助醫師判斷臨床優先性、並增進工作流程效率以及有效跨團隊照護為該創作發明主要特色。 Acute kidney injury (Acute kidney injury, AKI) is a common complication of inpatients, which has an important impact on patient prognosis and hospitalization costs. Although automatic calculation of changes in serum creatinine concentration (Scr) can improve AKI recognition, the improvement of control procedures and clinical results has no consistent effect at the same time, and it may also increase the work of nephrology notes Work load and use of medical resources. In 2016, Kanagasundaram and others tried to understand the user’s experience of using in-patient AKI & CCDSS, and found that when the warning may interrupt the user’s expected workflow, especially when it contains complex or mandatory operation options, it may induce the user to try Quickly close the warning system and continue to complete the originally expected workflow. Therefore, although the way to solve AKI alert fatigue may be different, how to assist physicians in judging clinical priorities, and improve workflow efficiency and effective cross-team care are the main features of this creative invention.

綜上所述，現有的急性腎損傷藥物警示系統具有下列缺失： In summary, the existing acute kidney injury drug warning system has the following defects:

1.警示疲倦發生：(1)警示的頻率過於氾濫導致對警示的注意力下降；(2)警示不夠即時，警示時醫療端早已察覺；(3)偽陽性太高：因Scr隨機變異、實驗室儀器標準化改變、或提示到透析病人；(4)未考量警示顏色、大小以及過多內容對使用者視覺的負荷；(5)未提供相關藥品處置、劑量建議或替代用藥選擇。 1. Warning fatigue occurs: (1) The frequency of the warning is too extensive resulting in decreased attention to the warning; (2) The warning is not immediate enough, the medical side has already noticed the warning; (3) The false positive is too high: due to random variation of Scr, experiment The standardization of laboratory equipment was changed, or a dialysis patient was prompted; (4) The visual color of the warning, the size, and the excessive visual load on the user were not taken into account; (5) The relevant drug disposal, dosage recommendations, or alternative medication options were not provided.

2.人機介面互動複雜：(1)強制點選警示修改、中斷、延緩反應或認為為正確劑量，降低醫師自主醫療判斷，可能導致劑量不足或完全避免必要藥品；(2)未使用現存醫療病歷資料，要求需手動鍵入額外資訊(如體重)以提供(劑量)建議。 2. Human-machine interface interaction is complex: (1) Mandatory click on the warning to modify, interrupt, delay the response or consider the correct dose, reduce the physician’s independent medical judgment, which may result in insufficient dose or completely avoid the necessary drugs; (2) not use existing medical treatment For medical records, it is required to manually enter additional information (such as weight) to provide (dose) recommendations.

3.中斷工作流程：(1)需額外溝通裝置或未嵌入電子病歷使用介面；(2)干擾預期工作流程而覆蓋警示。 3. Interrupt the work flow: (1) additional communication device or interface not embedded in the electronic medical record is required; (2) interference with the expected work flow and coverage warning.

因此根據上述缺失，先前技術仍有改善空間。 Therefore, according to the above lack, there is still room for improvement in the prior art.

本案揭露一種智能化急性腎損傷藥物警示系統，包括一執行於電腦的急性腎損傷藥物警示系統，該急性腎損傷藥物警示系統包括一自動計算腎損傷資訊模組、一用藥群組提示模組及一藥物劑量調整建議模組；該自動化計算腎損傷資訊模組能自動計算過去預定天數的血清肌酸酐濃度變化，當運算結果符合7日內血清肌酸酐濃度上升2倍(含)以上，該自動化計算腎損傷資訊模組會將上述運算結果、近期腎功能(eGFR值)及背景資訊傳送至醫院的醫療資訊系統(Health information system,HIS)；該用藥群組提示模組關聯該自動化計算腎損傷資訊模組，並比對住院現狀用藥和急性腎損傷藥物資料庫，每一筆藥品都有對應的藥品類別，當至少二筆藥品符合相同的藥品類別時，統一呈現上述藥品潛在風險建議；該藥物劑量調整建議模組關聯該用藥群組提示模組，顯示現狀藥物使用及劑量建議。 This case discloses an intelligent acute kidney injury drug warning system, including an acute kidney injury drug warning system implemented in a computer. The acute kidney injury drug warning system includes a self Automatic calculation of kidney injury information module, a medication group prompt module and a drug dose adjustment suggestion module; the automatic calculation of kidney injury information module can automatically calculate the change of serum creatinine concentration in the past predetermined days, when the calculation result meets 7 During the day, the serum creatinine concentration increased by more than 2 times (inclusive), the automatic calculation of kidney injury information module will send the above calculation results, recent renal function (eGFR value) and background information to the hospital's medical information system (Health Information System, HIS) ); The medication group prompt module is related to the automated calculation of kidney injury information module, and compares the current hospitalization medication and acute kidney injury drug database, each drug has a corresponding drug category, when at least two drugs match the same For the drug category of the drug, the above potential drug risk recommendations are presented uniformly; the drug dose adjustment suggestion module is associated with the drug group prompt module to display the current drug use and dose recommendations.

