精實手法降低注射藥品給藥疏失以提升用藥安全

目的：2015年衛生福利部之病人安全年度目標之一為「提升用藥安全」。凡是人皆可能發生疏失，期能應用條碼系統降低疏失發生以提升用藥安全。方法：一、成立「住院注射藥品給藥作業流程」推動小組；二、擬訂現況及改善後之住院注射藥品給藥作業流程價值流程圖；三、明確問題為「調劑審核錯誤」、「藥品傳送延遲」及「給藥錯誤」；四、擬定與實施「建構藥品圖庫連結資訊系統」、「評估條碼建置需求並提出設備採購」、「進行藥車改造」、「加強給藥正確性稽核機制」及「製作正確給藥教學影片」五大對策。結果：一、建構住院注射藥品條碼作業；二、改善住院藥品傳送作業流程；三、縮短臨時藥囑交付前置時間；四、提高工作人員及推動小組成員滿意度。結論：利用精實醫療手法，改善住院注射藥品給藥作業流程，除縮短給藥延遲時間、降低給藥錯誤、提升工作人員滿意度外，推動小組之品管手法運用、活動信心及創新與潛能開發，亦有顯著進步。

關鍵字

精實；注射藥品；用藥安全

並列摘要

Objective: 2015 Patient Safety Goals in Taiwan established by the Food and Drug Administration includes medication safety. To err is human. This quality improvement program aims to use the barcode system in injection medication to improve medication safety. Methods: 1. Establishing the quality improvement team in injection medication safety. 2. Observing the process and value streams. 3. Identifying process problems as dispensing near miss, delaying in medication delivery, and drug administration error. 4. Developing and implementing five action plans in dispensing, transferring and administration processes. Results: 1. Implemented the barcode system in injection medication. 2. Standardized work in hospital policies and procedures. 3. Reduced the Lead Time from dispensing to administration. 4. Improving the employee satisfaction. Conclusions: This quality improvement program helps hospital to improve medication supply process, to reduce the waiting time in medication delivery, and to enhance employee satisfaction. Therefore, this quality improvement program is a useful strategy to improve medication management.

並列關鍵字

Lean Methods ； Injection Medication ； Medication Safety

國際替代計量

精實手法降低注射藥品給藥疏失以提升用藥安全

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