運用品管手法提升高齡住院病人用藥整合率

Implemented Quality Control Circle for Improving Medication Reconciliation in Geriatric Inpatients

洪碧蓮(Pi-Lien Hung) ； 林佩津(Pei-Chin Lin) ； 陳妙婷(Miao-Ting Chen) ； 陳蓉誼(Jung-Yi Chen) ； 李寶琳(Pao-Lin Li) ； 李尉綺(Wei-Chi Li) ； 王子誠(Zi-Cheng Wang) ； 黃慈婷(Tzu-Ting Huang) ； 梁晏慈(Yen-Tzu Liang)

《臺灣臨床藥學雜誌》 26卷2期 (2018/04) Pp. 132-141

https://doi.org/10.6168/FJCP.201804_26(2).0006

摘要

目的：健保署估計，每年民眾因重複被開立藥品，浪費藥費超過3億6,000萬元。「健保雲端藥歷系統」供醫事人員即時查詢，避免病人因藥物相關問題導致住院或死亡發生。針對多種病症及多項用藥的高齡長者，更需執行用藥整合。方法：結合雲端藥歷運用於住院病人用藥整合，以品管手法：利用柏拉圖、魚骨圖及三現原則找出介入前高齡醫學科病人住院72小時內藥師未完成用藥整合6項真因，擬訂兩大對策。比較對策執行前（n = 275，2015年1 ~ 12月）、執行中（n = 97，2016 年7 ~ 9月）、執行後（n = 91，2016年10 ~ 12月），提升高齡醫學科病人住院72小時內藥師完成藥物整合率執行成效。結果：高齡醫學科病人住院72小時內藥師完成藥物整合率，由執行前44.0%、執行中76.3% (p ＜ 0.0001)至執行後86.8% (p ＜ 0.0001)。臨床藥師執行用藥整合，發現藥物相關問題，約占執行個案20%，預防因藥物劑量不當、無依病人現況給予藥物治療及潛在藥物不良反應案件。結論：自備藥開立系統建置完成後，節省院內藥品花費，創造了每年可節省7,200萬藥物重複開立的龐大經濟效益。

關鍵字

用藥整合 ； 雲端藥歷 ； 品管手法

並列摘要

Objective: According to Taiwan's National Health Insurance Administration (NHIA), medical expenditure for duplicate medications exceeds NT$360 million each year. The patient-centered National Health Insurance (NHI) PharmaCloud system helps physicians and pharmacists implement medication reconciliation, especially for older patients. Methods: This study establishes a medication reconciliation service that can be combined with the NHI PharmaCloud system. By implementing a quality control circle (QCC), we analyze the available data to identify six actual causes of failure to perform medication reconciliation and have provided plans to prevent such failures. We compare the effectiveness of the plans and medication reconciliation within 72 hours of admission between the preintervention period from January to December 2015 (n = 275), the intervention period from July to September 2016 (n = 97), and the postintervention period from October to December 2016 (n = 91). Results: The clinical pharmacist implemented rate of medication reconciliation within 72 hours of admission increased from 44.0% in preinterventional group to 76.3% in the interventional group (p ＜ 0.0001) and then to 86.8% in the postinterventional group (p ＜ 0.0001). During the implemented medication reconciliation, clinical pharmacists discovered drug-related issues, which accounted for approximately 20% of the implementation of cases, and in doing so prevented potentially adverse drug reactions and the prescription of improper drug doses and incorrect drug treatments. Conclusions: After establishing a medication reconciliation process, duplicate medications are decreased, resulting in drug cost savings for older patients admitted to hospital. This creates considerable economic savings of NT$72 million annually.

並列關鍵字

Medication Reconciliation ； PharmaCloud System ； Quality Control Circle