本案另揭露該自動化計算腎損傷資訊模組於預定時間運算血清肌酸酐濃度變化並傳送至醫囑系統，以及於另一預定時間傳送簡訊至相關醫護人員的行動裝置進行推播通知，所述預定時間係採用大數據分析院內Scr報告時間與醫師處方行為而設定，以兼顧資訊系統運算耗能與通報時效。 The case also discloses that the automatic calculation of kidney injury information module calculates the change of serum creatinine concentration at a predetermined time and sends it to the doctor's order system, and sends a text message to the mobile device of the relevant medical staff for push notification at another predetermined time. It is set by using big data to analyze the Scr report time in the hospital and the doctor's prescription behavior to take into account the energy consumption of the information system and the timeliness of notification.

本發明的優點如下： The advantages of the present invention are as follows:

1.降低警示疲倦：(1)兼顧資訊系統運算效率與發送次數，達到及時提示與用藥整合效果；(2)採取改善全球腎臟病預後組織(Kidney Disease Improving Global Outcomes,KDIGO)AKI嚴重程度藥物與劑量調整共識定義(即7日內血清肌酸酐濃度上升2倍(含)以上)，降低偽陽性發生風險，並提高藥物適度中斷或調整接受度；(3)該急性腎損傷藥物警示系統提供視覺化、人性化與結構化設計，降低使用者視覺的負荷。 1. Reduce warning fatigue: (1) Take into account the computing efficiency of the information system and the number of transmissions to achieve timely prompting and medication integration; (2) Take measures to improve the severity of Kidney Disease Improving Global Outcomes (KDIGO) AKI drugs and Consensus definition of dose adjustment (that is, the serum creatinine concentration rises by more than 2 times (inclusive) within 7 days), reduces the risk of false positives, and improves the moderate interruption of the drug or adjusts the acceptance; (3) The acute kidney injury drug warning system provides visualization , Humanized and structured design, reduce the user's visual load.

2.簡化人機介面互動：(1)採用軟式警示互動，保留醫師醫療自主性；(2)減少手動輸入額外資訊以提供劑量調整建議。 2. Simplify human-machine interface interaction: (1) Use soft warning interaction to keep physicians Treatment autonomy; (2) Reduce manual input of additional information to provide recommendations for dose adjustment.

3.避免中斷工作流程：協助醫師判斷處置優先順序，避免中斷預期工作流程。 3. Avoid interrupting the work flow: assist the physician to determine the priority of treatment and avoid interrupting the expected work flow.

10:急性腎損傷藥物警示系統 10: Acute kidney injury drug warning system

12:自動計算腎損傷資訊模組 12: Automatic calculation of kidney injury information module

14:用藥群組提示模組 14: Medicine group prompt module

16:藥物劑量調整建議模組 16: Drug dose adjustment suggestion module

圖1為本案警示系統方塊示意圖 Figure 1 is a block diagram of the warning system of the case

圖2為本案實施流程方塊示意圖 Figure 2 is a block diagram of the implementation process of this case

