- 期刊
應用Flumazenil作為測量不良事件之觸發工具
Flumazenil as Trigger Tool for Measuring Adverse Drug Events
摘要
目的：本研究應用美國醫療改善中心(Institute for Healthcare Improvement, IHI)在1999年發展之IHI Global Trigger Tool中M8 Flumazenil的觸發來探討院內benzodiazepine (BZD)不適當使用的狀況。方法：本研究為回溯性分析本院電子資料庫，以藥品碼搜尋2013年1月1日至12月31日門、急診及住院分別使用flumazenil及midazolam之病人。分析年齡及性別，記錄每位病人使用flumazenil之前24小時是否有注射midazolam。有使用者列為midazolam潛在性不適當使用族群，無使用者查詢門診有效處方是否有benzodiazepine 類鎮靜安眠劑，瞭解病人benzodiazepine藥品的來源，列為潛在誤用／濫用benzodiazepine 族群。應用Microsoft Excel 2010進行資料整理。結果：研究期間共有12,692 人次使用midazolam，分別為住院3,812 人次 (30%)、門／急診8,880 人次 (70%)。病人平均年齡57±18歲。使用midazolam 住院病人中有27位有使用flumazenil (0.7%)，而門診則有5位(0.06%)。門、急診共有51位病人使用flumazenil。使用flumazenil前24小時內有注射midazolam共有5位(10%)，midazolam應用於侵入性檢查，其中大腸鏡3位、內視鏡1位、1位經內視鏡逆行性膽胰管攝影術。於研究期間院內執行侵入性檢查的病人，大腸鏡共有2,089人、內視鏡共有5,122人，需要BZD解毒劑分別為0.14% (3/2,089)及0.04% (2/5,122)。90%病人因口服BZD過量而至急診就醫使用flumazenil。其中10位病人(22%)於本院門診處方有開立BZD。結論：Flumazenil是benzodiazepine專一性的解毒劑，分析其處方型態可有效瞭解院內benzodiazepine使用是否有不適當使用的狀況，進而擬定改善措施。
並列摘要
Objective: We use M8 flumazenil in IHI Global Trigger Tool to assess the appropriateness of benzodiazepine use in our hospital. Methods: Retrospective data analysis was performed at a medical center Changhua Christian Hospital from an electronic database derived from the Hospital's computerized physician order entry system. We select patients receiving flumazenil during January 2013 to December 2013. Patient orders were check for the injectable midazolam before flumazenil use or oral benzodiazepine prescribed in the previous outpatient prescription. Data analysis involved descriptive statistical analysis. Results: During the study period, 12,692 person-time administered midazolam, 3,812 person-time (30%) was inpatient and 8,880 person-time (70%) was outpatient (which included emergency visit). The mean age was 57 ± 18 years. Twenty-seven (0.7%) inpatient and 5 (0.06%) outpatient using flumazenil. Flumazenil was administered to 51 outpatients during the study period. Five patients (10%) received midazolam followed by flumazenil during examination. During the study period, patient undergoing colonoscopy and endoscopy was 2,089 and 5,122 respectively. The incidence rate of midazolam reversal during colonoscopy and endoscopy was 0.14% (3/2,089) and 0.02% (1/5,122) respectively. Most of the patients (90%) administered flumazenil at emergency room for oral benzodiazepine overdose. Ten patients (22%) have outpatient prescription with oral benzodiazepine in Changhua Christian Hospital. Conclusions: Flumazenil may serve as trigger tool for measuring benzodiazepine adverse drug events.