醫院藥師於養護機構建置用藥安全機制之探討

How Hospital Pharmacists Deliver Pharmaceutical Care to Secure Drug Safety in a Long-term Care Organization

陳淑梅(Shu-Mei Chen) ； 李季黛(Chi-Tai Lee) ； 陳妙婷(Miao-Ting Chen) ； 李建立(Eric Kin-Lap Lee) ； 曾碧萊(Pi-Lai Tseng)

《長期照護雜誌》 15卷3期 (2011/12) Pp. 259-272

https://doi.org/10.6317/LTC.201112_15(3).0009

摘要

本文主要為某醫學中心藥師介入180床養護機構，進行藥事照護之經驗分享，主要分為兩部分，第一部份討論養護機構的藥事管理暨給藥流程，其中包含電腦作業之建置、藥品安全管理評估及給藥正確性的評估；第二部分著重於協助增進機構簽約之社區藥師評估處方的能力。方法：醫院藥師自2010至2011年為期21個月，共至養護機構進行13次訪視，依照不同任務，每次會有2－8位藥師進行4－8小時訪視。結果：就醫院藥師介入於藥事管理暨給藥流程方面，首先，成功將機構用藥資料電子化，協助機構建置「長期照護機構營運暨照顧管理系統」，以及編修適當的給藥記錄單；第二，共完成4次藥品安全管理評估，評估分數由21分進步到28分（總分34分）；第三，共進行2次護理人員給藥正確性評估，初次結果為近五成的住民出現處方轉錄錯誤，再次評估時發現約三成住民發生給藥頻率不正確的情形。在增進機構簽約社區藥師能力方面，主要完成機構與社區藥師簽訂合約，並提供社區藥師持續教育，共進行2次簽約社區藥師對住民用藥建議之適當性評估，發現「同類用藥」未被發現之比例、「一級交互作用」未被發現之比例、「建議不適當」筆數，以及醫院藥師給予新建議數之筆數皆有下降。結論：為落實機構住民之正確給藥及高品質藥物之使用與評估，建議機構應聘用「專任」藥事照護藥師給予協助，而相關藥事執業法規之修訂，也會有利於住民用藥安全之執行。

關鍵字

養護機構 ； 藥事照護 ； 藥事管理 ； 給藥正確性

並列摘要

The goal of this paper was to share the experiences generated by a medical center contracted with a 180-bed private long-term care organization by providing pharmaceutical care practice. First part involved the assessment of their medication use management system such as the computer system for drug management, drug safety evaluation and appropriateness of drug administration. The second part involved the assessment of the capability of their contracted community pharmacists in providing cognitive service on appropriateness of drug prescribing. Methods: During January 2010 to September 2011, a total of 21 months, we scheduled 13 visits by various job responsibilities. Each visit needed 2 to 8 consultant pharmacists from our medical center and took at least 4 to 8 hours to complete the scheduled assessment. Outcomes: First, we successfully developed a user friendly drug management computer system which started the use of newly established electronic drug administration records. Secondly, after performing 4 visits for drug safety evaluation, the safety score increased from 21 to 28, maximum of 34. Thirdly, after performing 2 visits on checking the appropriateness of drug administration, about 50% of prescription hand written errors were corrected because of using the new computer entering system; however, still 30% of medication was placed wrongly into the medication box e.g. wrong frequency. The other major responsibility of the team was to enhance the capability of the contracted community pharmacists to be able to find out drug therapy problems on prescription drugs by providing continuing education to them. Finally, the percentages of duplicated use of drugs with the same pharmacological effect, drug therapy with major drug-drug interaction and inappropriate drug use recommendations were reduced. Also, drug recommendations given by our team members also decreased. Conclusion: In order to ensure the appropriateness of drug administration and quality use of medication, in-house full time pharmacist should be recruited by the organization and related regulation on pharmacy practice should be developed.

並列關鍵字

long term care organization ； pharmaceutical care ； medication management ； the appropriateness of drug administration