圖3為改善全球腎臟病預後組織對於急性腎損傷嚴重程度分類示意圖 Figure 3 is a schematic diagram of the classification of the severity of acute kidney injury by the global prognosis organization of kidney disease

圖4為2015至2017年醫院血中肌酸酐報告發布時間分布 Figure 4 shows the distribution time of blood creatinine report in the hospital from 2015 to 2017

圖5單一成分(單方)藥品群組提示方式 Figure 5 Single component (unilateral) drug group reminding method

圖6多成份(複方)藥品群組提示方式 Figure 6 Multi-component (composite) drug group reminding method

圖7現狀AKI相關用藥劑量檔案串連方式 Figure 7 Current status of AKI-related medication dosage file concatenation methods

圖8使用端登入醫囑時以彈跳視窗進行AKI提示與藥品修改建議 Figure 8 AKI prompts and drug modification suggestions in the pop-up window when using the terminal to log in to the medical order

圖9點選劑量查詢時彈跳劑量調整視窗 Figure 9 Bounce dose adjustment window when clicking on the dose query

圖10群組化選單進行藥品管理 Figure 10 Grouped menu for drug management

圖11習用醫療文獻中的AKI藥品警示畫面(一) Figure 11 AKI drug warning screen in conventional medical literature (1)

圖12習用醫療文獻中的AKI藥品警示畫面(二) Figure 12 AKI drug warning screen in conventional medical literature (2)

圖1~圖3，本發明揭露一種智能化急性腎損傷藥物警示系統，包括一執行於電腦的急性腎損傷藥物警示系統10，該急性腎損傷藥物警示系統10包括一自動計算腎損傷資訊模組12、一用藥群組提示模組14及一藥物劑量調整建議模組16；該自動化計算腎損傷資訊模組1 2能自動計算過去預定天數的血清肌酸酐濃度(Serum creatinine,Scr)變化，當運算結果符合7日內血清肌酸酐濃度上升2倍(含)以上，該自動化計算腎損傷資訊模組12會將上述運算結果、近期腎功能(eGFR值)及背景資訊傳送至醫院的醫療資訊系統(Health information system,HIS)；該用藥群組提示模組14關聯該自動化計算腎損傷資訊模組12，並比對住院現狀用藥(Active drug)和急性腎損傷(Acute kidney injury,AKI)藥物資料庫，每一筆藥品都有對應的藥品類別，當至少二筆藥品符合相同的藥品類別時，統一呈現上述藥品潛在風險建議；該藥物劑量調整建議模組16關聯該用藥群組提示模組14，顯示現狀藥物使用及劑量建議。 1 to 3, the present invention discloses an intelligent acute kidney injury drug warning system, including an acute kidney injury drug warning system 10 executed on a computer, the acute kidney injury drug warning system 10 includes an automatic calculation of kidney injury information module 12. A medication group prompt module 14 and a drug dose adjustment suggestion module 16; the automatic calculation of kidney injury information module 1 2 Automatically calculate the change of serum creatinine concentration (Secr creatinine, Scr) in the past predetermined days. When the calculation result is within 7 days, the serum creatinine concentration rises more than 2 times (inclusive), the automatic calculation of kidney injury information module 12 will The calculation results, recent renal function (eGFR value) and background information are sent to the hospital's medical information system (Health Information System, HIS); the medication group prompt module 14 is associated with the automated calculation of kidney injury information module 12 and compared The current database of active drugs and acute kidney injury (AKI), each drug has a corresponding drug category. When at least two drugs meet the same drug category, the potential risks of the above drugs are presented uniformly Recommendation; the drug dose adjustment suggestion module 16 is associated with the medication group prompt module 14 to display the current drug use and dose recommendations.

本發明具體的實施例如下： The specific embodiments of the present invention are as follows:

參閱圖2~圖4，執行運作於電腦的該急性腎損傷藥物警示系統10具有該自動計算腎損傷資訊模組12、該用藥群組提示模組14及該藥物劑量調整建議模組16。 Referring to FIGS. 2 to 4, the acute kidney injury drug warning system 10 running on a computer has the automatic kidney injury information module 12, the medication group prompt module 14 and the drug dose adjustment suggestion module 16.

