優化藥物過敏提示系統之成效分析

目的：各醫療院所已廣泛使用電子化醫囑輸入系統（computerized physician order entry, CPOE）減少藥物處方開立錯誤，但相關系統必須定期優化來提升成效。本研究將探討藥師介入優化藥物過敏電腦提示系統於提報門診藥物過敏異常處方的變化。方法：本研究回溯性分析臺灣北部四間醫院2012年10月～2019年3月藥師提報門診開立藥物過敏異常處方紀錄的趨勢。研究期間藥物過敏CPOE優化採兩階段進行，第一階段（2013年4月起）：每月藥師介入將過敏藥物紀錄整合轉碼，主動提示藥師以優化審核系統；第二階段（2018年10月起）：醫師開立處方含過敏藥物時必須勾選處方原因。結果以門診藥物過敏異常處方提報率呈現，定義為藥師提報門診藥物過敏異常處方件數除以所有門診處方張數。主要分析系統優化前後半年門診藥物過敏異常處方提報率的變化。結果：分析四間醫院兩階段介入前後半年共納入7,988,666門診處方張數及981件門診藥物過敏異常處方。藥師門診藥物過敏異常處方提報率於第一階段藥師審核系統優化後，從（千分之0.08）（158/1,943,130）上升到（千分之0.14）（284/1,975,992）；於第二階段醫師開方系統優化後，從（千分之0.23）（459/2,020,812）下降到（千分之0.04）（80/2,048,732），不同醫院間皆有相似的變化趨勢。結論：優化CPOE可協助藥師把關過敏異常處方，並減少醫師開立已知過敏的藥物，有助於提升病人的用藥安全。

關鍵字

電子化醫囑輸入系統；藥物過敏；藥師介入；用藥安全

並列摘要

Objective: Computerized physician order entry (CPOE) systems are widely used to prevent medication errors in hospitals. However, the associated systems need to be optimized regularly to improve effectiveness. This study aims to analyze pharmacist intervention through an optimized drug allergy alert system and changes in outpatient drug allergy reporting rates. Methods: This retrospective study, conducted from October, 2012 to March, 2019 among four hospitals in Northern Taiwan, analyzed reporting trends in outpatient drug allergy cases over the two-stage optimization of the CPOE system during the study period. During the first stage, pharmacists have intervened monthly to integrate drug allergy coding and were proactively reminded to optimize the auditing system since April, 2013. During the second stage, physicians have been required to enter a reason when prescribing allergy inducing medicines since October, 2018. We have compared changes in the outpatient drug allergy reporting rate for 6 months before and after optimization. Results: We have identified a total of 7,988,666 outpatient cases and 981 drug allergy cases for 6 months before and after the two intervention stages. After the first stage, the outpatient drug allergy reporting rate increased from (0.08 per mille) (158/1,943,130) to (0.14 per mille) (284/1,975,992). After the second stage, the reporting rate decreased from (0.23 per mille) (459/2,020,812) to (0.04 per mille) (80/2,048,732). The trends in reporting rates were similar among the four hospitals. Conclusions: Optimization of drug allergy alerting in a CPOE system can not only significantly reduce prescription errors involving known allergenic drugs, but also improve pharmacists' monitoring of prescriptions for patient medication safety.

並列關鍵字

Computerized Physician Order Entry Systems ； Drug Allergy ； Pharmacist Intervention ； Medication Safety

國際替代計量

優化藥物過敏提示系統之成效分析

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