用藥安全危險因子之文獻回顧

Risk Factors for Medication Safety Problems- A Literature Review

陳巧欣(Ciao-Sin Chen) ； 史海雯(Hai-Wen Shih) ； 楊秀琍(Hsiu-Li Yang) ； 黃莉蓉(Li-Jung Huang) ； 林慧玲(Fe-Lin Lin Wu) ； 蘇錦玲(Chin-Ling Su)

《臺灣臨床藥學雜誌》 27卷2期 (2019/04) Pp. 91-106

https://doi.org/10.6168/FJCP.201904_27(2).0002

摘要

本文藉由文獻搜尋，回顧並彙整近期研究中發現的病人用藥安全危險因子。經全面性搜尋PubMed資料庫中從2015年1月至2017年12月間發表的文獻，使用的關鍵字包括「medication safety」、「risk factors」、「population」或「population group」。在719篇搜尋結果中，共27篇文獻與藥物安全切題相關且有討論至少一個病人用藥安全危險因子。病人用藥安全問題包括處方錯誤、調劑錯誤、給藥錯誤、服藥錯誤、用藥整合錯誤、服藥順從性不佳、藥物交互作用、藥物不良反應及藥物相關的住院事件。最常被研究的族群包括老人，其次為多重用藥的病人、糖尿病病人、心血管疾病病人、認知功能障礙的病人、孕婦及兒童。我們歸納出最常見的九個病人用藥安全危險因子包括多重用藥、高齡、藥物處方複雜、多重共病症、針劑的使用、心血管疾病藥物的使用、精神藥物的使用、嗎啡類或術後止痛藥物的使用及抽菸。從文獻回顧中發現最常見的九個用藥安全危險因子。未來期可藉由這些危險因子辨認具有潛在高風險的病人，設計出個別化的用藥教育計畫以增進用藥安全。

關鍵字

用藥安全 ； 危險因子 ； 族群 ； 文獻回顧

並列摘要

To identify the risk factors that influence medication safety in patients through compilation of literature review. We carried out a systematic search for literature published during the period from January 2015 to December 2017 through PubMed. The keywords we used included ＂medication safety,＂ ＂risk factors,＂ ＂population＂ or ＂population group.＂ In the 719 articles we found, 27 studies investigated medication safety problems and involved at least one risk factor. The medication safety problems included prescribing errors, dispensing errors, administration error, unintentional medication, reconciliation discrepancy, non-adherence, drug-drug interaction, adverse drug reaction, and hospitalization associated with medication-related problems. The most frequently studied populations include older patients, patients with polypharmacy, patients with cardiovascular disease, patients with diabetes, patients with cognitive impairment, pregnant women, and pediatric patients. Polypharmacy, older age, complexity of regimen, multiple comorbidities, use of parenteral drugs, use of cardiovascular drugs, use of psychotropic drugs, use of opioid or postoperative analgesics, and smoking were the most frequently reported risk factors for medication safety problems. Nine most frequently reported risk factors were associated with higher risk in medication safety problems. These potential risk factors may be used to identify patients at risk and initiate intervention to improve the medication safety.

並列關鍵字

Medication Safety ； Risk Factors ； Population Group ； Review