A部分：該自動計算腎損傷資訊模組12。 Part A: The automatic calculation of kidney injury information module 12.

首先採樣病患的血液樣本，並根據血液樣本獲得血清肌酸酐濃度Scr₁，上述Scr₁為病人最新抽血值中的血清肌酸酐濃度，再由該自動計算腎損傷資訊模組12自動運算過去7天內的血清肌酸酐濃度變化取得Scr₂，上述Scr₂為7天內最低值的血清肌酸酐濃度，將Scr₁與Scr₂進行計算並過濾結果，當血清肌酸酐濃度變化量符合改善全球腎臟病預後組織(Kidney Disease Improving Global Outcomes,KDIGO)第二期急性腎損傷(Scr-based stage II)的定義時，意即Scr1/Scr2≧2，該自動計算腎損傷資訊模組12便會自動提取系統已運算完成且通報近期腎功能數值(eGFR值)的結果，一同發送背景資訊至醫院的醫療資訊系統中(Health information system,HIS)。 First sample the patient's blood sample, and obtain the serum creatinine concentration Scr ₁ according to the blood sample. The above Scr ₁ is the serum creatinine concentration in the patient's latest blood draw value, and then the automatic calculation of kidney injury information module 12 automatically calculates the past The change in serum creatinine concentration within 7 days obtains Scr _{2. The} above Scr ₂ is the lowest serum creatinine concentration in 7 days. Scr ₁ and Scr ₂ are calculated and the result is filtered. When Kidney Disease Improving Global Outcomes (KDIGO) is defined as Scr-based stage II, which means Scr1/Scr2≧2, the automatic calculation of kidney injury information module 12 will automatically The extraction system has completed the calculation and reported the results of recent renal function values (eGFR values), and together sends background information to the hospital's medical information system (Health Information System, HIS).

該自動計算腎損傷資訊模組12的通報時機： The automatic calculation of the notification timing of the kidney injury information module 12:

(1)以病歷號-住院號配對啟動該自動計算腎損傷資訊模組12：為了降低警示頻率過高而導致的訊息疲勞，同一病歷號-住院號配對若符合急性腎損傷定義僅發送1次警示(無論急性腎損傷是否有進展)。具體來說，病人第一次住院配對符合急性腎損傷定義時便會提示醫師或相關醫護人員，由於醫師或相關醫療人員已經知道病人腎功能變化，持續的提示將會造成醫師或相關醫療人員的困擾，故隨後不再提示；然而，當病人轉床、轉病房或分段結清(住院時間過長)時，由於病人的照護人員可能改變，故該自動計算腎損傷資訊模組12將會利用住院號與病歷號的配對改變，再次啟動系統的比對提示。 (1) Start the automatic calculation of kidney injury information module 12 with medical record number-hospital number pairing: In order to reduce the fatigue of messages caused by too high warning frequency, the same medical record number-hospital number pairing will only be sent once if it meets the definition of acute kidney injury Warning (regardless of whether there is progress in acute kidney injury). Specifically, when the patient is matched with the definition of acute kidney injury for the first time in hospital, the doctor or related medical staff will be prompted. Because the doctor or related medical staff already knows that the patient's renal function has changed, the continuous prompt will cause the doctor or related medical staff to Disturbance, so it will not be prompted later; however, when the patient transfers to the bed, transfers to the ward, or clears in stages (the hospital stay is too long), because the patient’s caregiver may change, the automatic calculation of kidney injury information module 12 will use the hospitalization The pairing of the number and the medical record number is changed, and the comparison prompt of the system is started again.

