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  • 期刊

藥物不良反應防護機制的建構與成效

Establishment and Impact of Protection Mechanism in the Prevention of Adverse Drug Reaction (ADR) Recurrence

摘要


目的:當藥物相關的不良事件僅以文字紀錄的形式保存時,需要仰賴人工的辨識,但容易有疏漏。希望利用資訊系統的比對與提示功能,能強化醫療人員辨識與攔截不適當藥物的使用。方法:以某醫學中心的資訊系統為例,結合收集資訊、資料轉譯和處方監測攔截三大概念進行系統架構。以adverse drug reaction (ADR)線上通報系統、電子病歷的過敏欄位做為主要的資料收集來源,另設置E-codes資訊平臺,由藥師主動發掘未被通報的個案。建立「過敏紀錄比對院內藥品辨識系統」與「過敏藥品編碼系統」,將收集資訊轉譯為系統可辨識格式後形成比對資料庫,同時設置「同成分/過敏藥物群組」擴大系統比對能力,並將比對結果同步即時回饋至醫師與藥師端,進行處方攔截。結果:在2015年以E-codes偵測到506件潛在ADR,經藥師評估後有297件為ADR,E-codes的陽性預測率為58.7%。系統提示醫師端的內容有14.5%來自於過敏藥品編碼系統,47.1%為同成分/過敏群組。經由處方監測系統的建置,藥師提報藥物不良事件相關的疑義處方件數,由每季平均32.3件增加為164.3件,成長5.1倍。結論:E-codes可有效協助發掘未被通報的ADR事件。而透過建置系統轉譯文字形式紀錄與設置群組藥物,可以強化系統的辨識能力。藉由導入資訊系統有助於藥師發現更多藥物不良事件相關問題。

並列摘要


Objective: When adverse drug events are documented on written form, manual identification is done; omissions occur easily. To use the information system's comparison and prompting functions strengthen medical staff's capacity identifying and preventing inappropriate medication. Methods: The example is a medical center's information system; its structure combines three major concepts of information collection, data transcription, and prescription monitoring. The adverse drug reaction (ADR) online reporting system and allergy field of electronic medical records are used as main source of data collection. The E-codes information platform is built, and pharmacists explore unreported cases. "Collate allergy record recognition system" and "allergy drug coding system" are established to transcribe and convert information into a format forming a database, building a "same component/ allergy drug group" expanding the system's comparison capability, the results are uploaded simultaneously to physician's and pharmacist's terminals. Results: In 2015, 506 potential ADRs were detected through E-codes. After pharmacist evaluation, 297 were confirmed ADRs, and the positive predictive value was 58.7%. 14.5% of the system prompted notifications were from "allergy drug coding system", and 47.1% from the "same component/allergy group". Through the establishment of prescription monitoring system, the number of doubtful/questionable prescriptions reported by pharmacists has risen averagely 32.3 cases and quarterly to 164.3 cases, representing an increase of 5.1 times. Conclusions: E-codes help discovering unreported ADR events. The system's identification capability is further enhanced by establishing written record transcription, conversion function, and drug groups. The implementation of an information system supports pharmacists find more issues about adverse drug events.

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