(2)定時更新該自動計算腎損傷資訊模組12以及於預定時間發送簡訊至相關醫護人員的手機：本案以大數據分析資訊系統過去兩年Scr報告發送時間分布，並考量醫師處方需求，設計該自動計算腎損傷資訊模組12啟動Scr運算時間為07：00、13：00、19：00及24：00，並及時發送AKI警示的訊息至醫囑系統進行更新，另外在上班時段08：30及13：00發送簡訊至主治醫師與藥師手機，以利相關醫護人員掌握病人腎功能變化。 (2) Regularly update the automatic calculation of kidney injury information module 12 and send a short message to the mobile phone of the relevant medical staff at a predetermined time: In this case, the big data analysis information system sent the distribution of Scr reports in the past two years, and considered the prescription needs of physicians. The automatic calculation of kidney injury information module 12 starts the Scr calculation time for 07:00, 13:00, 19:00 and 24:00, and sends the AKI warning message to the doctor's order system for update in time, and at 08:30 during working hours And 13:00 to send text messages to the mobile phone of the attending physician and pharmacist, so that the relevant medical staff can master the changes in the patient's renal function.

(3)醫囑系統開啟後會彈跳出AKI訊息：當相關醫護人員登入至所述醫囑系統的頁面時便會彈跳出AKI訊息，以便醫師於進行處方或處置開立前，便能掌握病人腎功能變化以及處方應調整的訊息，此外更可降低對醫護人員工作干擾，提高工作效率。 (3) The AKI message will pop up after the medical order system is opened: when the relevant medical staff logs in to the page of the medical order system, the AKI message will pop up, so that the doctor can grasp the patient's renal function before making a prescription or disposing The change and the information that the prescription should be adjusted, in addition, it can reduce the interference to the work of medical staff and improve work efficiency.

B部分：該藥物群組提示模組14。 Part B: The drug group reminder module 14.

參閱圖5~圖7，並搭配圖1、圖2，B部分關聯至A部分，藥物群組提示分成兩個部分，第一部分為單一成份(單方)藥品，第二部分為多成份(複方)與單複方藥品群組稽核方式。本案AKI用藥提示檔材料編號(警示藥品)參酌英、美著名急性腎損傷著作、醫學文獻與醫院內相關專科醫師建議，以廣義腎毒性藥品(直接造成腎臟毒性、藥物累積導致毒性與影響電解質變化)為重點警示藥品，而非全面納入需腎功能劑量調整藥品，保留臨床藥物使用彈性，兼顧病人用藥安全。當病人現狀用藥符合建置檔案中的品項時，系統會彈跳視窗提示醫師。本案的藥品類別排序採用ATC5碼、ATC7碼及藥師編碼。ATC7碼為世界衛生組織給予藥品全球統一的身分證，共有7個大寫英文字母或順序組成(B01AC06)，編碼意義為(解剖學位置(B)-治療學分類(01)-藥理學分類(A)-化學結構分類(C)-化合物分類(06))，ATC5碼則為該藥品品項化學結構分類，以上述國際分類標準進行類別設定原則。 Refer to Figures 5 to 7, and in conjunction with Figures 1 and 2, Part B is related to Part A. The drug group prompt is divided into two parts, the first part is a single component (unilateral) drug, and the second part is a multicomponent (composite) Audit method with single compound medicine group. In this case, the AKI drug reminder file number (warning drug) refers to the famous acute kidney injury works in the United Kingdom and the United States, medical literature, and the recommendations of relevant specialists in the hospital. The generalized nephrotoxic drugs (direct renal toxicity, drug accumulation, toxicity and electrolyte changes) ) Is to focus on warning drugs, rather than comprehensively including drugs that require dose adjustment for renal function, to retain the flexibility of clinical drugs and to take into account the safety of patients' medication. When the patient's current medication meets the items in the build file, the system will pop up the window to prompt the physician. In this case, ATC5 code, ATC7 code and pharmacist code were used to sort the drug category. The ATC7 code is the global unified identity card given by the World Health Organization for drugs. It consists of 7 capital letters or sequences (B01AC06), and the coding meaning is (anatomical position (B)-therapeutic classification (01)-pharmacological classification (A )-Chemical structure classification (C)-Compound classification (06)), ATC5 code is the chemical structure classification of the drug item, and the principle of class setting is based on the above international classification standards.

參閱圖5，第一部分的單一成份(單方)藥品，是比對住院現狀用藥與AKI用藥提示檔材料編號(批價藥碼)後，當多筆藥品符合相同藥品類別時，統一呈現該類別的建議，其中原則依序依照ATC5碼(代表多項藥品具相同化學結構)、ATC7碼(相同成份藥品但有多規格或劑型時)、藥師編碼(非上述原則由藥師自行編碼者)進行類別排序。 Referring to Figure 5, the single-component (single-party) drug in the first part is the comparison of the current hospitalization drug and the AKI drug prompt file material number (batch price code). When multiple drugs meet the same drug category, the drug will be presented in a unified manner. It is recommended that the principles be sorted according to the ATC5 code (representing that multiple drugs have the same chemical structure), ATC7 code (when the drug has the same ingredient but multiple specifications or dosage forms), and the pharmacist code (other than the above principle is coded by the pharmacist).

參閱圖6，第二部分的多成份(複方)與單複方藥品群組稽核方式，是將複方成份藥品拆成若干單一成份，並依照單方編碼原則依序依照ATC5碼(代表多項藥品具相同化學結構)、ATC7碼(相同成份藥品但有多規格或劑型時)、藥師編碼(非上述原則由藥師自行編碼者)，若屬同一藥品類別時，則進行群組類別提示。 Referring to Figure 6, the second part of the multi-component (composite) and single-compound drug group audit method is to split the compound-component drugs into several single components and follow the ATC5 code in sequence according to the single-party coding principle (representing that multiple drugs have the same chemical Structure), ATC7 code (when the same ingredient medicine has multiple specifications or dosage forms), pharmacist code (other than the above principle is coded by the pharmacist), if it belongs to the same drug category, a group category prompt will be given.

圖7則是連結住院現狀AKI相關用藥之材料編號與相關品項腎功能劑量檔，以及時提供該藥品劑量查詢。 Figure 7 is a link to the current hospitalization AKI related drug material number and related items renal function dose file, to provide the drug dose query in time.

C部分：該藥物劑量調整建議模組16。 Part C: Suggested Module 16 for the adjustment of the dose of this drug.

同樣參閱圖5~圖7，並搭配圖1、圖2，C部分與B部分相互關聯，連結住院現狀AKI相關用藥的材料編號，與該品項腎功能用藥檔，以及時提供該藥品劑量查詢；由於目前臨床研究尚未針對AKI的用藥劑量有明確個別化品項建議，故當符合系統稽核AKI定義時，將會列出由慢性腎臟疾病(Chronic Kidney Disease,CKD)病人建議不同腎功能數值參考劑量，由醫師依據病人實際狀況進行劑量選擇，而非單獨給予一個明確劑量建議。 Refer also to Figures 5 to 7, and in conjunction with Figures 1 and 2, Part C and Part B are related to each other, linking the material number of AKI-related medications for the current hospitalization status, and the drug file for the renal function of this item, and provide the drug dosage query in time ;Because the current clinical research has not clearly formulated individual chemical recommendations for the dosage of AKI, when it meets the definition of system audit AKI, it will list the reference values of different renal functions recommended by patients with chronic kidney disease (CKD) The dosage is determined by the physician according to the actual condition of the patient, rather than giving a clear dosage recommendation alone.

接著參閱圖8~圖10，本案的該急性腎損傷藥物警示系統10將該自動計算腎損傷資訊模組12、該用藥群組提示模組14及該藥物劑量調整建議模組16整合於電腦視窗的同一畫面，採用更人性化、視覺化的設計。此外更是提供了有效背景資訊、單複方藥品群組提示以及結構化語句設計。有效背景資訊係指以簡潔語句提供急性腎損傷處置所需相關資訊(例如：腎功能變化幅度、換算AKI分期、最近腎功能數值與警示藥品處置與劑量調整建議)，及時提供接受者後續處置參考；單複方藥品群組提示主要依單方藥理機轉、風險形態予個別藥品特性做為群組編立依據，複方藥品則分拆內含成分藥品，依上述原則進行編碼，相同群組同一警示內容，區塊顯示，降低視覺負荷；而結構化語句設計則是在各個藥品類別下方會給予建議，此建議是依序以建議處置(某條件環境)、追蹤事項、病人衛教、替代用藥、不調整潛在風險作為語句設計，簡潔與結構化的建議內容，提高警示接受度。 8 to FIG. 10, the acute kidney injury drug warning system 10 in this case integrates the automatic calculation of kidney injury information module 12, the medication group prompt module 14 and the drug dose adjustment suggestion module 16 into a computer window The same screen is designed with a more humane and visual design. In addition, it provides effective background information, single and compound drug group reminders, and structured sentence design. Effective background information refers to providing relevant information required for the treatment of acute kidney injury in a concise sentence (for example: changes in renal function, conversion of AKI stage, recent renal function values and warning drug treatment and dosage adjustment recommendations), and provide the recipient with subsequent treatment reference in a timely manner ; The single compound medicine group reminder is mainly based on the single pharmacological mechanism, the risk profile and the characteristics of individual drugs as the basis for the group establishment. The compound medicines are divided into the component medicines and coded according to the above principles. The same group has the same warning content , Block display, reduce visual load; and the structured sentence design is to give suggestions under each drug category, this suggestion is to sequentially recommend treatment (a certain environment), follow-up matters, patient health education, alternative medicine, not Adjust potential risks as sentence design, within concise and structured recommendations Content, improve warning acceptance.

本案的該急性腎損傷藥物警示系統10採用軟式警示互動模式，除了不強迫醫生回覆對警示的認同，同時也不要求接收者手動輸入參數運算，可直接提取已經存在檢驗系統中的eGFR值，提高工作效率。 In this case, the acute kidney injury drug warning system 10 adopts a soft warning interactive mode, in addition to not forcing the doctor to reply to the warning, and also not requiring the recipient to manually input parameter calculations, it can directly extract the eGFR value already existing in the inspection system to improve Work efficiency.

需注意的是，上述實施例僅為例示性說明本發明之原理及其功效，而非用於限制本發明之範圍。任何熟於此項技術之人均可在不違背本發明之技術原理及精神下，對實施例作修改與變化。因此本發明之權利保護範圍應如後述之申請專利範圍所述。 It should be noted that the above-mentioned embodiments are only illustrative of the principles and effects of the present invention, rather than limiting the scope of the present invention. Anyone who is familiar with this technology can make modifications and changes to the embodiments without violating the technical principles and spirit of the present invention. Therefore, the scope of protection of the rights of the present invention should be as described in the scope of patent application described later.

14:用藥群組提示模組 14: Medicine group prompt module

16:藥物劑量調整建議模組 16: Drug dose adjustment suggestion module

Claims

一種智能化急性腎損傷藥物警示系統，包括：一執行於電腦的急性腎損傷藥物警示系統，該急性腎損傷藥物警示系統包括一自動計算腎損傷資訊模組、一用藥群組提示模組及一藥物劑量調整建議模組；該自動化計算腎損傷資訊模組能自動計算過去7日內的血清肌酸酐濃度變化，當運算結果符合7日內血清肌酸酐濃度上升2倍(含)以上，該自動化計算腎損傷資訊模組會將上述運算結果、近期腎功能(eGFR值)及背景資訊傳送至醫院的醫療資訊系統(Health information system,HIS)；該用藥群組提示模組關聯該自動化計算腎損傷資訊模組，並比對住院現狀用藥和急性腎損傷藥物資料庫，每一筆藥品都有對應的藥品類別，當至少二筆藥品符合相同的藥品類別時，統一呈現上述藥品潛在風險建議；該藥物劑量調整建議模組關聯該用藥群組提示模組，顯示現狀藥物使用及劑量建議。 An intelligent acute kidney injury drug warning system includes: an acute kidney injury drug warning system executed on a computer. The acute kidney injury drug warning system includes an automatic calculation of kidney injury information module, a medication group prompt module and a Drug dose adjustment suggestion module; the automatic calculation of kidney injury information module can automatically calculate the change of serum creatinine concentration in the past 7 days. When the calculation result meets the increase of serum creatinine concentration by more than 2 times (inclusive) within 7 days, the automatic calculation of kidney The injury information module will send the above calculation results, recent renal function (eGFR value) and background information to the hospital's medical information system (Health Information System, HIS); the medication group prompt module is associated with the automated calculation of kidney injury information model Group, and compare the current hospitalization medication and acute kidney injury drug database, each drug has a corresponding drug category, and when at least two drugs meet the same drug category, the above drug potential risk recommendations are presented uniformly; the drug dose adjustment The suggestion module is associated with the medication group prompt module to display the current medication use and dosage recommendations.

如申請專利範圍第1項所述之智能化急性腎損傷藥物警示系統，其中該自動化計算腎損傷資訊模組以病歷號-住院號配對模式於預定時間運算血清肌酸酐濃度變化並傳送訊息至醫囑系統。 The intelligent acute kidney injury drug warning system as described in item 1 of the patent application scope, wherein the automatic calculation of kidney injury information module calculates the change of serum creatinine concentration at a predetermined time in a medical record number-hospital number matching mode and sends a message to the doctor system.

如申請專利範圍第1項所述之智能化急性腎損傷藥物警示系統，其中該自動化計算腎損傷資訊模組於預定時間傳送簡訊至相關醫護人員的行動裝置進行推播通知。 The intelligent acute kidney injury drug warning system as described in item 1 of the patent application scope, wherein the automatic calculation of kidney injury information module sends a short message to the mobile device of the relevant medical personnel for push notification at a predetermined time.

如申請專利範圍第2項所述之智能化急性腎損傷藥物警示系統，其中所述預定時間係採用大數據分析院內Scr報告時間與醫師處方行為而設定，以兼顧資訊系統運算耗能與通報時效。 The intelligent acute renal injury drug warning system as described in item 2 of the patent application scope, wherein the predetermined time is set by using big data to analyze the in-hospital Scr report time and the doctor's prescription behavior to take into account the energy consumption of the information system and the timeliness of notification .

如申請專利範圍第2項所述之智能化急性腎損傷藥物警示系統，其中當相關醫護人員登入至所述醫囑系統的頁面時便會彈跳出AKI訊息，以便醫師於進行處方或處置開立前，能掌握病人腎功能變化以及處方應調整的訊息。 The intelligent acute kidney injury drug warning system as described in item 2 of the patent application scope, in which the relevant medical staff will pop up the AKI message when logging into the page of the medical order system, so that the doctor can prescribe or dispose before issuing , Can grasp the patient's kidney function changes and the information that the prescription should be adjusted.

如申請專利範圍第1項所述之智能化急性腎損傷藥物警示系統，其中該用藥群組提示模組又分為單方成份藥品類別及複方成份藥品類別，所述單方成份藥品類別根據藥理機轉、風險型態給予個別藥品特性作為群組編立依據，所述複方成份藥品類別先拆分成個別的單方成份藥品類別，再依據單方成份藥品類別的群組編立依據分類。 The intelligent acute kidney injury drug warning system as described in item 1 of the patent application scope, wherein the medication group reminder module is further divided into a single component drug category and a compound component drug category, the single component drug category is transferred according to the pharmacological mechanism 1. The risk type gives individual drug characteristics as a basis for group establishment. The compound ingredient drug category is first split into individual unilateral ingredient drug categories, and then grouped according to the group ingredient drug category group establishment basis classification.

如申請專利範圍第1項所述之智能化急性腎損傷藥物警示系統，其中該用藥群組提示模組係依序以建議處置(某條件環境)、追蹤事項、病人衛教、替代用藥、不調整潛在風險作為結構化語句以構成建議內容。 The intelligent acute kidney injury drug warning system as described in item 1 of the patent application scope, wherein the medication group reminder module is in order to recommend disposal (a certain environment), follow-up matters, patient health education, alternative medication, no Adjust potential risks as structured sentences to constitute recommendations.

如申請專利範圍第1項所述之智能化急性腎損傷藥物警示系統，其中該急性腎損傷藥物警示系統採用軟式警示互動模式，不強迫醫生回覆對警示的認同，可直接提取已經存在檢驗系統中的eGFR值。 The intelligent acute kidney injury drug warning system as described in item 1 of the patent application scope, in which the acute kidney injury drug warning system adopts a soft warning interactive mode, without forcing the doctor to reply to the warning, it can directly extract the existing inspection system. EGFR value.